脑源性神经营养因子与子宫内膜异位症患者卵子胚胎发育潜能的相关性研究

发布时间：2018-04-18 23:05

本文选题：子宫内膜异位症 + 不孕　；参考：《河北医科大学》2017年硕士论文

【摘要】：子宫内膜异位症(endometriosis,EMs)是指具有生长功能的子宫内膜组织(腺体和间质)出现在子宫腔以外的任何部位而引起的一种疾病。为育龄期妇女最常见的疾病之一,也是引起不孕症的常见原因。体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)技术为不孕症患者提供了有效的治疗方法,但与其他类型的不孕症患者相比,子宫内膜异位症患者的IVF-ET妊娠结局较差。子宫内膜异位症导致IVF-ET不良妊娠结局的原因纷繁复杂,而卵母细胞质量下降可能是影响临床治疗结局的重要因素之一。在卵母细胞的生长发育过程中,除了下丘脑-垂体-卵巢轴(hypothalamus-pituitary-ovary axis,HPOA)的调节,卵巢局部微环境中自分泌、旁分泌的生长因子及生物活性物质也发挥着重要作用。因此,近年来从卵泡液的成分及颗粒细胞等方面对卵母细胞质量进行评估引起了普遍关注。有研究指出,脑源性神经营养因子(Brain-derived eurotrophic factor,BDNF)对卵泡的生长发育具有重要作用,并且有研究发现,以正常妇女作对照,EMs患者卵泡液中BDNF水平下降明显。综上所述,本实验通过测定子宫内膜异位症患者血清、卵泡液中BDNF水平,探讨BDNF与子宫内膜异位症的关系,及BDNF对卵母细胞质量及早期胚胎发育的可能影响,从而为指导临床治疗提供新的理论依据。目的:通过测定BDNF在子宫内膜异位症患者卵巢刺激周期中血清及卵泡液中的水平,探讨BDNF与子宫内膜异位症之间的关系,及BDNF对卵母细胞质量和胚胎发育潜能的影响。方法:选取于2016年2月至2016年11月在河北医科大学第二医院生殖医学科行体外受精-胚胎移植的不孕症患者:子宫内膜异位症35例(A组),以同期单纯因输卵管因素不孕患者35例(B组)作为对照组。收集患者取卵日空腹血及所有卵泡液。用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)测定两组血清、卵泡液中BDNF水平;比较两组的临床、实验室指标和临床结局等;比较两组患者血清、卵泡液中BDNF的水平;分析两组血清中BDNF水平与卵泡液中BDNF水平的相关性;分析两组血清、卵泡液中BDNF水平与年龄、不孕年限、基础激素水平、控制性卵巢刺激(controlled ovarian stimulation,COS)天数、促性腺激素(gonadotropin,Gn)用量等一般资料的相关性;分析两组血清、卵泡液中BDNF水平与获卵数、受精数(率)、正常受精数(率)、卵裂数(率)、可移植胚胎数(率)、优质胚胎数(率)及妊娠结局等的相关性。结果:1子宫内膜异位症组和对照组临床指标的比较:EMs组Gn用量2775.00(1725.00)IU高于对照组2325.00(1462.50)IU,但差异无统计学意义(Z=-1.727,P0.05);两组患者的年龄、不孕年限、基础FSH水平、COS天数和HCG日激素水平比较无统计学差异。2子宫内膜异位症组和对照组的实验室指标的比较:EMs组和对照组的受精数为9.00(5.00)枚vs 10.00(6.00)枚,正常受精数为7.00(5.00)枚vs 9.00(5.00)枚,差异均有统计学意义(Z=-2.078,P0.05;Z=-1.986,P0.05)。两组优胚率分别为22.65%vs 30.48%,差异有统计学意义(χ2=5.229,P0.05)。EMs组和对照组的获卵数、受精率、正常受精率、卵裂数(率)、优胚数、可移植胚胎数(率)比较差异均无统计学意义。3子宫内膜异位症组和对照组临床结局的比较:EMs组和对照组的种植率分别是26.53%vs 49.06%,差异有统计学意义(χ2=5.471,P0.05);妊娠率分别是58.33%vs 70.37%,EMs组低于对照组,但差异无统计学意义(χ2=0.806,P0.05)。4子宫内膜异位症组和对照组血清和卵泡液中BDNF水平的比较:EMs组和对照组血清BDNF水平分别为35.25±16.93ng/ml vs36.71±17.81ng/ml,EMs组低于对照组,但差异无统计学意义(t=-0.351,P0.05);EMs组和对照组卵泡液BDNF水平分别为2.87(2.27)ng/ml vs 4.66(3.76)ng/ml,EMs组明显低于对照组,差异有统计学意义(Z=-2.308,P0.05)。5 BDNF水平与临床指标的相关关系:卵泡液中BDNF水平与患者HCG日孕酮水平呈负相关(rs=-0.254,P0.05)。6 BDNF水平与实验室指标的相关关系:卵泡液中BDNF水平与获卵数、受精数、卵裂数呈正相关(rs=0.335,P0.05;rs=0.323,P0.05;rs=0.287,P0.05;rs=0.253,P0.05),与可移植胚胎数成负相关(rs=-0.253,P0.05)。7血清BDNF水平与卵泡液BDNF水平的无明显相关性(rs=0.170,P0.05)。8妊娠组和非妊娠组BDNF水平的比较:A、B两组中,妊娠组分别为A1组(14例)、B1组(19例),未妊娠组分别为A2组(10例)、B2组(8例)。A1、A2组血清、卵泡液中BDNF浓度分别为33.26±17.57ng/m vs 43.56±19.13ng/m和2.56(2.28)ng/m vs 2.96(3.60)ng/m,两组比较差异均无统计学意义(t=-1.365,P0.05;Z=-0.586,P0.05);B1、B2组血清、卵泡液中BDNF浓度分别为39.27±17.44ng/m vs 31.27±18.40ng/m和4.90±2.67ng/m vs 4.33±3.30ng/m,两组比较差异均无统计学意义(t=1.071,P0.05;t=0.475,P0.05)。结论:子宫内膜异位症患者血清和卵泡液中BDNF的水平低于对照组,卵泡液中BDNF与患者的平均获卵数、受精数、卵裂数呈正相关,提示BDNF可能在卵母细胞的发育和早期胚胎发育的过程中有重要影响。妊娠组与非妊娠组血清和卵泡液中BDNF水平无统计学差异,尚不能用BDNF预测不孕症患者的妊娠结局。
[Abstract]:Objective : To investigate the relationship between BDNF and endometriosis , and to explore the relationship between BDNF and endometriosis , and to explore the effect of BDNF on the quality of oocytes and the potential of fetal development . The levels of BDNF in serum and follicular fluid were correlated with age , age of infertility , basal hormone level , controlled ovarian stimulation ( COS ) and gonadotropin ( Gn ) . The results showed that the levels of BDNF in endometriosis group and control group were higher than those in control group ( 23.25 . 00 ) , but there was no statistical difference ( Z = - 1.727 , P0.05 ) . There was significant difference between the two groups ( 22.65 % vs 30.48 % , 蠂2 = 5.229 , P0.05 ) . The levels of BDNF in endometriosis group and control group were 2.87 ( 2.27 ) ng / ml vs 4.66 ( 3.76 ) ng / ml respectively . The levels of BDNF in endometriosis group and control group were 2.87 ( 2.27 ) ng / ml vs 4.66 ( 3.76 ) ng / ml , respectively . The levels of BDNF in endometriosis group and control group were 2.87 ( 2.27 ) ng / ml vs 4.66 ( 3.76 ) ng / ml , respectively . The levels of BDNF in serum and follicular fluid were 33.26 卤 17.57ng / m vs 43.56 卤 19.13ng / m and 2.56 卤 19.13ng / m and 2.56 卤 19.13ng / m and 4.90 卤 2.67ng / m vs 2.96 ( 3.60 ) ng / m , respectively . The levels of BDNF in serum and follicular fluid were 39.27 卤 17.44ng / m vs 31.27 卤 18.40ng / m and 4.90 卤 2.67ng / m vs 4.33 卤 3.30ng / m , respectively . There was no significant difference between the two groups ( t = 1.071 , P0.05 ; t = 0.475 , P0.05 ) . Conclusion : BDNF levels in serum and follicular fluid of patients with endometriosis were lower than those in control group . BDNF in the follicular fluid was positively correlated with the average number of oocytes , the number of fertilization and the number of oocytes . It suggested that BDNF might play an important role in the development of oocytes and the development of early embryonic development .

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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