PCOS患者卵泡液中内脂素、网膜素-1及代谢成分表达与IVF-ET的相关性研究

发布时间：2018-03-13 02:18

  本文选题：多囊卵巢综合征　切入点：体外受精/卵细胞浆内单精子注射-胚胎移植　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探究多囊卵巢综合征(PCOS)患者卵泡液中内脂素、网膜素-1及代谢成分在体外受精-胚胎移植(IVF-ET)中对卵泡生长、胚胎发育及妊娠结局的作用。方法选取2015年10月-2016年6月在宁医大总院生殖医学中心接受IVF/ICSI-ET的患者共130例。采用长方案或拮抗剂方案,根据2003年鹿特丹诊断标准,将患者分为PCOS组及非PCOS组。以BMI作为判断肥胖的标准,肥胖组:BMI≥25kg/m2,体重正常组:18.5kg/m2≤BMI25kg/m2。根据BMI将上述两组进一步分为两亚组,共四组:A正常体重PCOS组;B:肥胖PCOS组;C:正常体重对照组;D:肥胖对照组。记录患者一般情况、血清激素水平(b FSH,b LH,b E2、T)、COH及IVF结局;测定卵泡液及血清中内脂素、网膜素-1水平及血脂水平(TC、TG、HDL、LDL)。结果1.PCOS患者卵泡液中内脂素浓度及TC浓度显著高于非PCOS组(8.91±7.93 VS2.38±3.01、0.76±0.16 VS 0.68±0.18,P0.05);网膜素-1浓度及HDL浓度显著低于非PCOS组(138.02±181.88 VS 524.42±469.92、0.51±0.13 VS 0.51±0.13,P0.05);PCOS组血清中TG浓度明显高于非PCOS患者(1.62±1.09 VS 1.21±0.61,P0.05)。2.按BMI分层:1)A组与B组比较:A组血清中TC、TG、LDL均显著低于B组(4.14±0.67 VS 4.78±0.97、1.21±0.72 VS 2.25±1.26、2.02±0.53 VS 2.68±0.85,P0.05),HDL显著高于B组(1.35±0..26 VS 1.01±0.30,P0.05);2)A组与C组比较:A组卵泡液中内脂素、TC显著高于C组(8.25±8.17 VS 2.75±3.87、0.79±0.16 VS 0.64±0.15,P0.05),网膜素-1及HDL显著低于C组(156.49±218.21 VS 424.94±476.18、0.49±0.14VS 0.64±0.14,P0.05);3)B组与D组比较:B组卵泡液内脂素、TG、LDL显著高于D组(9.89±7.59 VS 1.96±1.75、0.22±0.08 VS 0.20±0.06、0.27±0.31 VS 2.23±0.62,P0.05),网膜素-1浓度显著低于D组(101.95±60.04 VS 585.53±449.53,P0.05),B组血清中TG、LDL显著高于D组(2.25±1.26 VS 1.47±0.61、2.68±0.85 VS 2.23±0.62,P0.05),HDL浓度显著低于D组(1.01±0.30 VS 1.16±0.27,P0.05);4)C组与D组比较:C组卵泡液中TG、LDL浓度显著低于D组(0.16±0.02 VS 0.20±0.06、0.08±0.09VS 2.23±0.62,P0.05),C组血清中TG浓度显著低于D组(0.97±0.52 VS 1.47±0.61,P0.05),HDL浓度显著高于D组(1.40±0.24 VS 1.16±0.27,P0.05);其余指标各组间差异无统计学意义(P0.05)。3.PCOS组获卵数、MII卵数、受精数、卵裂数、卵裂率均显著高于非PCOS组(19.16±9.97 VS 14.31±7.35、15.43±8.29 VS 11.45±5.80、12.62±6.97 VS 10.34±5.49、12.22±6.92 VS 9.73±5.44,96.85%VS 94.07%,P0.05);PCOS组受精率明显低于非PCOS组(81.79%VS 90.28%,P0.05)。4.PCOS患者卵泡液中内脂素浓度与获卵数(r=0.546,P0.05)、优胚数(r=0.479,P0.05)呈正相关;PCOS患者卵泡液中网膜素-1浓度与BMI(r=-0.667,P0.05)、LDL(r=-0.498,P0.05)呈负相关,与卵泡液中HDL(r=0.582,P0.05)呈正相关。5.妊娠组内脂素浓度明显高于未妊娠组(6.91±7.57 VS 4.75±6.11,P0.05);妊娠组网膜素-1浓度明显低于未妊娠组(277.98±361.75 VS 406.23±448.73,P0.05)。结论1.PCOS患者卵泡液中内脂素水平升高及网膜素-1水平降低,在排除体质因素的影响后,该结论仍成立,提示内脂素及网膜素-1或许可以作为预测PCOS指标之一。2.PCOS患者卵泡液中内脂素含量与获卵数及优胚数呈正相关,网膜素浓度与BMI、LDL呈负相关,与HDL呈正相关,提示针对PCOS患者卵泡局部微环境中内脂素浓度调控可能会改善妊娠结局;3.卵泡液中内脂素、网膜素-1浓度可能是预测IVF患者妊娠结局的良好指标之一。
[Abstract]:Objective to explore the polycystic ovary syndrome (PCOS) patients with follicular fluid visfatin, omentin and -1 metabolites in in vitro fertilization and embryo transfer (IVF-ET) on follicular growth, embryo development and pregnancy outcomes. Methods from October 2015 June -2016 year in Nanjing Medical University General Hospital Reproductive Medical Center for patients undergoing IVF/ICSI-ET were in 130 cases. The long program or antagonist, according to the diagnosis standard of Rotterdam in 2003, the patients were divided into PCOS group and non PCOS group. Using BMI as the criteria for obesity, obesity group: BMI = 25kg/m2, 18.5kg/m2 = BMI25kg/m2.: normal weight group according to the BMI of the two groups were further divided into two sub groups, a total of the four group: A group PCOS B: group PCOS normal weight; obesity; C: normal weight control group; D: obese control group. Record the general condition of patients, serum hormone levels (B, FSH, B, LH, B, E2, T, COH and IVF) outcome; determination of follicular fluid and serum visfatin, 缃戣啘绱，

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