發(fā)布時(shí)間：2018-12-11 22:48

【摘要】：目的:隨著人們生活水平的提高和國家社會的進(jìn)步,許多從前少見的疾病如高血壓、糖尿病發(fā)病率逐年升高,而生活環(huán)境的改變也導(dǎo)致了不孕不育患者的增多。雖然輔助生殖技術(shù)的出現(xiàn)滿足了部分患者的生育需求,但妊娠成功率仍然達(dá)不到理想的水平。在體外受精-凍融胚胎移植過程中,成功的因素除了優(yōu)秀的胚胎質(zhì)量,也取決于子宮內(nèi)膜容受性。目前已知胞飲突細(xì)胞于胚胎植入窗口期在內(nèi)膜上表達(dá),胞飲突被推測為一種子宮內(nèi)膜容受性的標(biāo)志物。我們實(shí)驗(yàn)組通過檢測植入窗口期胞飲突表達(dá)的情況以及分析胚胎移植后的妊娠結(jié)局,探索胞飲突是否可以作為子宮內(nèi)膜容受性的標(biāo)志,對胚胎移植后成功妊娠是否具有預(yù)后價(jià)值。方法:選擇在我院即將進(jìn)行FET-HRT周期的172名不孕婦女。其中46名婦女參與了第一部分研究,以在激素替代周期中給予孕酮補(bǔ)充后3至7天(以P+3、P+4天等表示)觀察胞飲突的每日變化。其余126例參與了另一部分研究以檢查胞飲突計(jì)數(shù)和激素替代周期冷凍胚胎移植的妊娠率的相關(guān)性。此研究使用掃描電子顯微鏡捕獲胞飲突圖像,然后使用圖像處理程序量化胞飲突計(jì)數(shù)和形態(tài)亞型,摸索胞飲突評估所需的最少視野數(shù),使用改進(jìn)的胞飲突評分方法進(jìn)行量化分析。結(jié)果:(1)分析顯示1個(gè)病例需要至少60個(gè)內(nèi)膜面視野來產(chǎn)生可重復(fù)的胞飲突評估結(jié)果。(2)總胞飲突數(shù)在P+6天達(dá)到峰值,然后略有下降。完全發(fā)育的胞飲突的每視野平均數(shù)目也在P+6天達(dá)到最大值。(3)胞飲突的表達(dá)情況在妊娠成功和妊娠失敗的受試者之間顯著不同。結(jié)論:我們提出的改進(jìn)的胞飲突復(fù)合評分系統(tǒng)對于子宮內(nèi)膜胞飲突的數(shù)量及形態(tài)的評估和對子宮內(nèi)膜容受性的判斷具有較大幫助,子宮內(nèi)膜胞飲突評估對胚胎移植后成功妊娠具有較高預(yù)后價(jià)值。
[Abstract]:Objective: with the improvement of people's living standard and the progress of national society, many diseases such as hypertension and diabetes are increasing year by year, and the change of living environment leads to the increase of infertile patients. Although the emergence of assisted reproductive technology to meet the reproductive needs of some patients, but the success rate of pregnancy is still not up to the ideal level. In vitro fertilization-freeze-thawing embryo transfer process, success factors, in addition to excellent embryo quality, but also depends on endometrial receptivity. At present, it is known that the proteasome cells express on the endometrium during the implantation window, and the process is supposed to be a biomarker of endometrial receptivity. In our experimental group, we examined the expression of cellular processes during window implantation and analyzed the outcome of pregnancy after embryo transfer to explore whether the process could be used as a sign of endometrial receptivity. It has prognostic value for successful pregnancy after embryo transfer. Methods: 172 infertile women undergoing FET-HRT cycle in our hospital were selected. Forty-six women participated in the first part of the study to observe the daily changes of cellular processes after progesterone supplementation was given 3 to 7 days later (expressed as P 3 / P 4 days). The remaining 126 cases participated in another part of the study to examine the correlation between the number of cell processes and the pregnancy rate of hormone replacement cycle frozen embryo transfer. In this study, scanning electron microscopy was used to capture the image of the process, and then the image processing program was used to quantify the number of counts and morphologic subtypes of the process, and to explore the minimum number of visual fields needed for the assessment of the process. The quantitative analysis was carried out by using the improved grading method of phlogistic process. Results: (1) Analysis showed that at least 60 endomembranous visual fields were needed in one case to produce repeatable evaluation results. (2) the total number of neuronal processes reached its peak at P6 days and then decreased slightly. The average number of fully developed processes per visual field also reached the maximum on P6 days. (3) the expression of proteasome was significantly different between the subjects who were pregnant successfully and failed during pregnancy. Conclusion: the improved compound grading system is helpful for the evaluation of the number and morphology of the process and the judgment of the receptivity of the endometrium. The evaluation of endometrial cell process has high prognostic value for successful pregnancy after embryo transfer.
【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】：2017
【分類號】：R714.8
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本文編號：2373364