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目的 探讨多囊卵巢综合征 (PCOS)患者临床内分泌代谢改变对子宫内膜病变的影响。方法 用组织学方法检测 94例PCOS患者子宫内膜病理改变 ,用放射免疫学方法测定血清泌乳素、黄体生成激素、卵泡刺激素、雌二醇、睾酮、雄烯二酮水平 ,82例同时行糖耐量及胰岛素释放实验。结果 ① 70例PCOS患者子宫内膜为无排卵型 ,其中增殖期内膜 45例 ,增殖症 2 5例 (单纯增生 2 3例、不典型增生 2例 ) ;2 4例为排卵型子宫内膜 ,其中13例分泌反应不佳 ,11例分泌反应良好。②无排卵型子宫内膜组与排卵型子宫内膜组比较 ,前者血清空腹及糖负荷后 6 0min、12 0min的胰岛素水平和胰岛素曲线下面积明显增高 (P均 <0 0 5 )。③子宫内膜增殖症患者与增殖期内膜患者比较 ,前者胰岛素曲线下面积明显增高 (P <0 0 5 ) ,其中单纯增生患者糖负荷后 6 0min、12 0min的胰岛素水平和胰岛素曲线下面积比增殖期内膜患者明显增高 (P均 <0 0 5 )。结论 PCOS患者高胰岛素血症是导致无排卵型子宫内膜的重要因素之一 ,增高的胰岛素对子宫内膜的异常增生也可能起促进作用。
Objective To investigate the effect of clinical endocrine and metabolic changes on endometrial lesions in patients with polycystic ovary syndrome (PCOS). Methods The pathological changes of endometrium in 94 PCOS patients were detected by histological method. Serum prolactin, luteinizing hormone, follicle-stimulating hormone, estradiol, testosterone and androstenedione levels were measured by radioimmunoassay. Glucose tolerance and insulin release experiments. Results ① The endometrium in 70 patients with PCOS was anovulatory, including 45 cases of proliferative endometrium, 25 cases of proliferation (simple hyperplasia of 23 cases, 2 cases of atypical hyperplasia); 24 cases of ovulation endometrial , Of which 13 cases of poor secretion response, secretion of 11 cases of good. ② In the anovulatory endometrium group and the ovulation endometrium group, the serum levels of insulin and the area under the insulin curve were significantly higher at 60 min and 120 min after fasting and glucose loading (P <0.05). ③ The area under the curve of insulin in endometrial hyperplasia patients was significantly higher than that in endometrial hyperplasia patients (P <0 05). The area of insulin and the area under insulin curve at 60 min and 120 min after hyperglycaemia Than proliferative endometrium was significantly higher (P all <0 05). Conclusion Hyperinsulinemia in PCOS patients is one of the important factors leading to anovulatory endometrium. Increased insulin may also promote the abnormal endometrial hyperplasia.