胰岛素抵抗对女性生殖功能的影响

doi:10.12280/gjfckx.20210716

摘要/Abstract

摘要：

胰岛素抵抗（insulin resistance,IR）不仅是各种代谢性疾病的重要病因之一,也是影响女性生殖功能的一项重要因素。近年IR对女性生殖功能的影响越来越受到国内外学者的重视,并从不同角度、不同层面对IR影响女性生殖功能的问题进行了一系列研究。IR通过扰乱卵母细胞线粒体功能,破坏氧化与抗氧化的平衡状态,产生炎症因子,使卵母细胞质量下降,线粒体功能损伤加重IR,卵母细胞质量进一步下降,如此形成恶行循环。IR通过影响子宫内膜的能量代谢、AMP活化蛋白激酶（AMP-activated protein kinase,AMPK）通路和磷脂酰肌醇3激酶/蛋白激酶B（phosphatidylinositol 3-kinase/protein kinase B,PI3K/Akt）通路分子的表达、慢性炎症状态以及其他微小分子的表达,使子宫内膜容受性下降,最终导致生育能力降低。此外,多种不良妊娠结局及妊娠并发症也与IR有关,如IR是自然流产的一个危险因素,妊娠前IR会增加妊娠期糖尿病的发生率,也会增加后代出现葡萄糖耐受不良、巨大儿、肥胖和高血压等的风险。

关键词: 胰岛素抗药性, 卵母细胞, 子宫内膜, 信号传导, 妊娠结局

Abstract:

Insulin resistance (IR) is not only one of the important cause of various metabolic diseases, but also an important factor affecting female reproductive function. In recent years, more and more attention has been paid to the effect of IR on female reproductive function by scholars at home and abroad, and a series of studies on the influence of IR on female reproductive function have been carried out from different angles and levels. By disturbing the function of mitochondria of oocyte, destroying the balance of oxidation and antioxidation, producing inflammatory factors, the oocyte quality decreases, the damage of mitochondrial function aggravates IR, and the oocyte quality further decreases, which is a vicious circle. IR reduces endometrial receptivity and ultimately leads to reduced fertility by affecting endometrial energy metabolism, expression of AMPK pathway and PI3K/Akt pathway molecules, chronic inflammatory state and expression of other micro molecules. In addition, a variety of adverse pregnancy outcomes and pregnancy complications are also related to IR. For example, IR is a risk factor for spontaneous abortion, and pre-pregnancy IR will increase the incidence of gestational diabetes, as well as the risk of glucose intolerance, macrocephaly, obesity and hypertension in offspring.

Key words: Insulin resistance, Oocyte, Endometrium, Signal transduction, Pregnancy outcome

韩乐, 马瑞红, 赵志梅, 夏天. 胰岛素抵抗对女性生殖功能的影响[J]. 国际妇产科学杂志, 2022, 49(1): 116-120.

HAN Le, MA Rui-hong, ZHAO Zhi-mei, XIA Tian. The Effect of Insulin Resistance on Female Reproductive Function[J]. Journal of International Obstetrics and Gynecology, 2022, 49(1): 116-120.

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