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目的:探讨多囊卵巢综合征(PCOS)患者膜结合型前列腺素合酶-1(mPGES-1)和环氧合酶-2(COX-2)在子宫内膜组织的表达及临床意义。方法:选择2005年6月至2007年6月华北煤炭医学院生殖内分泌门诊诊断为PCOS的患者21例为PCOS组,卵巢功能正常的不孕患者20例为对照组。PCOS组采用二甲双胍/达英-35联合治疗。病例均测体重、身高、性激素六项及75g葡萄糖耐量试验(OGTT)和胰岛素释放试验(IRT)。并于月经干净3～5天(闭经患者确认为卵泡期)取子宫内膜组织,采用免疫组织化学技术检测PCOS组治疗前后及对照组中mPGES-1和COX-2的表达。结果:PCOS组患者BMI、HOMA-IR、空腹胰岛素(I0)、75g葡萄糖负荷后2h胰岛素(I120)及T均明显高于对照组患者(P均<0.05);治疗前PCOS组mPGES-1和COX-2在子宫内膜的表达显著高于对照组(P<0.01),治疗后两因子的表达与治疗前比较明显下降(P<0.01)。结论:PCOS患者子宫内膜可能处于一种慢性炎症状态,子宫内膜mPGES-1和COX-2过度表达可能是导致患者子宫内膜异常增生和不孕的原因之一,二甲双胍/达英-35联合应用可逆转该炎症状态,可能有利于孕卵着床和预防子宫内膜癌发生。
Objective: To investigate the expression and clinical significance of membrane-associated prostaglandin synthase-1 (mPGES-1) and cyclooxygenase-2 (COX-2) in endometrial tissue of patients with polycystic ovary syndrome (PCOS). Methods: From June 2005 to June 2007, 21 patients with PCOS diagnosed as PCOS in North China Coal Medical College were selected as PCOS group and 20 patients with normal ovarian function as control group. PCOS group metformin / up to -35 combination therapy. The body weight, height, sex hormones and 75g glucose tolerance test (OGTT) and insulin release test (IRT) were measured. Endometrial tissues were taken from 3 to 5 days after menstruation was clean (follicular phase was confirmed by amenorrhoea), and the expression of mPGES-1 and COX-2 in PCOS group before and after treatment and control group were detected by immunohistochemistry. Results: The BMI, HOMA-IR, fasting insulin (I0), insulin I120 and T in 2h after glucose loading in PCOS group were significantly higher than those in control group (all P <0.05). Before treatment, mPGES- The expression of COX-2 in the endometrium was significantly higher than that in the control group (P <0.01). The expression of COX-2 in the endometrium was significantly lower than that before treatment (P <0.01). CONCLUSION: The endometrium of PCOS patients may be in a chronic inflammatory state. The overexpression of mPGES-1 and COX-2 may be one of the causes of abnormal endometrial hyperplasia and infertility in patients with PCOS. Metformin / Combined application can reverse the inflammatory state, may be conducive to implantation of the pregnant egg and prevention of endometrial cancer.