The Research On The Correlation Between Visfatin And Endometrium Lesion In Polycystic Ovary Syndrome

Section One The level of serum visfatin among the different clinic phenotype of PCOSObjective: The aim of this study was to assess the clinical significance of serum levels expression of visfatin in relation to polycystic ovary syndrome,serum expression of visfatin among the different clinicphenotype of polycystic ovary syndrome, and we even further investigated therelationship between the serum visfatin levels and PCOS.Methods:collected 77 patients of serum samples from the gynecological endocrine outpatient clinic and the center of Assisted reproductive who were diagnosed as PCOS as case group, 47 patients of serum samples the ones who need the reproductive because of the factors of male factor or Blocked fallopian tubes as control group. All the subjects were excluded from other endocrinopathy and did not have any hormonal therapy for the past 3 months.circulating hormonal parameters were measured in all patients,insulin release test were measured in PCOS group and fasting blood glucose and insulin measured in control. ELISA method was used to measure the serum levels of visfatin in all the groups.Results:Ⅰ.The characteristic of endocrine and the different expression of visfatin between the PCOS and control group.PCOS group of average age29.60±4.13, the incidence of obesity was61.04%,the rate of insulin resistance was about 44.16%, The incidence of insulin resistance in obese patients was 61.70%(29/47), the incidence rate of hyperandrogenism was33.77%, the incidence rate of LH/FSH > 2was 38.96%, and the incidence rate of menstruation was 72.72%. In the control group,incidence of obesity was16.33%,the rate of insulin resistance was about34.69%,The incidence of insulin resistance in obese patients was47.06%. In PCOS group the levels of serum visfatin was53.311±32.710ng/ml,higher than the control group in lipid levels of41.874±27.745ng/ml, with significantly statistical difference(p < 0.05). Patients in the PCOS group the levels of BMI, waist circumference, WHR, LH / FSH,testosterone, fasting blood glucose were significantly higher than those of the control group, the difference is statistically significant(P < 0.05).Ⅱ. Comparison of different clinical phenotypes and the expression of serum visfatin levels in PCOS group1.According to the BMI : Serum visfatin levels in obese group was 67.364 +27.836ng/ml, Serum visfatin levels in non-obese group was29.373±26.023 ng/ml, the difference was statistically significant(P < 0.05).2. According to the HOMA-IR: Serum visfatin levels in IR group was70.557±27.158ng/ml,Serum visfatin levels in IR group was 38.276±29.811ng/ml, the difference is statistically significant(p<0.05).3. According to the androgen level: Serum visfatin levels in hyperandrogenism group was56.059±32.195 ng/ml, Serum visfatin levels in unhyperandrogenism group was51.792±33.238ng/ml, the difference is no statistically significant(p>0.05).Ⅲ. The correlation and regression analysis between the serum levels of visfatin and the factors in the PCOS groupPearson correlation analysis showed that visfatin serum levels was correlated with BMI(r=0.549, p=0.000), waist circumference(r=0.560, p=0.000), hip circumference(r=0.489, p=0.000), WHR(r=0.247, p=0.035), LH(r= 0.299, p=0.012),LH/FSH(r= 0.326, p=0.006, HOMA-IR(r=0.349, p=0.016)), triglycerides(r=0.337,p=0.031), multiple stepwise regression analysis showed that waist circumference and HOMA-IR are the independent risk factors of serum visfatin levels in patients with PCOS。Conclusion:1. The serum level of visfatin is higher in PCOS group, especially in patients with obesity and insulin resistance. Elevated visfatin is an important feature of the PCOS.2. waist circumference and HOMA-IR are the independent risk factors of serum visfatin levels in patients with PCOS, visfatin may be an important indicator of metabolic abnormalities in PCOS.Section two The expression of visfatin in the endometrium of PCOSObjective: To investigate the expression of visfatin and its relationship with endometrial lesions in PCOS patients and its possible acting pathways.Methods: Collect 56 cases of uterine bleeding and infertility, irregular line before IVF or ICSI operation endometrium of PCOS patients,in the control group for the same period because of tubal infertility and male infertility curettage surgery patients 46 cases.Serum was collected simultaneously with the first part of the determination of indicators.used in the Western Blot method to detect expression of visfatin in endometrial tissue and key protein AKT, P-AKT, ERK1 / 2, P-ERK1 / 2 in PI3 K /AKT, MAPK / ERK signaling pathway, the immunohistochemical method to detect visfatin expression in endometrial tissue, analyze the relationship between the serum level of visfatin and the expression visfatin in endometrium,,analyze between the expression visfatin in endometrium and clinicopathological characteristics, analyze endometrial the relationship between visfatin expression level and protein AKT,P-AKT, ERK1 / 2, P-ERK1 expression level / 2 of PI3 K / AKT, MAPK / ERK signaling pathway.Results:1.Each group of endometrial pathological changes:normal endometrium accounted for 66.07% in PCOS group,endometrial hyperplasia and cancer accounted for 33.93%, the control group without the occurrence of endometrial hyperplasia and cancer. the incidence of endometrial hyperplasia and cancer was significantly higher in PCOS group,, serum levels of visfatin in PCOS endometrial hyperplasia and cancer group were higher than normal endometrium PCOS group, the difference was statistically significant(p <0.05),2.Results of Immunohistochemistry:expression of visfatin in endometrial tissue in PCOS group accounted for 87.5% higher than the control group 76.1%, the difference was statistically significant(p <0.05), the expression of visfatin in endometrial lesions PCOS group 94.7% higher than in the normal endometrial tissue PCOS 83.7%, the difference was statistically significant(p <0.05). High expression of visfatin in obese PCOS group(75%) than non-obese PCOS group(35%), High expression of visfatin in IR PCOS group(76.9%) than non-IR PCOS group(46.7%),the difference was statistically significant(p <0.05).3.expression of visfatin in endometrial tissue expression in PCOS(immunohistochemistry score) and serum visfatin was positively correlated(r = 0.450,p = 0.003), the difference was statistically significant(p <0.05).4.Results of Western Blot:The protein expression of visfatin in PCOS group and in endometrial lesions group was higher than that of the control group and in normal endometrium group, The protein expression of visfatin in obese PCOS group and in IR PCOS groupwas higher than of non-obese PCOS group and non-IR PCOS,the difference was statistically significant(P < 0.05).5.The protein expression of P-AKT in PCOS group and in endometrial lesions groupwas higher than that of the control group and in normal endometrium group,The protein expression of P-AKT in obese PCOS group and in IR PCOS was higher than non-obese PCOS group and in non-IR PCOS,the difference was statistically significant(P < 0.05), AKT was no significant differencein all groups(p>0.05).6.The protein expression of P-ERK1/2 in PCOS group and in endometrial lesions group was higher than that of the control group and in normal endometrium group, The protein expression of P-ERK1/2 in obese PCOS group IR PCOS group and was higher than that non-obese PCOS group and non-IR PCOS,the difference was statistically significant(P < 0.05),ERK1/2was no significant differencein all groups(p> 0.05).7.The protein expression of visfatin in endometrial tissue in PCOS group was positively correlated with BMI(r = 0.595, p = 0.000), waist circumference(r = 0.599,p = 0.000), hip circumference(r = 0.641, p = 0.000), HOMA-IR( r = 0.571, p =0.000), serum visfatin(r = 0.670, p = 0.000), T(r=0.293,p=0.031),P-AKT(r = 0.459,p = 0.000), P-ERK1 / 2(r = 0.552, p = 0.002)。Conclusion:1. The expression of visfatin in endometrial hyperplasia and cancer tissue in PCOS group was higher.associated with obesity, insulin resistance and serumlevel of visfatin,visfatin may be factor of endometrial lesion in PCOS.2. The protein expression of visfatin in endometrial tissue in PCOS group was positively correlated with BMI, waist circumference, hip circumference, HOMA-IR,serum visfatin, P-AKT, P-ERK1 / 2.Obesity and insulin resistance in PCOS patients may induce the occurrence of endometrial hyperplasia and carcinogenesis through the activation of AKT and ERK1/2 signaling proteins in the PI3K/AKT and MAPK/ERK pathways.