胰岛素/胰岛素样生长因子在生殖器官子宫内膜异位症发病中的作用

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论证。生长因子在外阴子宫内膜异位症的发病机制中起着重要作用。胰岛素和胰岛素样生长因子参与月经周期和妊娠早期子宫内膜的增殖和蜕膜化，可能间接影响月经逆行期间子宫内膜的侵袭和子宫内膜异位症疼痛综合征的形成。然而，关于外生殖器官子宫内膜异位症患者的子宫内膜和子宫内膜样异位中胰岛素样生长因子和胰岛素含量的文献资料较少且矛盾。

目的是研究胰岛素系统和胰岛素样生长因子1在外生殖器子宫内膜异位症发病机制中的作用。

材料与方法。进行横断面研究，包括糖代谢研究（糖耐量试验）、月经周期增殖期妇女手术材料血清胰岛素样生长因子1、胰岛素、性激素水平测定及免疫组化分析：患者有子宫内膜异位症（子宫内膜层和子宫内膜异位）和无子宫内膜异位症（子宫内膜层）。染色检测胰岛素受体和胰岛素样生长因子1的表达。然后计算受体表达的相对面积和光密度，用统计学方法分析各组间这些指标的差异。

结果。对131例患者的检查结果进行分析。这些女性在年龄和体重以及身高特征上具有可比性：101例为外阴子宫内膜异位症，30例为对照组。与对照组相比，外生殖器子宫内膜异位症患者的碳水化合物代谢的特征是刺激胰岛素水平增加2.1倍。研究小组血液中胰岛素样生长因子1的水平没有差异。各组间受体表达差异有统计学意义。外生殖器子宫内膜异位症患者子宫内膜胰岛素受体光密度降低（p=0.007），胰岛素样生长因子I受体表达水平高于对照组子宫内膜（p=0.002）。在评估胰岛素受体表达时，子宫内膜异位的中位值较对照组子宫内膜降低（p<0.001）。胰岛素样生长因子1受体在子宫内膜异位症病灶中的表达较相同患者的子宫内膜降低（p<0.001）。

结论。研究结果表明，外生殖器子宫内膜异位症患者的胰岛素/胰岛素样生长因子1系统的功能存在显著特征。这包括被刺激胰岛素水平的增加，由于胰岛素受体表达的减少而引起的子宫内膜的相对胰岛素抵抗，以及子宫内膜胰岛素样生长因子1（一种强大的生长因子）受体的增加。

作者简介

Margarita Florova

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

编辑信件的主要联系方式.
Email: fm.sergeevna@gmail.com
ORCID iD: 0000-0003-4569-3827
SPIN 代码: 1480-7599
Researcher ID: P-3005-2017
俄罗斯联邦, Saint Petersburg

Maria Yarmolinskaya

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; North-Western State Medical University named after I.I. Mechnikov

Email: m.yarmolinskaya@gmail.com
ORCID iD: 0000-0002-6551-4147
SPIN 代码: 3686-3605
Scopus 作者 ID: 7801562649
Researcher ID: P-2183-2014

MD, Dr. Sci. (Med.), Professor, Professor of the Russian Academy of Sciences

俄罗斯联邦, Saint Petersburg

Natalya Tkachenko

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Email: liberin@mail.ru
ORCID iD: 0000-0001-6189-3488
SPIN 代码: 9633-6701
Researcher ID: K-1734-2018

Cand. Sci. (Biol.)

俄罗斯联邦, Saint Petersburg

Gulrukhsor Tolibova

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; North-Western State Medical University named after I.I. Mechnikov

Email: gulyatolibova@yandex.ru
ORCID iD: 0000-0002-6216-6220
SPIN 代码: 7544-4825
Scopus 作者 ID: 23111355700
Researcher ID: Y-6671-2018

MD, Dr. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Tatyana Tral

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Email: ttg.tral@yandex.ru
ORCID iD: 0000-0001-8948-4811
SPIN 代码: 1244-9631
Scopus 作者 ID: 37666260400

MD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

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2. 图1 胰岛素受体在主要组、对照组及子宫内膜异位中的表达（相对面积，%）。EGE—外生殖器子宫内膜异位

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3. 图2 胰岛素受体在子宫内膜异位症患者（a）和对照组患者（b）子宫内膜中的表达。×400

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4. 图3 胰岛素样生长因子1（IGF-1）受体的表达（相对面积，%）在外阴子宫内膜异位症患者、对照组和子宫内膜异位症患者的子宫内膜中

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5. 图4 胰岛素样生长因子1受体在子宫内膜异位症患者（a）和对照组患者（b）子宫内膜中的表达。×400

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版权所有 © Florova M., Yarmolinskaya M., Tkachenko N., Tolibova G., Tral T., 2021



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