多囊卵巢综合征卵泡颗粒细胞提前对黄体生成素反应

目的： 探讨多囊卵巢综合征（PCOS）卵泡液中激素和颗粒细胞黄体生成素（LH）受体mRNA表达的关系。方法: 对PCOS组12例和对照组15例患者于月经周期的第7-10 d手术获取卵泡和卵泡液，采用微粒子化学发光法检测卵泡液中卵泡刺激素（FSH）、LH、孕酮（P）、雌二醇（E2）和胰岛素（insulin）的水平，采用ELISA检测卵泡液中雄烯二酮（A）的水平，对颗粒细胞和卵泡膜细胞LH受体mRNA进行RT-PCR半定量检测。结果: PCOS组卵泡液中LH［（3.8±2.1 vs 1.7±0.8)U/L, P<0.01］、A［(600.0±373.4 vs 212.4±205.4)μg/L, P<0.05］和颗粒细胞LH受体mRNA的表达(0.29±0.16 vs 0.12±0.13, P<0.01)显著高于对照组， PCOS组卵泡的颗粒细胞提前表达LH受体mRNA; 对照组卵泡直径小于 7 mm 时，RT-PCR检测不到颗粒细胞LH受体mRNA表达，而PCOS组卵泡直径达到 4 mm 时，发现颗粒细胞LH受体mRNA已提前表达。颗粒细胞LH受体mRNA的表达与卵泡液中LH(r=0.67,P<0.01)、胰岛素(r=0.51,P<0.05)及卵泡膜细胞LH受体mRNA表达的水平(r=0.6,P<0.01)呈正相关。结论: PCOS的卵泡液中存在高水平的LH，PCOS卵泡颗粒细胞提前对LH反应，颗粒细胞和卵泡膜细胞合成A和P增强，这可能是PCOS卵泡发育停滞的原因之一。

Premature response to luteinizing hormone of granulosa cells from women with polycystic ovary syndrome

AIM:To demonstrate the relationship between hormones in follicular fluid and the expression of LH receptor in granulosa cells (GC) in anovulatory women with polycystic ovary syndrome (PCOS). METHODS:Follicles were obtained from 12 women with PCOS and 15 women with normal menstrual period through surgery at time between day 7 and day 10 of menstrual cycle. The accumulations of estrogen (E2), progesterone (P), luteinizing hormone (LH), follicle stimulating hormone (FSH) and insulin in follicular fluid were determined by a automatism chemiluminescent microparticle immunoassay (CMIA) for the quantitative determination. The accumulation of androstenediol (A) was determined by ELISA. The amounts of the mRNA expressions of LH receptors from GC and theca cells (TC) respectively were measured by RT-PCR using β-actin as intra-control simultaneously. RESULTS:The levels of LH ［(3.8±2.1 vs 1.7±0.8)IU/L, P<0.01］, A ［(600.0±373.4 vs 212.4±205.4)μg/L, P<0.05］ and expressions of LH receptor mRNA of GC (0.29±0.16 vs 0.12±0.13, P<0.01) and TC (0.46±0.14 vs 0.34±0.09，P<0.05) in the women of PCOS group were statically higher than those in control group. The expression of LH receptor mRNA was not detected by RT-PCR in control group when the diameter of an follicle was less than 7 mm, while it was detected in women with PCOS when it remained as small as 4 mm. Expression of LH receptor mRNA in granulose cells was positive related to the concentration of LH (r=0.67, P<0.01) and insulin (r=0.51, P<0.05) in follicular fluid, and that in theca cells (r=0.60, P<0.01). CONCLUSION:The high level of LH in follicular fluid occurs and GC responds to LH prematurely and more intensively in anovulatory women with PCOS. Larger amount of A and P was produced as a result. All of above may contribute to the mechanism of anovulatory.