CAJ | 학술논문

目的：探讨胰岛素样生长因子结合蛋白1（IGFBP-1）在多囊卵巢综合征（polycystic ovary syn-drome，PCOS）早期自然流产患者中的表达及临床意义。方法选择妊娠＜12周的PCOS流产患者77例为试验组，同期正常妊娠＜12周要求人工流产者68例为对照组。2组均于孕3～5周、孕6～8周和孕9～11周采用酶联免疫吸附法（ enzyme-linked immunosorbent assay ，ELISA）检测早期外周静脉血中IGFBP-1、IGF-1、人性激素结合球蛋白（ SHBG ）、空腹胰岛素、空腹血糖、睾酮和游离睾酮，同时采用流式细胞术检测蜕膜组织中IGFBP-1和IGF-1的表达。结果试验组孕3～5周和孕9～11周空腹血清胰岛素水平及孕3～5周空腹血糖显著高于对照组（ P ＜0．01），但孕6～8周血清胰岛素水平及孕6～8周和孕9～11周空腹血糖与对照组比较差异无统计学意义（ P ＞0．05）。不同孕周试验组睾酮和游离睾酮均显著高于对照组（ P＜0．01），IGFBP-1和SHBG水平显著低于对照组（ P ＜0．05或＜0．01），IGF-1水平与对照组比较差异无统计学意义（ P ＞0．05）。以β-actin作为内参照，试验组不同孕周蜕膜组织中IGFBP-1蛋白的表达显著低于对照组（ P ＜0．05），而IGF-1蛋白的表达显著高于对照组（ P ＜0．05）。结论 PCOS早期自然流产患者血清中IGFBP-1、SHBG水平降低以及流产蜕膜组织中IGFBP-1、IGF-1蛋白表达的减少，提示子宫内膜上皮及间质功能障碍可能是PCOS患者发生流产的重要环节。
목적：탐토이도소양생장인자결합단백1（IGFBP-1）재다낭란소종합정（polycystic ovary syn-drome，PCOS）조기자연유산환자중적표체급림상의의。방법선택임신＜12주적PCOS유산환자77례위시험조，동기정상임신＜12주요구인공유산자68례위대조조。2조균우잉3～5주、잉6～8주화잉9～11주채용매련면역흡부법（ enzyme-linked immunosorbent assay ，ELISA）검측조기외주정맥혈중IGFBP-1、IGF-1、인성격소결합구단백（ SHBG ）、공복이도소、공복혈당、고동화유리고동，동시채용류식세포술검측세막조직중IGFBP-1화IGF-1적표체。결과시험조잉3～5주화잉9～11주공복혈청이도소수평급잉3～5주공복혈당현저고우대조조（ P ＜0．01），단잉6～8주혈청이도소수평급잉6～8주화잉9～11주공복혈당여대조조비교차이무통계학의의（ P ＞0．05）。불동잉주시험조고동화유리고동균현저고우대조조（ P＜0．01），IGFBP-1화SHBG수평현저저우대조조（ P ＜0．05혹＜0．01），IGF-1수평여대조조비교차이무통계학의의（ P ＞0．05）。이β-actin작위내삼조，시험조불동잉주세막조직중IGFBP-1단백적표체현저저우대조조（ P ＜0．05），이IGF-1단백적표체현저고우대조조（ P ＜0．05）。결론 PCOS조기자연유산환자혈청중IGFBP-1、SHBG수평강저이급유산세막조직중IGFBP-1、IGF-1단백표체적감소，제시자궁내막상피급간질공능장애가능시PCOS환자발생유산적중요배절。
Objective To investigate the expression and clinical significance of IGFBP1- in early spontaneous abortion patients with polycystic ovary syndrome .Methods 77 early spontaneous abortion patients with PCOS ( pregnant period <12 weeks ) were enrolled as experimental group , and 68 normal pregnant women ( pregnant period <12 weeks ) who asked for induced abortion were enrolled as control group .The levels of IGFBP-1,IGF-1,SHBG,fasting insulin,fasting glucose,total testosterone and free testosterone in peripheral vein blood were detected by ELISA respectively in 3 ~5 weeks,6 ~8 weeks,9 ~11 weeks after pregnancy for both groups.The expression levels of IGFBP-1 and IGF-1 in decidua tissue were detected by flow cytometry.Results As compared with those in control group ,the levels of fasting insulin in 3~5wk and 9~11wk and fasting glucose in 3~5wk were significantly increased in experimental group ( P <0.01),however,there were no significant differences in the levels of fasting insulin in 6 ~8wk and fasting glucose in 6 ~8wk and 9~11wk between experimental group and control group ( P >0.05).The levels of testosterone and free testosterone in the three experimental groups were significantly higher than those in control group ( P <0.01),however,the levels of IGFBP-1and SHBG were significantly lower than those in control group ( P <0.05 or <0.01).There were no significant differences in the levels of IGF-1 between experimental group and control group ( P >0.05).Takingβ-actin as interior reference , the expression levels of IGFBP-1 in decidua tissue in experimental group were significantly lower than those in control group ( P <0.05),however,the expression levels of IGF-1 in decidua tissue in experimental group were significantly higher than those in control group ( P <0.05).Conclusion The reduction of serum IGFBP-1 and SHBG concentrations and decrease of expression levels of IGFBP-1 and IGF-1 in decidua tissue of early spontaneous abortion patients with PCOS suggests that endometrial epithelial and stromal dysfunction may play an important role in the pathogenesis of early spontaneous abortion in patients with PCOS .