胰岛素抵抗和糖酵解代谢与子宫内膜息肉发生的相关性研究  

Study of Correlation between Insulin Resistance and Glycolytic Metabolism and Occurrence of Endometrial Polyps

作　　者：李扬志[1] 陈亚肖[1] 陈冬梅[1] 谢小倩 张超 谢梅青[1] LI Yang-zhi;CHEN Ya-xiao;HEN Dong-mei;XIE Xiao-qian;ZHANG Chao;XIE Mei-qing(Department of Obstetrics and Gynecology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou,510120)

机构地区：[1]中山大学孙逸仙纪念医院妇产科,510120

出　　处：《岭南急诊医学杂志》2024年第5期487-491,共5页Lingnan Journal of Emergency Medicine

摘　　要：目的:探讨子宫内膜息肉(EP)的发生与子宫内膜局部胰岛素抵抗和糖酵解代谢的关系。方法:选择2023年6月至2024年2月中山大学孙逸仙纪念医院妇科诊断为EP并接受宫腔镜手术的患者230例和非EP患者220例为研究对象,行OGTT及胰岛素释放试验,比较两组糖代谢异常和胰岛素抵抗的差异。从EP患者中提取EP组织及周围正常子宫内膜组织,比较两者PI3K/Akt信号通路及Glut4蛋白的表达水平,糖酵解酶和中间产物表达水平的差异。结果:1.EP组FPG、OGTT 2h、FINS、1hINS、2hINS和HOMA-IR水平均明显高于非EP组(P均<0.05)。2.EP患者中,与正常子宫内膜相比,EP组织中胰岛素诱导的激酶p-AKT(Ser473)、p-PI3K(Tyr458)表达均明显上调,p-IRS1(Ser307)、葡萄糖转运体Glut4、糖酵解代谢调节蛋白己糖激酶I(Hexo Ⅰ)、己糖激酶Ⅱ(HexoⅡ)、丙酮酸激酶M亚型1/2(PKM1/2)和血小板磷酸果糖激酶(PFKP)的表达均明显降低,乳酸脱氢酶A(LDHA)表达明显增加(P均<0.05)。结论:EP患者存在外周血胰岛素抵抗。Glut4诱导子宫内膜的局部胰岛素抵抗和糖酵解代谢功能障碍,可能导致EP形成。Objective:To explore the relationship between the occurrence of endometrial polyps(EP)and endometrial local insulin resistance and glycolytic metabolism.Methods:From Jun 2023 to Feb 2024,230 patients diagnosed with EP and underwent hysteroscopic surgery were enrolled in the Department of Gynecology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,and 220 patients with non-EP were studied.OGTT and insulin release assays were performed to compare the differences in glucose metabolism and insulin resistance between the two groups.EP tissues and surrounding normal endometrial tissues were extracted from EP patients,and the differences in PI3K/Akt signaling pathway,expression levels of Glut4 protein,glycolytic enzymes and intermediate products were compared.Results:The levels of FPG,OGTT 2h,FINS,1hINS,2hINS and HOMA-IR in the EP group were significantly higher than those in the non-EP group(all P<0.05).In EP patients,compared with the normal endometrium,the expression of insulin-induced kinases p-AKT(Ser473)and p-PI3K(Tyr458)were up-regulated,p-IRS1(Ser307)and glucose transporter Glut4 were down-regulated,and the expression of glycolysis metabolism-regulated proteins Hexo Ⅰ,HexoⅡ,PKM1/2 and PFKP were decreased.However,the expression of LDHA was increased(all P<0.05).Conclusions:Peripheral blood insulin resistance is present in patients with EP.Glut4 induces local insulin resistance and glycolytic metabolic dysfunction of the endometrium,which may lead to EP formation.

关 键 词：子宫内膜息肉 GLUT4 胰岛素抵抗 糖酵解 

分 类 号：R711.74[医药卫生—妇产科学]