补肾调冲法对多囊卵巢综合征患者抗苗勒氏管激素及卵细胞质量的影响

Effects of Shen Invigorating and Chong-channel Regulating Method on Anti-Müllerian Hormone and Oocyte Quality in Polycystic Ovarian Syndrome Patients

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中文关键词: 补肾调冲法多囊卵巢综合征卵细胞质量抗苗勒氏管激素

英文关键词:Shen Invigorating and Chong-channel Regulating Method polycystic ovarian syndrome oocyte quality anti-Müllerian hormone

基金项目:国家自然科学基金资助项目(No.30672706,81072836);山东省自然科学基金资助项目(No.ZR58)

作者	单位
连方	山东中医药大学附属医院中西医结合生殖与遗传中心
赵帅	山东中医药大学第一临床学院妇科教研室

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中文摘要:

目的通过研究补肾调冲法对多囊卵巢综合征(PCOS)不孕患者行体外受精(in vitro fertilization,IVF)血清、卵泡液中抗苗勒氏管激素(anti-Müllerian hormone,AMH)的影响及其与卵细胞质量的关系,探讨补肾调冲法对PCOS卵细胞质量影响的机制。方法 60例将行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)的PCOS患者随机分为2组,试验组(二至天癸颗粒合西药组)和对照组(西药组),每组30例。观察两组患者注射人毛膜促性腺激素(human chorionic gonadotropin,HCG)日单个卵雌二醇(estradiol,E2)水平及卵泡膜血流阻力指数(resistive index,RI)、搏动指数(pulsatility index,PI),两组取卵数、优质卵率、受精率、卵裂率、优质胚胎率的差异以及血清、卵泡液中AMH含量的差异。对血清、卵泡液中AMH水平与优质卵率、优质胚胎率的关系分别进行相关性检验,同时行血清、卵泡液中AMH两者含量的相关分析。结果 (1)试验组单个卵E2水平、优质卵率、受精率、卵裂率、优质胚胎率均显著高于对照组(P<0.05)。(2)试验组卵泡膜血流RI、PI均显著低于对照组(P<0.05)。(3)试验组血清、卵泡液AMH水平均明显低于对照组(P<0.01)。血清、卵泡液中AMH两者含量呈依赖性正相关,卵泡液中AMH水平均与优质卵率、优质胚胎率呈明显负相关。结论补肾调冲法可提高PCOS患者卵细胞质量,其机制与调节血清、卵泡液AMH水平,调节高雄激素水平,改善PCOS病理生理变化,改善卵巢微环境有关,尚需进一步探讨。

英文摘要:

Objective To study the effects of Shen Invigorating and Chong-channel Regulating Method(SCRM) on anti-Müllerian hormone(AMH) and its correlation with oocyte quality in the serum and the follicular fluid of infertile patients with polycystic ovarian syndrome(PCOS) who received in vitro fertilization(IVF),thus studying the mechanism of SCRM on the oocyte quality of PCOS patients.Methods Sixty infertile patients with PCOS undergoing in vitro fertilization and embryo transfer(IVF-ET) were randomly assigned to two groups,30 in each.Erzhi Tiangui Granule combined with Western medicine was given to patients in the treatment group,while Western medicine was given to those in the control group.The single oocyte estradiol(E2) level,the resistive Index(RI),the pulsatility index(PI) of the follicular membrane,the number of harvested oocytes,the high quality oocyte rate,the fertilization rate,the cleavage rate,the high quality embryo rate,and the difference of AMH in the serum and the follicular fluid were observed between the two groups.The correlation tests were performed between the levels of AMH in the serum and the follicular fluid and the rates of high quality oocyte and high quality embryo.Meanwhile,the correlation analysis of the AMH level between the serum and the follicular fluid was also conducted.Results(1) The single oocyte E2 level,the high quality oocyte rate,the fertilization rate,the cleavage rate,the high quality embryo rate were significantly higher in the treatment group than in the control group(P<0.05).(2) The RI and the PI of the follicular membrane both significantly more decreased in the treatment group than in the control group(P<0.05).(3) The levels of AMH in the serum and the follicular fluid were obviously lower in the treatment group than in the control group(P<0.01).The AMH levels in the serum and the follicle fluid were positively correlated.The level of AMH in the follicular fluid was obviously negatively correlated with the high quality oocyte rate and the high quality embryo rate.Conclusions SCRM could improve the oocyte quality of PCOS patients.Its mechanisms were correlated with regulating the AMH levels in the serum and the follicular fluid,adjusting the androgen level,improving the pathophysiological changes of PCOS patients,and activating the ovarian microenvironment.It is necessary to carry out further studies.

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