生长激素对子宫内膜异位症术后不孕患者IVF治疗结局的影响

发布时间：2018-02-24 20:38

本文关键词： 子宫内膜异位症不孕症体外受精生长激素胰岛素样生长因子-I　出处：《福建医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：观察并探讨生长激素对卵巢子宫内膜异位症术后不孕患者，在IVF-ET(体外受精-胚胎移植)助孕治疗中的效果及可能的机制，为临床应用提供理论依据。方法：来自2013年1月至2013年12月在我院就诊行IVF-ET的不孕患者,选取其中卵巢子宫内膜异位症（EMS）术后不孕患者51例，输卵管因素不孕患者61例，分两部分；分别按照是否应用GH再分研究组和对照组。所有患者均在我中心采用GnRH-a超长/长方案降调节，，达降调标准后予促性腺激素（Gn）启动。Gn启动日始应用GH(注射用重组生长激素,赛增)2.5IU/日至注射HCG（绒促性素）日为研究组，未用GH为对照组。观察比较各组患者卵巢反应、子宫内膜的各项指标及助孕结局。应用化学发光法检测患者血清及卵泡液中生长激素（GH）、胰岛素样生长因子-I(IGF-I)及胰岛素样生长因子结合蛋白-3(IGFBP-3)的浓度。采用SPSS13.0行数据统计学分析。结果： 1.GH对EMS术后不孕患者的卵巢反应、子宫内膜情况及IVF-ET结局的影响：EMS患者两组间的各项临床基本资料均无统计学差异(P0.05)。两组间实验室及治疗结局资料比较,达菲林用药量、Gn天数、Gn总量、HCG日E2水平、获卵数、受精率、2PN受精率、卵裂率、移植胚胎数目、周期取消率、子宫内膜厚度及形态基本相似(P0.05)；研究组优质胚胎率、种植率、妊娠率较对照组在数值上有增高，但无统计学差异(P0.05)。 2.GH对输卵管因素不孕患者的卵巢反应、子宫内膜情况及IVF-ET结局的影响:输卵管因素不孕患者两组间的各项临床基本资料均无统计学差异(P0.05)。两组间实验室及治疗结局资料比较，达菲林用药量、Gn天数、Gn总量、HCG日E2水平、获卵数、受精率、2PN受精率、优质胚胎率、囊胚形成率、顶级囊胚形成率、种植率、妊娠率，子宫内膜厚度及形态,这些观察指标相近,均无统计学差异(P0.05)。 3.研究组与对照组间降调前、Gn启动前，血清GH、IGF-I、和IGFBP-3水平均无统计学差异(P0.05)。取卵日，GH组患者的血清及卵泡液IGF-I水平均高于对照组（P0.05），有统计学差异。血清及卵泡液中的GH及IGFBP-3水平与对照组相比无统计学差异(P0.05)。结论： 1.生长激素对卵巢子宫内膜异位症术后不孕患者的IVF-ET治疗结局有改善趋势，其机制可能与GH使IGF-I水平升高有关。认为在EMS不孕患者中可考虑通过添加生长激素改善妊娠结局。 2.生长激素对输卵管因素不孕患者的卵巢反应及IVF-ET治疗结局无影响。临床不推荐其为内分泌正常不孕患者的常规用药。
[Abstract]:Objective: to observe the effect and possible mechanism of growth hormone (GH) in IVF-ET (in vitro fertilization-embryo transfer) assisted pregnancy in infertile patients with ovarian endometriosis, and to provide theoretical basis for clinical application. Methods: from January 2013 to December 2013, 51 infertile patients with ovarian endometriosis and 61 infertile patients with tubal factor were selected. According to whether GH was subdivided into study group and control group, all patients were treated with GnRH-a super long / long regimen down-regulation in our center, and then they were treated with GH (recombinant growth hormone for injection) on the start day after reaching the standard of lowering the modulation of gonadotropin. The ovarian reaction of patients in each group was observed and compared between 2.5 IUD / day and HCG injection day, while GH was not used as control group. Chemiluminescence assay was used to detect the concentrations of growth hormone (GH), insulin-like growth factor (IGF-I) and insulin-like growth factor binding protein (IGFBP-3) in serum and follicular fluid. Results:. 1. Effects of GH on ovarian response, endometrium and IVF-ET outcome in infertile patients after EMS. There was no significant difference in clinical data between the two groups (P 0.05). Total number of days of administration of Dafiline and total amount of Gn HCG E2, egg number, fertilization rate, fertilization rate, cleavage rate, number of embryos transferred, cycle cancelling rate, endometrial thickness and morphology were basically similar (P0.05); the rate of high quality embryos, the rate of implantation, the rate of implantation, The pregnancy rate was higher than that of the control group, but there was no statistical difference (P 0.05). 2. Effects of GH on ovarian response, endometrium and IVF-ET outcome in infertile patients with tubal factors: there was no significant difference in clinical data between the two groups (P 0.05). The total number of days of administration of Dafiline and the total amount of Gn were: E2 level of HCG day, number of eggs obtained, fertilization rate of 2PN, rate of high quality embryo, blastocyst formation rate, rate of top blastocyst formation, implantation rate, pregnancy rate, endometrial thickness and morphology, which were similar to each other. There was no statistical difference (P 0.05). 3. Between the study group and the control group, before Gn was started, There was no significant difference in serum GH, IGF-I and IGFBP-3 levels. The levels of IGF-I in serum and follicular fluid of GH group were significantly higher than those in control group (P 0.05). There was no significant difference in GH and IGFBP-3 levels in serum and follicular fluid compared with control group (P 0.05). Conclusion:. 1. Growth hormone has a tendency to improve the outcome of IVF-ET treatment in infertile patients with ovarian endometriosis after operation, and its mechanism may be related to the elevation of IGF-I level. It is suggested that in infertile women with EMS, it may be considered to improve the outcome of pregnancy by adding growth hormone. 2. Growth hormone has no effect on ovarian response and outcome of IVF-ET treatment in infertile patients with tubal factors, and is not recommended as a routine medication for infertile patients with normal endocrine function.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.6

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