本文選題：安宮黃體酮　切入點(diǎn)：孕激素環(huán)境下促排卵　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景及研究目的:孕激素環(huán)境下促排卵(Progestin primed ovarian stimulation,PPOS)是以利用孕激素抑制LH峰為理念的一種新的促排卵方案,臨床研究發(fā)現(xiàn)黃體期內(nèi)源性的孕激素及卵泡早期輔助使用外源性孕激素安宮黃體酮(medroxyprogesterone acetate,MPA)均可有效抑制早發(fā)LH峰,此外,與短方案相比,PPOS方案需使用較大劑量的人絕經(jīng)促性腺素(hMG),推測(cè)這可能是由于孕激素環(huán)境下卵泡對(duì)促性腺激素的敏感性略低,亦或是由于孕激素影響了卵泡顆粒細(xì)胞的功能而導(dǎo)致的。本課題也驗(yàn)證了卵泡早期使用MPA可以有效抑制早發(fā)LH峰這一觀點(diǎn)。有學(xué)者通過體外培養(yǎng)大鼠顆粒細(xì)胞的研究發(fā)現(xiàn),MPA可以抑制雌激素的分泌。體內(nèi)的研究則發(fā)現(xiàn)MPA對(duì)促性腺激素誘導(dǎo)的大鼠卵巢分泌的雌激素沒有影響,但可抑制卵巢中芳香化酶的活性。因此卵泡早期MPA的使用是否會(huì)通過抑制促卵泡生成素(follicle stimulating hormone,FSH)誘導(dǎo)的芳香化酶的表達(dá)而影響雌激素的合成,目前尚不清楚。我們的研究目的在于通過檢測(cè)PPOS方案中卵巢顆粒細(xì)胞FSH受體表達(dá)水平以了解卵泡對(duì)促性腺激素的反應(yīng)及MPA是否通過影響顆粒細(xì)胞分泌雌激素的能力來影響卵泡的生長(zhǎng),旨在為進(jìn)一步優(yōu)化促排卵方案奠定基礎(chǔ)。方法:本實(shí)驗(yàn)選取了2015年3月-2015年10月在上海市第九人民醫(yī)院輔助生殖中心行體外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)助孕的不孕癥患者共112例。其中行PPOS方案促排卵者62例,50例行短方案促排卵者作為對(duì)照組。收集所有患者促排卵過程中血液樣本,采用化學(xué)發(fā)光法檢測(cè)血清性激素水平。應(yīng)用密度梯度離心法收集所有患者卵泡液中顆粒細(xì)胞,實(shí)時(shí)熒光定量PCR法(Realtime PCR)和蛋白質(zhì)印跡法(Western blot)檢測(cè)顆粒細(xì)胞內(nèi)芳香化酶(CYP19A1)、促性腺激素受體(FSHR、LHR)和雌激素受體(ERβ)的表達(dá)水平。結(jié)果:1、PPOS組血清LH水平在促排卵過程中逐漸降低,且無一例發(fā)生早發(fā)LH峰。2、促排卵過程中,血清E2水平隨著卵泡的長(zhǎng)大逐漸增加,兩組間并無統(tǒng)計(jì)學(xué)差異(P0.05);PPOS組血清FSH水平顯著性高于短方案組(P0.05)。3、PPOS組FSH受體(FSHR)在mRNA和蛋白水平均顯著高于短方案組FSHR(P0.05),雌激素受體β亞型在蛋白水平明顯高于短方案組(P0.05)。4、PPOS組顆粒細(xì)胞黃體生成素受體(LHR)和CYP19A1在mRNA水平和蛋白水平與短方案組相比無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:1、MPA可以有效控制超促排卵中早發(fā)LH峰的發(fā)生,PPOS可能是全胚冷凍策略下最合適的促排卵方案。2、卵泡期孕激素環(huán)境下促排卵對(duì)卵巢反應(yīng)性沒有產(chǎn)生不良影響。3、MPA沒有對(duì)顆粒細(xì)胞中芳香化酶的表達(dá)及其分泌雌激素的能力產(chǎn)生明顯影響。
[Abstract]:Background and objective: Progestin primed ovarian stimulation (PPOSs) is a new ovulatory stimulation scheme using progesterone to inhibit LH peak. Clinical studies have shown that endogenous progesterone in luteal phase and exogenous progesterone medroxyprogesterone acetateMPA) can effectively inhibit early LH peak. Compared with the short regimen, the PPOS regimen requires a higher dose of human menopausal gonadotropin (hMGG), which may be due to the lower sensitivity of follicles to gonadotropin in progesterone environment. Or because progesterone affects the function of follicular granulosa cells. This study also proves that early use of MPA in follicles can effectively inhibit early LH spike. Some scholars in vitro cultured rat granulosa cells. It was found that MPA could inhibit the secretion of estrogen. In vivo, MPA had no effect on gonadotropin-induced estrogen secretion in the ovary of rats. But it can inhibit the activity of aromatase in ovary. Therefore, whether the use of MPA in early follicular stage may affect the synthesis of estrogen by inhibiting the expression of aromatase induced by follicle stimulating hormone. It is not clear yet. Our aim is to investigate the follicle response to gonadotropin by detecting the expression level of FSH receptor in ovarian granulosa cells in PPOS protocol and whether MPA can affect the estrogen secretion of granulosa cells. To affect the growth of follicles, Methods: in order to lay the foundation for further optimization of ovulation promotion program, we selected infertile women who were assisted by IVF in vitro fertilization-embryo transfer IVF-ETS from March 2015 to October 2015 at the assisted Reproductive Center of Shanghai 9th people's Hospital. 62 patients with ovulation induced by PPOS regimen and 50 patients with ovulation induced by short regimen were used as control group. Blood samples were collected from all patients during ovulation promotion. Serum sex hormone levels were detected by chemiluminescence method. Granulosa cells were collected from follicular fluid of all patients by density gradient centrifugation. The expression of aromatase (CYP19A1), gonadotropin receptor (FSHRL) and estrogen receptor ER 尾 (ER 尾) in granulosa cells was detected by real time PCR and Western blot. During ovulation promotion, serum E2 level increased gradually with follicle growth. There was no significant difference between the two groups in the level of serum FSH in P0.05. 3PPOS group. The level of mRNA and protein in mRNA group was significantly higher than that in the short regimen group. The protein level of estrogen receptor 尾 subtype was significantly higher than that in the short regimen group. The level of estrogen receptor 尾 subtype was significantly higher than that in the short regimen group. CYP19A1 and luteinizing hormone receptor (LHRR) in granulosa cells were not significantly different from those in short regimen group in mRNA and protein levels. Conclusion CYP19A1 can effectively control the occurrence of early LH peak in hyperstimulation of ovulation and may be a whole embryo cryopreservation strategy. Ovulatory stimulation did not have any adverse effect on ovarian reactivity under the condition of follicular progesterone. 3 MPA had no significant effect on the expression of aromatase and the ability of estrogen secretion in granulosa cells.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.8

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 付曉強(qiáng),徐雷鳴;喉顆粒細(xì)胞腫瘤一例[J];中華放射學(xué)雜志;2002年04期

2 周志瑜;和一個(gè)發(fā)育中的牙釉質(zhì)器相聯(lián)系的顆粒細(xì)胞團(tuán)[J];國外醫(yī)學(xué).口腔醫(yī)學(xué)分冊(cè);1984年02期

3 鄭斐,呂時(shí)銘;白介素-6調(diào)節(jié)顆粒細(xì)胞雌孕激素分泌的作用[J];生殖與避孕;2001年02期

4 蘇小妹,張燕軍,劉鋒;大量前列腺巨嗜顆粒細(xì)胞1例[J];中國誤診學(xué)雜志;2003年09期

5 于寧昌;;人末梢單個(gè)核細(xì)胞產(chǎn)生顆粒細(xì)胞趨化因子[J];國外醫(yī)學(xué)(免疫學(xué)分冊(cè));1981年03期

6 余英豪，鄭玉清，張連郁;37例顆粒細(xì)胞雪旺氏瘤臨床病理分析[J];實(shí)用癌癥雜志;1994年01期

7 蘇小妹,張燕軍,劉鋒;尿檢中發(fā)現(xiàn)多量一過性前列腺巨嗜顆粒細(xì)胞1例[J];中國實(shí)驗(yàn)診斷學(xué);2003年06期

8 賈孟春;促性腺激素釋放激素高效類似物抑制人顆粒細(xì)胞分泌孕酮[J];國外醫(yī)學(xué)(計(jì)劃生育分冊(cè));1983年01期

9 ;口腔及頜骨內(nèi)顆粒細(xì)胞病損的臨床病理、免疫組化及超微結(jié)構(gòu)研究[J];國外醫(yī)學(xué).口腔醫(yī)學(xué)分冊(cè);1990年04期

10 王春梅,劉桂蓮,吳紅;消抗靈對(duì)離體培養(yǎng)的大鼠顆粒細(xì)胞雌孕激素生成的影響[J];牡丹江醫(yī)學(xué)院學(xué)報(bào);1999年03期

相關(guān)會(huì)議論文 前10條

1 楊雪;周從容;;胰島素樣生長(zhǎng)因子Ⅱ?qū)θ祟w粒細(xì)胞分泌功奶的影響[A];第二屆西部地區(qū)（12省區(qū)）婦產(chǎn)科學(xué)術(shù)會(huì)議論文匯編[C];2006年

2 沈健;馮云;龍?chǎng)┣?喇端端;;顆粒細(xì)胞水平抑制素B的表達(dá)及其在女性生殖中的意義[A];首屆滬浙婦產(chǎn)科學(xué)術(shù)論壇暨2006年浙江省婦產(chǎn)科學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2006年

3 丁婷;羅愛月;楊書紅;賴志文;盧運(yùn)萍;馬丁;王世宣;;小鼠卵巢顆粒細(xì)胞不同分離方法的比較[A];中華醫(yī)學(xué)會(huì)第三次全國絕經(jīng)學(xué)術(shù)會(huì)議暨絕經(jīng)相關(guān)問題學(xué)習(xí)班論文匯編[C];2011年

4 翁靜;諸定壽;;小鼠卵周圍顆粒細(xì)胞排卵后在輸卵管內(nèi)死亡過程的研究[A];第九次全國生殖生物學(xué)學(xué)術(shù)研討會(huì)論文摘要集[C];2003年

5 沈浣;;顆粒細(xì)胞與卵母細(xì)胞發(fā)育[A];中華醫(yī)學(xué)會(huì)第六次全國生殖醫(yī)學(xué)學(xué)術(shù)會(huì)議�？痆C];2012年

6 王春生;李晶;張滕子;寧方勇;樸善花;安鐵洙;;擬蜘蛛絲蛋白基因在小鼠顆粒細(xì)胞中的整合及其鑒定[A];中國畜牧獸醫(yī)學(xué)會(huì)動(dòng)物解剖學(xué)及組織胚胎學(xué)分會(huì)第十六次學(xué)術(shù)研討會(huì)論文集[C];2010年

7 甄t熑，

本文編號(hào)：1576025