發(fā)布時間：2018-08-03 16:40

【摘要】：目的：通過宮腔鏡對子宮內(nèi)膜實施微創(chuàng)手術(shù)，研究術(shù)前、術(shù)后子宮內(nèi)膜容受性相關(guān)因子的表達情況，從分子生物學(xué)角度分析宮腔鏡子宮內(nèi)膜微創(chuàng)術(shù)對子宮內(nèi)膜容受性產(chǎn)生的影響，探討其提高IVF胚胎著床率、妊娠率的臨床價值，從而為反復(fù)胚胎移植失敗的不孕癥患者提供新的治療方法。 方法：選取2011年11月至2012年9月于廣西醫(yī)科大學(xué)第一附屬醫(yī)院生殖中心就診的連續(xù)3次及以上IVF-ET周期治療失敗的不孕癥患者20例，于種植窗期抽血測定血清雌二醇及孕酮水平，宮腔鏡下觀察子宮內(nèi)膜形態(tài)、收集子宮內(nèi)膜標(biāo)本并實施子宮內(nèi)膜微創(chuàng)術(shù)。術(shù)后第1、2個月再次實施宮腔鏡子宮內(nèi)膜微創(chuàng)術(shù)，于術(shù)后第3個月的種植窗期返院收集外周血及子宮內(nèi)膜標(biāo)本。比較術(shù)前、術(shù)后3月血清性激素的變化。通過HE染色，光學(xué)顯微鏡下觀察子宮內(nèi)膜的分泌情況。運用免疫組化鏈霉菌抗生物素蛋白-過氧化酶連接（SP）法定位及半定量檢測子宮內(nèi)膜ER、PR、LIF、VEGF的表達情況。術(shù)后患者再次進行體外受精-胚胎移植，隨訪6個月，追蹤其胚胎著床、妊娠情況。實驗數(shù)據(jù)以均數(shù)標(biāo)準差(x±s)或率（%）表示，采用SPSS16.0軟件包處理。計量資料采用t檢驗，計數(shù)資料采用卡方檢驗。檢驗水準為雙側(cè)，α=0.05。 結(jié)果：20例反復(fù)胚胎移植失敗患者實施宮腔鏡子宮內(nèi)膜微創(chuàng)術(shù)治療，術(shù)前、術(shù)后3月血清雌、孕激素水平分別相比較（574.70±184.35VS618.91±217.85，P＞0.05；38.59±11.46VS43.60±8.85，P＞0.05），差異無統(tǒng)計學(xué)意義。術(shù)前、術(shù)后3月子宮內(nèi)膜分泌正常者與分泌不足者分別相比較（10％VS75%，90%VS25%, P＜0.01)，差異有統(tǒng)計學(xué)意義。術(shù)前、術(shù)后3月子宮內(nèi)膜容受性相關(guān)因子的比較：ER的表達（腺上皮0.165±0.007VS0.232±0.037，P＜0.01；間質(zhì)0.085±0.020VS0.124±0.020，P＜0.01），PR的表達（腺上皮0.030±0.009VS0.079±0.018，P＜0.01；間質(zhì)0.037±0.013VS0.087±0.018，P＜0.01），LIF的表達（0.204±0.015VS0.236±0.027，P＜0.01），VEGF的表達（0.155±0.025VS0.295±0.023， P＜0.01），經(jīng)比較差異均有統(tǒng)計學(xué)意義。術(shù)后患者再次進行體外受精-胚胎移植，隨訪6個月著床率為33.3%，妊娠率為27.8%。 結(jié)論： 1、宮腔鏡子宮內(nèi)膜微創(chuàng)術(shù)通過促進子宮內(nèi)膜雌孕激素受體的表達，改善子宮內(nèi)膜對卵巢性激素反應(yīng)的敏感性，使子宮內(nèi)膜厚度增加，分泌反應(yīng)增強。 2、宮腔鏡子宮內(nèi)膜微創(chuàng)術(shù)可以增強LIF、VEGF的表達，，刺激螺旋微小血管增生，豐富子宮內(nèi)膜血流，使子宮內(nèi)膜向適宜胚胎粘附的狀態(tài)轉(zhuǎn)換。 3、宮腔鏡子宮內(nèi)膜微創(chuàng)術(shù)可以改善反復(fù)胚胎移植失敗患者的子宮內(nèi)膜容受性，對提高IVF胚胎植入率和臨床妊娠率有重要的臨床價值。
[Abstract]:Objective: to study the expression of endometrial reception-related factors before and after hysteroscopy. The effect of hysteroscopic minimally invasive endometrial surgery on endometrial receptivity was analyzed from the point of view of molecular biology, and the clinical value of hysteroscopic endometrial minimally invasive surgery on endometrial receptivity was discussed in order to improve the implantation rate and pregnancy rate of IVF embryos. This provides a new treatment for infertility patients who have failed in repeated embryo transfer. Methods: from November 2011 to September 2012, 20 infertile patients who had failed in IVF-ET cycle treatment for 3 consecutive times or more were selected from the Reproductive Center of the first affiliated Hospital of Guangxi Medical University. The serum estradiol and progesterone levels were measured during implantation window period. Endometrial morphology was observed under hysteroscopy, endometrial specimens were collected and endometrial minimally invasive procedures were performed. Hysteroscopic endometrial minimally invasive surgery was performed at the 1st and 2nd month after operation. The peripheral blood and endometrial specimens were collected at the third month after implantation. To compare the changes of serum sex hormones before and after operation. The secretion of endometrium was observed by HE staining and optical microscope. The expression of (SP) was detected by immunohistochemical staining of streptomyces biotinyl protein-peroxidase (SP). The patients underwent in vitro fertilization-embryo transfer and were followed up for 6 months to track their embryo implantation and pregnancy. The experimental data are expressed as mean standard deviation (x 鹵s) or rate (%) and processed by SPSS16.0 software package. T test was used for measuring data and chi-square test was used for counting data. The test level was bilateral and 偽 -0. 05. Results 20 cases of failed repeated embryo transfer were treated with hysteroscopic minimally invasive endometrial surgery. The levels of serum estradiol and progesterone were 574.70 鹵184.35VS618.91 鹵217.85 (P > 0.05) and 38.59 鹵8.85 鹵8.85 (P > 0.05) before and 3 months after operation, respectively. There was no significant difference in serum estradiol and progesterone levels. Before and 3 months after operation, there were significant differences between normal and deficient endometrium secretion (10 vs 7590 vs 90 vs VS2590, P < 0.01). The expression of ER (0.165 鹵0.007VS0.232 鹵0.037) in glandular epithelium and 0.085 鹵0.020VS0.124 鹵0.020 in stroma (P < 0.01) were compared before and 3 months after operation. The expression of PR in glandular epithelium was 0.030 鹵0.009VS0.079 鹵0.018 (P < 0.01). The expression of 0.037 鹵0.013VS0.087 鹵0.018 0.013VS0.087 in interstitial tissue (0.204 鹵0.015VS0.236 鹵0.027, P < 0. 01) was significantly higher than that in control group (0.155 鹵0.025VS0.295 鹵0. 023, P < 0. 01). The rate of implantation and pregnancy were 33. 3 and 27. 8 respectively. Conclusion: 1. Hysteroscopic endometrial minimally invasive surgery can improve the sensitivity of endometrium to ovarian hormone by promoting the expression of estrogen and progesterone receptor and increase the thickness of endometrium. Hysteroscopic endometrial minimally invasive surgery can enhance the expression of VEGF, stimulate spiral microvascular hyperplasia, and enrich endometrial blood flow. Transition of endometrium to a state suitable for embryo adhesion. 3. Hysteroscopic endometrial minimally invasive surgery can improve endometrial receptivity in patients with repeated embryo transfer failure. It has important clinical value to improve IVF embryo implantation rate and clinical pregnancy rate.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R713.4

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