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中华妇幼临床医学杂志(电子版) ›› 2018, Vol. 14 ›› Issue (04) : 470 -476. doi: 10.3877/cma.j.issn.1673-5250.2018.04.016

所属专题： 文献；

综述

多囊卵巢综合征相关子宫内膜增生病变的研究进展
李小芳1, 李秀莹1, 林辉瑞1, 李荔1,†()   
  1. 1. 510010　广州，广东省妇幼保健院　广州医科大学附属广东省妇儿医院妇产科
  • 收稿日期:2018-02-09 修回日期:2018-06-15 出版日期:2018-08-01
  • 通信作者: 李荔

Research status of polycystic ovary syndrome and endometrial hyperplasia

Xiaofang Li1, Xiuying Li1, Huirui Lin1, Li Li1,†()   

  1. 1. Department of Obstetrics and Gynecology, Guangdong Women and Children′s Hospital of Guangzhou Medical University, Guangzhou 510010, Guangdong Province, China
  • Received:2018-02-09 Revised:2018-06-15 Published:2018-08-01
  • Corresponding author: Li Li
  • About author:
    Corresponding author: Li Li, Email:
  • Supported by:
    Science and Technology Planning Project of Departement of Science and Technology of Guangdong Province(2014A020212237); Natural Science Foundation of Guangdong Province(S2013010011984); Project of Health and Family Planning Commission of Guangdong Province(20133071); Project of Guangzhou Science and Technology Innovation Commission(201510010290); Project of Traditional Chinese Medicine Bureau of Guangdong Province(20184005)
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李小芳, 李秀莹, 林辉瑞, 李荔. 多囊卵巢综合征相关子宫内膜增生病变的研究进展[J]. 中华妇幼临床医学杂志(电子版), 2018, 14(04): 470-476.

Xiaofang Li, Xiuying Li, Huirui Lin, Li Li. Research status of polycystic ovary syndrome and endometrial hyperplasia[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2018, 14(04): 470-476.

多囊卵巢综合征(PCOS)是育龄期妇女常见的妇科内分泌疾病，常伴有内分泌环境异常及代谢功能紊乱。对于PCOS导致子宫内膜增生病变的具体发病机制，迄今尚不清楚。近年研究结果显示，PCOS患者的内分泌及代谢异常，可能导致子宫内膜增生病变。长期高水平雌激素、胰岛素抵抗、高雄激素血症、炎症因子、肥胖、瘦素等多种危险因素，均可影响子宫内膜相关分子及基因表达异常。笔者拟就PCOS与子宫内膜增生病变相关因素的最新研究进展进行阐述。

关键词: 多囊卵巢综合征, 子宫内膜增生, 受体，雌激素, 胰岛素抗药性, 炎症因子, 瘦素, 妇女

Polycystic ovary syndrome (PCOS) is a common gynecological endocrine disease in reproductive-aged women, which is usually accompanied by endocrine disorders and metabolic dysfunctions. However, its etiology and pathogenesis are not clear yet. Recent researches show that the disorder of endocrine and the abnormality of metabolism in PCOS patients may cause endometrial hyperplasia. Long-term and high-level of estrogen stimulation, insulin resistance, hyperandrogenism, inflammatory factor, obesity, leptin and other risk factors may influence the expression of molecules and genes in endometrium. This article focuses on these risk factors of PCOS and endometrial hyperplasia.

Key words: Polycystic ovary syndrome, Endometrial hyperplasia, Receptors, estrogen, Insulin resistance, Inflammatory factor, Leptin, women
图1 胰岛素介导的PI3K信号通路激活过程
[1]
Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and Meta-analysis[J]. Hum Reprod Update, 2014, 20(5): 748-758.
[2]
Royal College of Obstetricians and Gynaecologists, British Society for Gynaecological Endoscopy. Management of endometrial hyperplasia (Green-top guideline No. 67)[M]. London: RCOG, 2016: 1-30.
[3]
Haoula Z, Salman M, Atiomo W. Evaluating the association between endometrial cancer and polycystic ovary syndrome[J]. Hum Reprod, 2012, 27(5): 1327-1331.
[4]
Holm NS, Glintborg D, Andersen MS, et al. The prevalence of endometrial hyperplasia and endometrial cancer in women with polycystic ovary syndrome or hyperandrogenism[J]. Acta Obstet Gynecol Scand, 2012, 91(10): 1173-1176.
[5]
Li L, Zhang J, Deng Q, et al. Proteomic profiling for identification of novel biomarkers differentially expressed in human ovaries from polycystic ovary syndrome patients[J]. PLoS One, 2016, 11(11): e164538.
[6]
Li L, Mo H, Zhang J, et al. The role of heat shock protein 90B1 in patients with polycystic ovary syndrome[J]. PLoS One, 2016, 11(4): e152837.
[7]
Piltonen TT. Polycystic ovary syndrome: endometrial markers[J]. Best Pract Res Clin Obstet Gynaecol, 2016, 37(1): 66-79.
[8]
Shafiee MN, Khan G, Ariffin R, et al. Preventing endometrial cancer risk in polycystic ovarian syndrome (PCOS) women: could metformin help[J]. Gynecol Oncol, 2013, 132(1): 248-253.
[9]
Fanta M. Is polycystic ovary syndrome, a state of relative estrogen excess, a real risk factor for estrogen-dependant malignancies[J]. Gynecol Endocrinol, 2013, 29(2): 145-147.
[10]
Lee DE, Park SY, Park SY, et al. Clinical and biochemical profiles according to homeostasis model assessment-insulin resistance (HOMA-IR) in Korean women with polycystic ovary syndrome[J]. J Menopausal Med, 2014, 20(3): 104-110.
[11]
Luo L, Xu L, Tang L．The expression of ER, PR in endometrial cancer and analysis of their correlation with ERK signaling pathway[J]．Cancer Biomark, 2017, 21(1): 145-149.
[12]
Zuo T, Zhu M, Xu W. Roles of oxidative stress in polycystic ovary syndrome and cancers[J]. Oxid Med Cell Longev, 2016, 2016: 8589318.
[13]
Cavalieri EL, Rogan EG. Depurinating estrogen-DNA adducts, generators of cancer initiation: their minimization leads to cancer prevention[J]. Clin Transl Med, 2016, 5(1): 12.
[14]
Liu S, Hu L, Yang M. Research progress of the effects of environmental estrogens mediated by G protein-coupled estrogen receptor 1[J]. Asian J Ecotoxicol, 2016, 11(1): 52-60.
[15]
李金皎，段华. G蛋白偶联雌激素受体对细胞增殖调节的研究进展[J]. 中国计划生育和妇产科，2016, 8(2): 23-27.
[16]
Saczko J, Michel O, Chwikowska A, et al. Estrogen receptors in cell membranes: regulation and signaling[J]. Adv Anat Embryol Cell Biol, 2017, 227: 93-105.
[17]
MacLaughlan SD, Palomino WA, Mo B, et al. Endometrial expression of Cyr61: a marker of estrogenic activity in normal and abnormal endometrium[J]. Obstet Gynecol, 2007, 110(1): 146-154.
[18]
宋振，高恒. CCN即早基因家族在脑胶质瘤发生机制中的研究进展[J]. 临床神经外科杂志，2014, 11(2): 153-155.
[19]
Hulchiy M, Nybacka A, Sahlin L, et al. Endometrial expression of estrogen receptors and the androgen receptor in women with polycystic ovary syndrome: a lifestyle intervention study[J]. J Clin Endocrinol Metab, 2016，101(2): 561-571.
[20]
Li X, Shao R. PCOS and obesity: insulin resistance might be a common etiology for the development of type Ⅰ endometrial carcinoma[J]. Am J Cancer Res, 2014, 4(1): 73-79.
[21]
Anagnostis P, Tarlatzis BC, Kauffman RP, et al. Polycystic ovarian syndrome (PCOS): long-term metabolic consequences[J]. Metabolism, 2017, pii: S0026-0495(17)30274-3.
[22]
Stepto NK, Cassar S, Joham AE, et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp[J]. Hum Reprod, 2013, 28(3): 777-784.
[23]
罗国群，邓伟芬，柳倩茹，等. PCOS患者子宫内膜病变和胰岛素受体表达的临床研究[J]. 中国计划生育学杂志，2013, 21(1): 32-35.
[24]
Li T, Mo H, Chen W, et al. Role of the PI3K-Akt signaling pathway in the pathogenesis of polycystic ovary syndrome[J]. Reprod Sci, 2016, 24(5): 646-655.
[25]
Zhang HY, Zhang YF, Han YK, et al. Activation and significance of the PI3K/Akt pathway in endometrium with polycystic ovary syndrome patients[J]. Chin J Obstet Gynecol, 2012, 47(1): 19-23.
[26]
Wang CF, Zhang G, Zhao LJ, et al. Overexpression of the insulin receptor isoform A promotes endometrial carcinoma cell growth[J]. PLoS One, 2013, 8(8): e69001.
[27]
Shafiee MN, Chapman C, Barrett D, et al. Reviewing the molecular mechanisms which increase endometrial cancer (EC) risk in women with polycystic ovarian syndrome (PCOS): time for paradigm shift[J]. Gynecol Oncol, 2013, 131(2): 489-492.
[28]
Cheung LW, Hennessy BT, Li J, et al. High frequency of PIK3R1 and PIK3R2 mutations in endometrial cancer elucidates a novel mechanism for regulation of PTEN protein stability[J]. Cancer Discov, 2011, 1(2): 170-185.
[29]
Shafiee MN, Seedhouse C, Mongan N, et al. Up-regulation of genes involved in the insulin signalling pathway (IGF1, PTEN and IGFBP1) in the endometrium may link polycystic ovarian syndrome and endometrial cancer[J]. Mol Cell Endocrinol, 2016, 424: 94-101.
[30]
De Marco P, Bartella V, Vivacqua A, et al. Insulin-like growth factor-Ⅰ regulates GPER expression and function in cancer cells[J]. Oncogene, 2013, 32(6): 678-688.
[31]
Oyama S, Izutsu T. Cell cycle analysis of endometrial cancer cells in vitro treated with growth factor and steroid hormone[J]. Hum Cell, 1992, 5(4): 363-371.
[32]
陈东思，刘建新，祁秀娟，等. IRS-1、ERK2蛋白表达及其丝氨酸磷酸化程度与PCOS患者胰岛素抵抗的关系[J]. 中华妇产科杂志，2016, 51(4): 293-295.
[33]
Song XR, Zhang HY, Zhang YF, et al. Extracellular signal-regulated protein kinase activation in endometrium with polycystic ovary syndrome and its significance[J]. Chin J Obstet Gynecol, 2010, 45(10): 767-771.
[34]
Holm NS, Glintborg D, Andersen MS, et al. The prevalence of endometrial hyperplasia and endometrial cancer in women with polycystic ovary syndrome or hyperandrogenism[J]. Acta Obstet Gynecol Scand, 2012, 91(10): 1173-1176.
[35]
Patlolla S, Vaikkakara S, Sachan A, et al. Heterogenous origins of hyperandrogenism in the polycystic ovary syndrome in relation to body mass index and insulin resistance[J]. Gynecol Endocrinol, 2018, 34(3): 238-242.
[36]
张仁浇，刘宏伟，白怀，等. 氧化应激与多囊卵巢综合征雄激素增多症关系的研究现状[J/CD]. 中华妇幼临床医学杂志(电子版), 2017, 13(6): 633-639.
[37]
Zhao PL, Zhang QF, Yan LY, et al. Functional investigation on aromatase in endometrial hyperplasia in polycystic ovary syndrome cases[J]. Asian Pac J Cancer Prev, 2014, 15(20): 8975-8979.
[38]
Piltonen TT. Polycystic ovary syndrome: Endometrial markers[J]. Best Pract Res Clin Obstet Gynaecol, 2016, 37: 66-79.
[39]
Li X, Pishdari B, Cui P, et al. Regulation of androgen receptor expression alters AMPK phosphorylation in the endometrium: in vivo and in vitro studies in women with polycystic ovary syndrome[J]. Int J Biol Sci, 2015, 11(12): 1376-1389.
[40]
陈欣，宋岩，邓永志，等. 慢性炎症因子参与多囊卵巢综合征发病的初步探讨[J]. 中国妇幼保健，2016, 31(22): 4635-4636.
[41]
王泽. 多囊卵巢综合征与慢性炎症因子[J]. 实用妇产科杂志，2014, 30(5): 339-341.
[42]
郑艳华，赖毛华，刘华，等. 慢性炎症及氧化应激与PCOS远期患病风险的研究进展[J]. 现代妇产科进展，2013, 22(8): 674-676.
[43]
Elfayomy AK, Almasry SM, Attia GM, et al. Enhanced expression of vascular endothelial growth factor and increased microvascular density in women with endometrial hyperplasia: a possible relationship with uterine natural killer cells[J]. Rom J Morphol Embryol, 2015, 56(2 Suppl): 725-734.
[44]
Friedenreich CM, Langley AR, Speidel TP, et al. Case-control study of inflammatory markers and the risk of endometrial cancer[J]. Eur J Cancer Prev, 2013, 22(4): 374-379.
[45]
Kubyshkin AV, Aliev LL, Fomochkina II, et al. Endometrial hyperplasia-related inflammation: its role in the development and progression of endometrial hyperplasia[J]. Inflamm Res, 2016, 65(10): 785-794.
[46]
张争，张学红. 肥胖与多囊卵巢综合征的相关分析[J]. 国际生殖健康/计划生育杂志，2012, 31(4): 316-318.
[47]
Ojeda-Ojeda M, Martínez-García MÁ, Alpañés M, et al. Association of TLR2 S450S and ICAM1 K469E polymorphisms with polycystic ovary syndrome (PCOS) and obesity[J]. J Reprod Immunol, 2016, 113: 9-15.
[48]
邓祥云，高楠，盛修贵. 糖代谢异常与肥胖型子宫内膜癌发生及靶向治疗的研究进展[J]. 中华妇产科杂志，2015, 50(11): 871-874.
[49]
刘婷婷，张淑香，高维萍. 血清瘦素和胰岛素生长因子Ⅱ与子宫内膜癌的相关性研究[J/CD]. 中华妇幼临床医学杂志(电子版), 2013, 9(5): 650-652.
[50]
涂晓宇，孙兆贵. 瘦素-受体系统与多囊卵巢综合征相关性的研究[J]. 生殖与避孕，2015, 35(12): 867-872.
[51]
Liu Y, Lyu L, Xiao W, et al. Leptin activates STAT3 and ERK1/2 pathways and induces endometrial cancer cell proliferation[J]. J Huazhong Univ Sci Technolog Med Sci, 2011, 31(3): 365-370.
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