血清、卵泡液和胚胎培养液中人绒毛膜促性腺激素水平与IVF-ET结局的关系

发布时间：2018-05-28 00:26

本文选题：卵泡液 + 胚胎培养液　；参考：《广西医科大学》2014年硕士论文

【摘要】：目的：通过检测体外受精-胚胎移植（IVF-ET）患者取卵日血清、卵泡液及胚胎培养液中β-hCG的水平，探讨其与IVF-ET临床结局的关系。方法：前瞻性对照研究2013年10月至2014年01月在广西医科大学第一附属医院生殖医学研究中心第一次行IVF-ET助孕治疗的68例不孕患者，均采用GnRH-a长方案超促排卵。将患者随机分为A、B两组，A组hCG日注射hCG的剂量为6000IU，共36例；B组注射hCG的剂量为10000IU，共32例。收集患者取卵前半小时血清、取卵时的卵泡液标本及D3胚胎移植日胚胎培养液，采用酶联免疫吸附试验法检测患者血清、卵泡液及胚胎培养液中β-hCG水平，并追踪其获卵数、卵母细胞受精、受精卵卵裂情况。分别将A、B两组按血清、卵泡液中β-hCG水平的高低分组比较其临床资料，同时按D3胚胎级别、妊娠与否、种植率的高低分组比较胚胎培养液中β-hCG水平，探讨β-hCG水平与IVF-ET结局的关系。结果：1.A、B两组的获卵数、正常受精率、卵裂率、优胚率、妊娠率分别为14.50±5.37个、70.7%、98.7%、64.0%、58.3%和12.81±5.16个、71.7%、98.3%、65.3%、56.2%，差异均无统计学差异（P＞0.05）。 2.A组血清β-hCG水平（170.49±38.38IU/L）明显低于B组（296.77±32.92IU/L）（P＜0.01）；A组卵泡液β-hCG水平127.73±24.87IU/L，B组卵泡液β-hCG水平119.39±22.46IU/L，两者无统计学差异（P＞0.05）；A、B两组卵泡液β-hCG水平均显著低于血清β-hCG水平（P＜0.01）。相关性分析表明A、B两组取卵日卵泡液β-hCG水平与血清β-hCG水平均呈显著正相关关系（A组rs=0.737，P＜0.001；B组r=0.538，P=0.001）。 3.将A、B两组分别按血清中不同β-hCG水平分成三小组比较（按百分位数法取临界值，A组分界值：155.14IU/L和176.21IU/L；B组分界值：280.27IU/L和312.11IU/L）：随着血清β-hCG水平升高，A、B两组内的各三小组间获卵数、正常受精率、优胚率及妊娠率均无统计学差异（P＞0.05）；将A、B两组分别按卵泡液中不同β-hCG水平分成三小组比较（A组分界值：116.56IU/L和133.71IU/L；B组分界值：106.38IU/L和122.57IU/L）：随着卵泡液β-hCG水平的增加，A组优胚率呈明显增长趋势（55.4%、62.5%、73.4%），并具有显著差异性（P=0.011），B组优胚率亦呈增长趋势（60.5%、63.6%、70.9%），但差异无统计学意义（P＞0.05）。 4.检测A组内34个I/8和B组内33个I/8胚胎培养液中β-hCG水平，平均值为1.16±0.07IU/L和1.07±0.04IU/L，比较无统计学差异（P＞0.05）；检测A组内15个II/8和B组内14个II/8胚胎培养液中β-hCG水平，平均值为1.04±0.10IU/L和1.05±0.12IU/L，比较无统计学差异（P＞0.05）。 5.在68例研究对象中，共有20例患者于D3所获胚胎中同时含有I/8和II/8胚胎，胚胎培养液β-hCG（IU/L）水平为1.09±0.13、1.05±0.08；16例含II/8和II/6，胚胎培养液中β-hCG（IU/L）水平为1.04±0.13、1.12±0.05；14例含II/6和II/4，胚胎培养液中β-hCG（IU/L）水平为1.15±0.16、1.08±0.11，比较发现不同级别的胚胎培养液中β-hCG水平差异无统计学意义（P＞0.05）。 6.妊娠组移植胚胎培养液中β-hCG水平为1.14±0.10IU/L，未妊娠组为1.09±0.04IU/L，两组间比较有统计学差异（P＜0.05）；胚胎种植率分别为0%、50%、100%对应组的胚胎培养液中β-hCG（IU/L）水平为1.09±0.04、1.11±0.07、1.29±0.05，差异具有统计学意义（P＜0.01）。结论：1.hCG日注射hCG剂量的高低（6000-10000IU）对IVF-ET结局无明显影响，建议对于OHSS高危患者，可适当减少hCG用量。 2.胚胎培养液中hCG水平与hCG日注射hCG的剂量及胚胎形态学评分无直接相关关系。 3.胚胎培养液中hCG为胚胎自身分泌，，在妊娠组及高胚胎种植率组培养液中hCG水平均较高，提示培养液中hCG水平较高的胚胎可能具有更好的发育潜能。
[Abstract]:Objective : To investigate the relationship between IVF - ET and IVF - ET in vitro fertilization - embryo transfer ( IVF - ET ) .

Methods : A prospective controlled study was conducted in 68 infertile women who underwent IVF - ET for the first time in the First Affiliated Hospital of Guangxi Medical University from October 2013 to January 2014 .
The levels of 尾 - hCG in serum , follicular fluid and embryo culture fluid were measured by enzyme - linked immunosorbent assay ( ELISA ) . The levels of 尾 - hCG in serum , follicular fluid and embryo culture fluid were measured by enzyme - linked immunosorbent assay ( ELISA ) .

Results : The number of oocytes , normal fertilization rate , cleavage rate and optimal embryo rate in group A and B were 14.50 卤 5.37 , 70.7 % , 97.7 % , 64.0 % , 58.3 % and 12.81 卤 5.16 , 71.7 % , 98.3 % , 65.3 % and 56.2 % , respectively , with no statistical difference ( P > 0.05 ) .

2 . Serum 尾 - hCG level in group A ( 170.49 卤 38.38IU / L ) was significantly lower than that in group B ( 296.77 卤 32.92IU / L ) ( P < 0.01 ) .
The levels of 尾 - hCG in group A were 127.73 卤 24.87IU / L and 119.39 卤 22.46IU / L , respectively . There was no statistical difference between the two groups ( P > 0.05 ) .
The levels of 尾 - hCG in both groups A and B were significantly lower than that in serum 尾 - hCG ( P < 0.01 ) . The correlation analysis showed that the levels of 尾 - hCG and 尾 - hCG in both groups A and B were positively correlated with the serum 尾 - hCG level ( group A rs = 0.737 , P < 0.001 ) .
B缁剅=0.538,P=0.001).

3 . A group A and B were divided into three groups according to different levels of 尾 - hCG in serum ( the critical value was obtained according to the percentage of percentile ) , the value of A was 155.14IU / L and 176.21IU / L .
B - component bound values : 280.27IU / L and 312.11IU / L ) : With the increase of serum 尾 - hCG level , there was no statistical difference between the three groups in both groups A and B ( P > 0.05 ) .
Group A and group B were divided into three groups according to the levels of 尾 - hCG in the follicular fluid ( A : 1160.56 IU / L and 133.71IU / L ) .
The B - component bound values : 106 . 38IU / L and 122 . 57IU / L ) : with the increase of 尾 - hCG level in the follicular fluid , the percentage of excellent embryo in group A was significantly increased ( 55.4 % , 62.5 % , 73.4 % ) , and there was a significant difference ( P = 0 . 011 ) , and that of group B was also increased ( 60.5 % , 63.6 % , 70.9 % ) , but there was no statistical significance ( P > 0.05 ) .

4 . The levels of 尾 - hCG in 33 I / 8 and group B of 34 I / 8 and group B in group A were measured , the mean value was 1.16 卤 0.07 IU / L and 1.07 卤 0.04 IU / L , there was no statistical difference ( P > 0.05 ) .
The average value of 尾 - hCG was 1.04 卤 0.10 IU / L and 1.05 卤 0.12 IU / L in 15 II / 8 and B group ( P > 0.05 ) .

5.The 尾 - hCG ( IU / L ) levels were 1.09 卤 0.13 , 1.05 卤 0.08 , respectively .
The levels of 尾 - hCG ( IU / L ) were 1.04 卤 0.13 , 1.12 卤 0.05 in 16 cases containing II / 8 and II / 6 .
The levels of 尾 - hCG ( IU / L ) were 1.15 卤 0.16 and 1.08 卤 0.11 respectively in 14 cases containing II / 6 and II / 4 , and there was no significant difference between 尾 - hCG levels in different grades of embryo culture fluid ( P > 0.05 ) .

6 . The 尾 - hCG level was 1.14 卤 0.10 IU / L in the pregnant group and 1.09 卤 0.04 IU / L in the unpregnant group ( P < 0.05 ) .
The rates of 尾 - hCG ( IU / L ) were 1.09 卤 0.04 , 1.11 卤 0.07 and 1.29 卤 0.05 respectively in the embryo culture medium of 0 % , 50 % and 100 % , respectively . The difference was statistically significant ( P < 0.01 ) .

Conclusion : 1 . The high level of hCG injection ( 6000 - 10000IU ) has no obvious effect on the outcome of IVF - ET , and it is suggested that the amount of hCG can be reduced due to OHSS high - risk patients .

2 . There was no direct correlation between the hCG level in the embryo culture fluid and the dose of hCG injected with hCG on the day of hCG injection and the embryonic morphology score .

3 . The hCG in the embryo culture medium is secreted by the embryo itself , and the hCG level in the culture fluid of the pregnancy group and the high - embryo implantation rate group is higher , suggesting that the embryo with higher hCG level in the culture medium may have better development potential .
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8

【参考文献】