發(fā)布時(shí)間：2018-03-08 13:23

  本文選題：胞飲突　切入點(diǎn)：黃體酮　出處：《浙江大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：在體外受精-凍融胚胎移植(IVF-FET)過程中,子宮內(nèi)膜容受性起著至關(guān)重要的作用,種植失敗仍然是IVF治療中主要的限制性因素。胚胎與子宮內(nèi)膜的發(fā)育不同步是導(dǎo)致種植失敗的主要原因。FET周期有很多優(yōu)點(diǎn),醫(yī)護(hù)人員和病人可以選擇胚胎解凍和移植的時(shí)間,減少并發(fā)癥,提高累積妊娠率等。在子宮內(nèi)膜準(zhǔn)備周期方案中,激素替代治療(HRT)相對來說方便、有效、安全,因此本課題為了評估激素替代-凍融胚胎移植(HRT-FET)周期的子宮內(nèi)膜容受性,檢測了子宮內(nèi)膜的形態(tài)學(xué)標(biāo)志物胞飲突,及與子宮內(nèi)膜容受性相關(guān)的其他分子標(biāo)志物,包括整合素ανβ3、同源框基因A10(HOXA10)蛋白和白血病抑制因子(LIF)的表達(dá)。 方法：選擇在我院即將行HRT-FET周期的46例不孕女性,根據(jù)子宮內(nèi)膜暴露于P連續(xù)使用的天數(shù)(3,4,5,6,7天)的不同分為5組,分別記為P3,P4,P5,P6,P7組,各組均在用完黃體酮的第二天取內(nèi)膜。應(yīng)用掃描電子顯微鏡(SEM)和蛋白免疫印跡(WB)方法分別評估子宮內(nèi)膜胞飲突的形態(tài)和覆蓋面積,及整合素αvβ3、HOXA10、LIF蛋白的表達(dá)。 結(jié)果：(Ⅰ)根據(jù)胞飲突發(fā)育的階段,我們將胞飲突分為：發(fā)育中、發(fā)育完全和衰退期三個(gè)階段。在HRT-FET患者中,SEM發(fā)現(xiàn)：發(fā)育中的胞飲突大部分出現(xiàn)在P5組中,患者子宮內(nèi)膜呈發(fā)育中的胞飲突狀態(tài)所占比例為55%(6/11)；發(fā)育完全的胞飲突主要出現(xiàn)在P6組中,患者子宮內(nèi)膜呈發(fā)育完全的胞飲突狀態(tài)所占比例為69%(9/13)；而衰退期的胞飲突主要出現(xiàn)在P7組中,患者子宮內(nèi)膜呈衰退期的胞飲突狀態(tài)所占比例為70%(7/10)。胞飲突發(fā)育提示,P6組患者子宮內(nèi)膜容受性的好于其他組。(Ⅱ)胞飲突的覆蓋面積：在P3和P4組中胞飲突的覆蓋面積非常低；P5,P6,和P7這三組都分別高于P3和P4組(P.0001)；在P6組中,胞飲突的覆蓋面積均高于P5和P7組(P.0001)；胞飲突覆蓋面提示,P6組患者子宮內(nèi)膜容受性好于其他組。(Ⅲ)分子標(biāo)志物：整合素avβ3, HOXA10與LIF蛋白的表達(dá)在P3vs.P4組中沒有差異,但是在P3vs.P6組,P5vs.P6組和P6vs.P7組比較中,P6組中整合素avβ3, HOXA10和LIF蛋白的表達(dá)最高,結(jié)果均有統(tǒng)計(jì)學(xué)差異；分子標(biāo)志物的表達(dá)提示,P6組患者的子宮內(nèi)膜容受性最佳。 結(jié)論：在本實(shí)驗(yàn)中心所實(shí)施的HRT方案中,大部分人黃體酮補(bǔ)充6天的子宮內(nèi)膜容受性最佳,這個(gè)時(shí)間可能最適合胚胎種植。根據(jù)第3天的凍融胚胎的發(fā)育情況,將第3天的胚胎移植到黃體酮補(bǔ)充了3天的子宮內(nèi),可能會更好的實(shí)現(xiàn)同步化。
[Abstract]:Objective: endometrial receptivity plays an important role in IVF-FETs during in vitro fertilization and frozen-thawed embryo transfer. Implantation failure is still a major limiting factor in the treatment of IVF. The synchronization of embryo and endometrium is the main reason for the failure of implantation. There are many advantages in the cycle of implantation. Health care workers and patients can choose the time of embryo thawing and transfer. In endometrial preparation cycle, hormone replacement therapy (HRT) is relatively convenient, effective and safe. Therefore, in order to evaluate the endometrial receptivity of HRT-FETs, a morphological marker of endometrium and other molecular markers related to endometrial receptivity, were detected. These include the expression of integrin 偽 謂 尾 3, homobox gene A10, HOXA10, and leukemia suppressor LIFs. Methods: 46 infertile women who were about to undergo HRT-FET cycle in our hospital were divided into 5 groups according to the days of continuous use of endometrium exposed to P). The endometrium of each group was collected on the second day after using progesterone. The morphology and coverage area of the endometrium and the expression of integrin 偽 v 尾 3HOXA10 LIF protein were evaluated by scanning electron microscopy (SEM) and Western blot (WB). Results (I) according to the stage of development, we divided the process into three stages: development, complete development and decline. In HRT-FET patients, it was found that most of the developing processes occurred in P5 group. The proportion of the endometrium of the patients with developing process was 55 / 11. The fully developed process mainly appeared in the P6 group, and the rate of the development of the endometrium in the P6 group was higher than that in the control group (P _ (6)). The percentage of the patients with fully developed cellular processes in the endometrium was 69 / 9 / 13, while the recessionary processes were mainly present in the P7 group. The percentage of patients with decayed endometrium was 70 / 10 / 10. The development of the process suggested that the endometrial receptivity of P6 group was better than that of other groups. (II) the coverage area of the process: in P3 and P4 groups, the percentage of the process was higher than that in the other groups. (2) the percentage of the ectopic process in the P6 group was higher than that in the other groups (P 3 and P 4). The area of P5, P6 and P7 were higher than that of P3 and P4, respectively. The coverage area of the process was higher than that of the P5 and P7 groups, indicating that the endometrial receptivity of the P6 group was better than that of the other groups. The expression of integrin av 尾 3, HOXA10 and LIF protein was not different in P3vs.P4 group. However, the expression of integrin av 尾 3, HOXA10 and LIF protein in P3vs.P6 group and P6vs.P7 group was the highest, and the expression of molecular markers suggested that the endometrial receptivity of P6 group was the best. Conclusion: in the HRT regimen implemented in this experimental center, most of people received progesterone supplementation for 6 days, which may be the most suitable time for embryo implantation, according to the development of freeze-thawed embryos on day 3. Transplanting the 3rd day embryo into the uterus supplemented with progesterone for 3 days may be better synchronized.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R714.8

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張穎;孫瑩璞;孫靖;卜志勤;王芳;;常規(guī)體外受精形成三倍體受精卵的相關(guān)因素分析[J];國際生殖健康/計(jì)劃生育雜志;2014年03期

2 孫家珍;陳帆;南燕;申素芳;;排卵期宮腔灌注hCG對復(fù)發(fā)性流產(chǎn)患者子宮內(nèi)膜胞飲突及臨床妊娠率的影響[J];廣東醫(yī)學(xué);2014年16期

3 陳琨;李琴芬;;子宮內(nèi)膜輕微吸刮術(shù)改善反復(fù)流產(chǎn)婦女子宮內(nèi)膜容受性的臨床研究[J];貴陽醫(yī)學(xué)院學(xué)報(bào);2015年02期

4 羅軼群;全松;;冷凍胚胎移植周期中黃體支持的研究現(xiàn)狀[J];國際生殖健康/計(jì)劃生育雜志;2015年04期

5 張金玉;李海霞;郭新宇;謝妍;袁啟龍;葛明曉;林德偉;鄧偉民;朱維芳;;益氣血補(bǔ)肝腎方對子宮內(nèi)膜整合素αvβ3表達(dá)的影響[J];武漢大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2013年06期

6 王s，

本文編號：1584078