本文選題：體外受精-胚胎移植 + 25羥維生素D��； 參考：《鄭州大學》2017年碩士論文

【摘要】：目的探討體外受精(in vitro fertilization,IVF)和卵母細胞漿內(nèi)單精子顯微注射(intrac ytoplasmic sperminjection,ICSI)不孕女性外周血中25羥維生素D的水平與其妊娠率的關(guān)系。資料與方法回顧性分析2015年12月至2017年1月鄭州大學第三附屬醫(yī)院生殖中心首次實施常規(guī)IVF/ICSI治療移植兩枚第三天新鮮胚胎,具有完整病例資料的618例年輕且卵巢儲備功能良好的不孕患者,收集病例資料包括一般信息、臨床治療、實驗室及隨訪資料。(1)納入標準:(1)符合行IVF、ICSI指征,新鮮周期移植兩枚第三天胚胎;(2)年齡≤35歲;(3)體重指數(shù)(body mass index,BMI)18-kg/m2;(4)卵巢儲備功能正常:雙側(cè)竇卵泡數(shù)(AFC)6個,基礎(chǔ)卵泡刺激素(Basic Follicle Stimulating Hormone,bFSH)10 IU/L,基礎(chǔ)雌激素(Basic Estradial,bE2)50 ng/L。(2)排除標準:排除惡性腫瘤(史)、高血壓、糖尿病、多發(fā)性硬化癥、需要長期藥物治療的內(nèi)分泌代謝性病、肝臟或腎臟疾病、高泌乳素血癥、多囊卵巢綜合征(Polycystic ovarian syndrome,PCOS)、口服復合維生素制劑或維生素D合劑補充維生素D。(3)采用化學發(fā)光法檢測血清25羥維生素D水平。將臨床診斷結(jié)果分為臨床妊娠組和未臨床妊娠組,將潛在影響血清25(OH)D水平和妊娠結(jié)局相關(guān)聯(lián)的變量進行單因素分析,將單因素分析有統(tǒng)計學差異的結(jié)果作為自變量,臨床妊娠作為因變量,納入Logistic回歸模型分析影響體外受精一胚胎移植妊娠結(jié)局的因素,進行影響臨床妊娠混雜因素的評估,觀察血清25(OH)D缺乏是否影響IVF/ICSI妊娠結(jié)局。(4)根據(jù)血清25(OH)D水平將研究對象分為A組:血清25(OH)D25nmol/L;B組:血清25(OH)D 25~50nmol/L;C組:血清25(OH)D50nmol/L,比較各組間的總獲卵數(shù)、成熟卵子總數(shù)、優(yōu)質(zhì)胚胎數(shù)、受精卵子總數(shù)、可利用胚胎數(shù)、生化妊娠率、臨床妊娠率有無差異。(5)所得數(shù)據(jù)運用SPSS21.0統(tǒng)計軟件進行整理分析,P0.05差異有統(tǒng)計學意義。結(jié)果(1)在618例研究對象中,維生素D嚴重缺乏的有167例,占本次研究對象總數(shù)的27%;維生素D缺乏的有173例,占調(diào)查人數(shù)的28%;維生素D不足的有275,占本次調(diào)查人數(shù)的44.5%;維生素D正常的有3人,占本次調(diào)查人數(shù)的0.5%;未發(fā)現(xiàn)有出現(xiàn)維生素D過量的情況。618例患者普遍存在普遍存在VD嚴重缺乏或缺乏,血清25-(OH)D均值為36.04±5.388nmol/L低于國外學者提出的75 nmol/L的成人維生素D標準;根據(jù)成人VD標準,僅有3名女性VD水平在正常范圍內(nèi),占0.5%,余95.5%的患者均不同程度存在VD缺乏或不足。(2)618例患者平均年齡28.81±3.55歲,妊娠組為387例(62.6%),未妊娠組231例(37.4%)。單因素分析結(jié)果顯示:妊娠組年齡小于未妊娠組[(28.59±3.49)vs.(29.28±3.64)歲],妊娠組HCG日子宮內(nèi)膜厚度大于未妊娠組[(11.63±2.09)vs.(10.52±2.54)mm],妊娠組已移植胚胎質(zhì)量高于未妊娠組[優(yōu)質(zhì)胚胎205(52.9)vs.99(42.9)],[非優(yōu)質(zhì)胚胎182(47.1)vs.132(57.1)],妊娠組的維生素D缺乏小于未妊娠組[維生素D缺乏187(48.3)vs.156(67.5)],[維生素D不缺乏200(51.7)vs.75(32.5)](P值均0.05)。將單因素分析有差異的年齡、子宮內(nèi)膜厚度、已移植胚胎質(zhì)量、血清25(OH)D水平納入logistics回歸模型,結(jié)果顯示:子宮內(nèi)膜厚度(OR=1.251,95%CI:1.013-1.545,p=0.037)、已移植胚胎質(zhì)量(OR=1.903,95%CI:1.123-3.226,p=0.017)、血清25羥維生素D缺乏(OR=0.995,95%CI:0.991-0.998,p=0.004)有統(tǒng)計學差異。(3)其中A組(維生素D25mol/L)167例,B組(維生素D 25~50mol/L)173例,C組(維生素D50mol/L)278例。三組在年齡、BMI、不孕年限、竇卵泡總數(shù)、E2、LH、FSH比較,差異均無統(tǒng)計學意義(P0.05)。三組生化妊娠率、臨床妊娠率相比較,差異有統(tǒng)計學意義(P0.05)。不同維生素D水平組間生化妊娠率比較,結(jié)果:A組64.2%(52/81),B組74.1%(60/81),C組83.3%(50/60)各組間的差異有統(tǒng)計學意義(P=0.039)。不同維生素D水平組間臨床妊娠率比較,結(jié)果:A組50.9%(85/167),B組59.1%(102/173),C組71.9%(200/278)各組間的差異有統(tǒng)計學意義(P=0.020)。而三組間Gn總量、Gn天數(shù)、HCG日E2、成熟卵子總數(shù)、優(yōu)質(zhì)胚胎數(shù)、受精卵子總數(shù)、可利用胚胎數(shù)、HCG日P、HCG日子宮內(nèi)膜厚度、總獲卵數(shù)、相比較差異無統(tǒng)計學意義(P0.05)。結(jié)論(1)行IVF/ICSI的年輕且卵巢儲備功能良好的不孕不孕癥女性患者血清維生素D水平普遍的缺乏或不足。(2)維生素D缺乏是IVF/ICSI患者臨床妊娠率的獨立影響因素。(3)血清維生素D缺乏可降低IVF/ICSI助孕的臨床妊娠率。(4)血清25(OH)D水平與獲卵數(shù)、成熟卵子總數(shù)、可利用胚胎數(shù)及胚胎質(zhì)量無顯著關(guān)系。
[Abstract]:Objective to investigate the relationship between the level of 25 hydroxyvitamin D in peripheral blood and the pregnancy rate in the peripheral blood of infertile women with in vitro fertilization (IVF) and oocyte plasma single sperm injection (intrac ytoplasmic sperminjection, ICSI). The data and methods reviewed the reproduction of the Third Affiliated Hospital of Zhengzhou University from December 2015 to January 2017. The center for the first time carried out conventional IVF/ICSI therapy for two third day fresh embryos and 618 young and good ovarian reserve patients with complete case data. The collection of case data included general information, clinical treatment, laboratory and follow-up data. (1) included the criteria: (1) conformed to the line IVF, ICSI indications, and two fresh cycle transplants. Three days embryos; (2) age less than 35 years old; (3) body mass index (body mass index, BMI) 18-kg/m2; (4) normal ovarian reserve function: 6 of bilateral sinus follicles (AFC), basal follicle stimulating hormone (Basic Follicle Stimulating Hormone, bFSH) 10 IU/L, basic estradiol 50 (2) exclusion criteria: elimination of malignant tumor (History), hypertension, sugar Urinary and multiple sclerosis, requiring long-term drug treatment of endocrine and metabolic diseases, liver or kidney disease, hyperprolactinemia, polycystic ovary syndrome (Polycystic ovarian syndrome, PCOS), oral compound vitamin preparation or vitamin D mixture supplemented vitamin D. (3) by chemiluminescence detection of serum 25 hydroxyvitamin D level. The results of bed diagnosis were divided into clinical pregnancy group and unclinical pregnancy group. Single factor analysis was carried out on the variables associated with the potential influence of serum 25 (OH) D level and pregnancy outcome. The results of statistical difference in single factor analysis were taken as independent variables. Clinical pregnancy was used as the dependent variable, and the Logistic regression model was incorporated into the analysis of the embryo transfer in vitro fertilization. The factors affecting the outcome of pregnancy were evaluated to affect the clinical pregnancy confounding factors and to observe whether the serum 25 (OH) D deficiency affected the IVF/ICSI pregnancy outcome. (4) according to the serum 25 (OH) D levels, the subjects were divided into A group: serum 25 (OH) D25nmol/L; B group: serum 25 (OH) D 25~50nmol/L; serum 25 The total number of mature eggs, the number of high quality embryos, the total number of fertilized eggs, the number of embryos, biochemical pregnancy rate and clinical pregnancy rate have no difference. (5) the data obtained by SPSS21.0 statistical software were analyzed, and the difference of P0.05 was statistically significant. (1) among the 618 subjects, there were 167 cases of severe vitamin D deficiency, which accounted for the total object of the study. 27% of the number, 173 cases of vitamin D deficiency, 28% of the number of investigators, 275 of vitamin D deficiency, 44.5% of the present survey, 3 of the normal vitamin D, 0.5% of the present survey, and the prevalence of VD severe deficiency or lack of serum 25- (OH) D mean in cases of vitamin D overdose 36.04 + 5.388nmol/L was lower than the 75 nmol/L standard of adult vitamin D proposed by foreign scholars. According to the adult VD standard, only 3 women were in the normal range, accounting for 0.5%, and the remaining 95.5% patients had VD deficiency or deficiency in varying degrees. (2) the average age of 618 patients was 28.81 + 3.55, the pregnancy group was 387 (62.6%), and no pregnancy group 231 (3) 7.4%). The results of single factor analysis showed that the age of pregnancy group was less than that of non pregnancy group [(28.59 + 3.49) vs. (29.28 + 3.64) years old], the endometrium thickness of pregnancy group was higher than that of non pregnancy group [11.63 + 2.09) vs. (11.63 + 2.09) vs. (10.52 + 2.54) mm], and the quality of the transplanted embryos in pregnancy group was higher than that of non pregnancy pregnancy group [205 (52.9) vs.99 (42.9)], [non quality embryo 182 (47.1) vs.1]. 32 (57.1)] the vitamin D deficiency in the pregnancy group was less than that of the non pregnancy group [vitamin D deficiency 187 (48.3) vs.156 (67.5)], [vitamin D without 200 (51.7) vs.75 (32.5)] (P value 0.05)). The age, the thickness of the endometrium, the transplanted embryo quality, the serum 25 (OH) D level were included in the logistics regression model, and the results showed that the uterus was in the uterus. Membrane thickness (OR=1.251,95%CI:1.013-1.545, p=0.037), the quality of transplanted embryos (OR=1.903,95%CI:1.123-3.226, p=0.017), serum 25 hydroxyvitamin D deficiency (OR=0.995,95%CI:0.991-0.998, p=0.004) had statistical differences. (3) 167 cases of A (vitamin D25mol/L), B group (vitamin D 25~50mol/L) 173 cases, three group (vitamin p=0.017) in 278 cases. Age, BMI, infertile years, total number of sinus oocytes, E2, LH, FSH, the difference was not statistically significant (P0.05). The difference between the three groups of biochemical pregnancy rates and the clinical pregnancy rate was statistically significant (P0.05). The results were compared between the groups of 64.2% (52/81), B group 74.1% (60/81) in group A and the differences among the 83.3% C groups. Statistical significance (P=0.039). The comparison of clinical pregnancy rates among groups of different vitamin D levels: group A 50.9% (85/167), group B, 59.1% (102/173), C group 71.9% (200/278), but three groups of Gn total, Gn days, HCG day, the number of mature eggs, the number of high-quality embryos, the total number of fertilized oocytes, the number of embryos can be utilized. The endometrium thickness and total number of acquired eggs on day P, HCG day were not statistically significant (P0.05). Conclusion (1) the prevalence of vitamin D in female patients with infertility and infertility with IVF/ICSI is generally deficient or inadequate. (2) vitamin D deficiency is an independent factor in the clinical pregnancy rate of IVF/ICSI patients. (3) serum (3) serum Vitamin D deficiency can reduce the clinical pregnancy rate of IVF/ICSI pregnancy. (4) the level of serum 25 (OH) D, the number of eggs obtained, the total number of mature eggs, and the number of embryos and the quality of embryo have no significant relationship.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.8

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