摘要
目的:分析体外受精(IVF)过程中超重及肥胖型多囊卵巢综合征(PCOS)患者卵子质量、胚胎发育潜能的差异,探讨补肾化痰方对此类患者IVF过程及结局的影响。方法:根据不同体质量将行IVF助孕的PCOS患者96个周期,分为3组:偏瘦型/正常组(A组)、超重/肥胖组(B1组)、中药+超重/肥胖组(B2组);比较3组一般资料、代谢水平、促排卵过程中药物使用情况、激素及实验室相关指标;分析各组间卵子质量、胚胎发育潜能及临床结局的差异。结果:与A组比较,B1组Gn使用总量、早期自然流产率显著升高(P<0.05),囊胚形成率、HCG日E;水平、临床妊娠率则显著降低(P<0.05)。超重/肥胖组经补肾化痰方预处理后,与B1组比较,B2组囊胚形成率、临床妊娠率均显著升高,早期自然流产率则显著降低(P<0.05)。进一步比较各组4个时点的葡萄糖(GLU)、胰岛素(INS)、胰高血糖素样肽(GLP-1)水平,与A组比较,B1、B2组的空腹及糖负荷后血糖及胰岛素水平均显著升高(P<0.05);空腹及餐后血GLP-1水平则显著降低,且餐后30 min的分泌高峰均消失。经补肾化痰方干预后,各时点GLP-1分泌均显著提高;60、120 min时GLU、INS则显著降低(P<0.05)。GC-MS代谢组学共鉴定出A组与B组患者卵泡液中存在6种代谢差异产物:戊糖醇1、反式乌头酸、亚油石酸、甘油酸、草酸、核酸。进一步进行通路分析(KEGG),代谢网络构建结果显示,A组与B组间主要存在二羧酸代谢与磷酸肌醇代谢通路。结论:在进行IVF助孕的PCOS患者中,BMI指数的升高会降低卵巢对Gn的敏感性,导致Gn用量增加;且随着BMI增加,其胚胎发育潜能、临床妊娠率均显著下降,早期自然流产率显著升高;超重/肥胖PCOS全身糖脂代谢紊乱更明显,同时卵巢局部存在显著代谢差异,其胚胎发育潜能的降低可能与卵巢局部代谢障碍及磷酸肌醇代谢通路有关。
Objective:To analyze the difference of egg quality and embryo development potential between overweight and obese patients with polycystic ovary syndrome(PCOS)in the process of in vitro fertilization(IVF).Methods:PCOS patients undergoing IVF treatment for 96 cycles were divided into three groups:lean/normal group(Group A),overweight/obesity group(Group B1),traditional Chinese medicine+overweight/obesity group(Group B2)To compare the general data,metabolic level,drug use,hormone and laboratory related indexes of 3 groups,and to analyze the difference of egg quality,embryo development potential and clinical outcome.Results:Compared with Group A,the total amount of Gn used and the rate of early abortion in Group B1 were significantly higher(P<0.05),while the rate of blastocyst formation,the level of HCG Daily E;and the rate of clinical pregnancy were significantly lower(P<0.05).The rate of blastocyst formation and clinical pregnancy in B2 group were significantly higher than that in B1 group,but the rate of early abortion was significantly lower than that in B1 group(P<0.05).The levels of glucose,insulin and GLP-1 at four time points in each group were compared.Compared with Group A,the levels of blood glucose and insulin were significantly higher in Group B1 and Group B2 after fasting and glucose load(P<0.05).The levels of GLP-1 in fasting and postprandial blood decreased significantly,and the peak of GLP-1 secretion disappeared half an hour after meal.After the intervention of Bushen Huatan Formula,GLP-1 secretion increased significantly at each time point,while GLU and INS decreased significantly at 60/120 min(P<0.05).Six metabolic products were identified in follicular fluid from group A,group B by GC-MS,they were pentose alcohol 1,trans-aconitic acid,linoleic acid,oxalic acid and nucleic acid.Further pathway analysis(KEGG)showed that there were two major metabolic pathways between the two groups:dicarboxylic acid metabolism and phosphatidylinositol metabolism.Conclusion:In PCOS patients assisted with IVF,the inc
作者
洪艳丽
薛瑾婷
陈小娟
蒯冰洁
聂晓伟
HONG Yan-li;XUE Jin-ting;CHEN Xiao-juan;KUAI Bing-jie;NIE Xiao-wei(Department of Reproductive Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China;Nanjing University of Chinese Medicine,Nanjing 210046,China)
出处
《中华中医药杂志》
CAS
CSCD
北大核心
2022年第1期527-532,共6页
China Journal of Traditional Chinese Medicine and Pharmacy
基金
国家自然科学基金青年科学基金项目(No.81904237)
江苏省自然科学基金青年科学基金项目(No.SBK2015040021)。
