本文選題：子宮內(nèi)膜異位癥 + 不孕��； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：子宮內(nèi)膜異位癥(endometriosis,EMs)是指具有生長功能的子宮內(nèi)膜組織(腺體和間質(zhì))出現(xiàn)在子宮腔以外的任何部位而引起的一種疾病。為育齡期婦女最常見的疾病之一,也是引起不孕癥的常見原因。體外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)技術(shù)為不孕癥患者提供了有效的治療方法,但與其他類型的不孕癥患者相比,子宮內(nèi)膜異位癥患者的IVF-ET妊娠結(jié)局較差。子宮內(nèi)膜異位癥導致IVF-ET不良妊娠結(jié)局的原因紛繁復雜,而卵母細胞質(zhì)量下降可能是影響臨床治療結(jié)局的重要因素之一。在卵母細胞的生長發(fā)育過程中,除了下丘腦-垂體-卵巢軸(hypothalamus-pituitary-ovary axis,HPOA)的調(diào)節(jié),卵巢局部微環(huán)境中自分泌、旁分泌的生長因子及生物活性物質(zhì)也發(fā)揮著重要作用。因此,近年來從卵泡液的成分及顆粒細胞等方面對卵母細胞質(zhì)量進行評估引起了普遍關(guān)注。有研究指出,腦源性神經(jīng)營養(yǎng)因子(Brain-derived eurotrophic factor,BDNF)對卵泡的生長發(fā)育具有重要作用,并且有研究發(fā)現(xiàn),以正常婦女作對照,EMs患者卵泡液中BDNF水平下降明顯。綜上所述,本實驗通過測定子宮內(nèi)膜異位癥患者血清、卵泡液中BDNF水平,探討B(tài)DNF與子宮內(nèi)膜異位癥的關(guān)系,及BDNF對卵母細胞質(zhì)量及早期胚胎發(fā)育的可能影響,從而為指導臨床治療提供新的理論依據(jù)。目的:通過測定BDNF在子宮內(nèi)膜異位癥患者卵巢刺激周期中血清及卵泡液中的水平,探討B(tài)DNF與子宮內(nèi)膜異位癥之間的關(guān)系,及BDNF對卵母細胞質(zhì)量和胚胎發(fā)育潛能的影響。方法:選取于2016年2月至2016年11月在河北醫(yī)科大學第二醫(yī)院生殖醫(yī)學科行體外受精-胚胎移植的不孕癥患者:子宮內(nèi)膜異位癥35例(A組),以同期單純因輸卵管因素不孕患者35例(B組)作為對照組。收集患者取卵日空腹血及所有卵泡液。用酶聯(lián)免疫吸附法(enzyme-linked immunosorbent assay,ELISA)測定兩組血清、卵泡液中BDNF水平;比較兩組的臨床、實驗室指標和臨床結(jié)局等;比較兩組患者血清、卵泡液中BDNF的水平;分析兩組血清中BDNF水平與卵泡液中BDNF水平的相關(guān)性;分析兩組血清、卵泡液中BDNF水平與年齡、不孕年限、基礎(chǔ)激素水平、控制性卵巢刺激(controlled ovarian stimulation,COS)天數(shù)、促性腺激素(gonadotropin,Gn)用量等一般資料的相關(guān)性;分析兩組血清、卵泡液中BDNF水平與獲卵數(shù)、受精數(shù)(率)、正常受精數(shù)(率)、卵裂數(shù)(率)、可移植胚胎數(shù)(率)、優(yōu)質(zhì)胚胎數(shù)(率)及妊娠結(jié)局等的相關(guān)性。結(jié)果:1子宮內(nèi)膜異位癥組和對照組臨床指標的比較:EMs組Gn用量2775.00(1725.00)IU高于對照組2325.00(1462.50)IU,但差異無統(tǒng)計學意義(Z=-1.727,P0.05);兩組患者的年齡、不孕年限、基礎(chǔ)FSH水平、COS天數(shù)和HCG日激素水平比較無統(tǒng)計學差異。2子宮內(nèi)膜異位癥組和對照組的實驗室指標的比較:EMs組和對照組的受精數(shù)為9.00(5.00)枚vs 10.00(6.00)枚,正常受精數(shù)為7.00(5.00)枚vs 9.00(5.00)枚,差異均有統(tǒng)計學意義(Z=-2.078,P0.05;Z=-1.986,P0.05)。兩組優(yōu)胚率分別為22.65%vs 30.48%,差異有統(tǒng)計學意義(χ2=5.229,P0.05)。EMs組和對照組的獲卵數(shù)、受精率、正常受精率、卵裂數(shù)(率)、優(yōu)胚數(shù)、可移植胚胎數(shù)(率)比較差異均無統(tǒng)計學意義。3子宮內(nèi)膜異位癥組和對照組臨床結(jié)局的比較:EMs組和對照組的種植率分別是26.53%vs 49.06%,差異有統(tǒng)計學意義(χ2=5.471,P0.05);妊娠率分別是58.33%vs 70.37%,EMs組低于對照組,但差異無統(tǒng)計學意義(χ2=0.806,P0.05)。4子宮內(nèi)膜異位癥組和對照組血清和卵泡液中BDNF水平的比較:EMs組和對照組血清BDNF水平分別為35.25±16.93ng/ml vs36.71±17.81ng/ml,EMs組低于對照組,但差異無統(tǒng)計學意義(t=-0.351,P0.05);EMs組和對照組卵泡液BDNF水平分別為2.87(2.27)ng/ml vs 4.66(3.76)ng/ml,EMs組明顯低于對照組,差異有統(tǒng)計學意義(Z=-2.308,P0.05)。5 BDNF水平與臨床指標的相關(guān)關(guān)系:卵泡液中BDNF水平與患者HCG日孕酮水平呈負相關(guān)(rs=-0.254,P0.05)。6 BDNF水平與實驗室指標的相關(guān)關(guān)系:卵泡液中BDNF水平與獲卵數(shù)、受精數(shù)、卵裂數(shù)呈正相關(guān)(rs=0.335,P0.05;rs=0.323,P0.05;rs=0.287,P0.05;rs=0.253,P0.05),與可移植胚胎數(shù)成負相關(guān)(rs=-0.253,P0.05)。7血清BDNF水平與卵泡液BDNF水平的無明顯相關(guān)性(rs=0.170,P0.05)。8妊娠組和非妊娠組BDNF水平的比較:A、B兩組中,妊娠組分別為A1組(14例)、B1組(19例),未妊娠組分別為A2組(10例)、B2組(8例)。A1、A2組血清、卵泡液中BDNF濃度分別為33.26±17.57ng/m vs 43.56±19.13ng/m和2.56(2.28)ng/m vs 2.96(3.60)ng/m,兩組比較差異均無統(tǒng)計學意義(t=-1.365,P0.05;Z=-0.586,P0.05);B1、B2組血清、卵泡液中BDNF濃度分別為39.27±17.44ng/m vs 31.27±18.40ng/m和4.90±2.67ng/m vs 4.33±3.30ng/m,兩組比較差異均無統(tǒng)計學意義(t=1.071,P0.05;t=0.475,P0.05)。結(jié)論:子宮內(nèi)膜異位癥患者血清和卵泡液中BDNF的水平低于對照組,卵泡液中BDNF與患者的平均獲卵數(shù)、受精數(shù)、卵裂數(shù)呈正相關(guān),提示BDNF可能在卵母細胞的發(fā)育和早期胚胎發(fā)育的過程中有重要影響。妊娠組與非妊娠組血清和卵泡液中BDNF水平無統(tǒng)計學差異,尚不能用BDNF預測不孕癥患者的妊娠結(jié)局。
[Abstract]:Objective : To investigate the relationship between BDNF and endometriosis , and to explore the relationship between BDNF and endometriosis , and to explore the effect of BDNF on the quality of oocytes and the potential of fetal development . The levels of BDNF in serum and follicular fluid were correlated with age , age of infertility , basal hormone level , controlled ovarian stimulation ( COS ) and gonadotropin ( Gn ) . The results showed that the levels of BDNF in endometriosis group and control group were higher than those in control group ( 23.25 . 00 ) , but there was no statistical difference ( Z = - 1.727 , P0.05 ) . There was significant difference between the two groups ( 22.65 % vs 30.48 % , 蠂2 = 5.229 , P0.05 ) . The levels of BDNF in endometriosis group and control group were 2.87 ( 2.27 ) ng / ml vs 4.66 ( 3.76 ) ng / ml respectively . The levels of BDNF in endometriosis group and control group were 2.87 ( 2.27 ) ng / ml vs 4.66 ( 3.76 ) ng / ml , respectively . The levels of BDNF in endometriosis group and control group were 2.87 ( 2.27 ) ng / ml vs 4.66 ( 3.76 ) ng / ml , respectively . The levels of BDNF in serum and follicular fluid were 33.26 鹵 17.57ng / m vs 43.56 鹵 19.13ng / m and 2.56 鹵 19.13ng / m and 2.56 鹵 19.13ng / m and 4.90 鹵 2.67ng / m vs 2.96 ( 3.60 ) ng / m , respectively . The levels of BDNF in serum and follicular fluid were 39.27 鹵 17.44ng / m vs 31.27 鹵 18.40ng / m and 4.90 鹵 2.67ng / m vs 4.33 鹵 3.30ng / m , respectively . There was no significant difference between the two groups ( t = 1.071 , P0.05 ; t = 0.475 , P0.05 ) . Conclusion : BDNF levels in serum and follicular fluid of patients with endometriosis were lower than those in control group . BDNF in the follicular fluid was positively correlated with the average number of oocytes , the number of fertilization and the number of oocytes . It suggested that BDNF might play an important role in the development of oocytes and the development of early embryonic development .

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.8

【參考文獻】

相關(guān)期刊論文 前4條

1 王雪;甄t熑，

本文編號：1770469