本文選題：高齡 + 腎氣陰兩虛　； 參考：《山東中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:在體外受精-胚胎移植(IVF-ET)過程中,觀察補(bǔ)腎中藥二至天癸顆粒對腎氣陰兩虛高齡不孕患者卵細(xì)胞質(zhì)量的影響,并檢測卵泡液中視黃醇結(jié)合蛋白4(RBP-4)以及卵巢顆粒細(xì)胞膜聯(lián)蛋白A5(Annexin A5)表達(dá),從細(xì)胞凋亡角度探討補(bǔ)腎中藥改善腎氣陰兩虛型高齡不孕患者卵細(xì)胞質(zhì)量的可能作用機(jī)制。方法:1.選取中醫(yī)辯證屬腎氣陰兩虛型因輸卵管因素接受IVF-ET助孕的高齡不孕患者66例,按照隨機(jī)數(shù)字表法分為實(shí)驗(yàn)組33例(二至天癸顆粒聯(lián)合西藥),對照組33例(安慰劑聯(lián)合西藥)。兩組患者分別給予二至天癸顆粒和安慰劑預(yù)處理3個(gè)月經(jīng)周期。比較兩組患者腎氣陰兩虛癥候積分在治療前后的變化情況,對比促性腺激素(gonadotropin,Gn)的用量以及用藥天數(shù),記錄兩組患者注射絨促性素(HCG)日的血清孕酮(P)、促黃體素(LH)水平,計(jì)算比較單個(gè)卵泡雌激素水平,統(tǒng)計(jì)比較兩組患者的獲卵數(shù)、優(yōu)質(zhì)卵率、受精率、優(yōu)質(zhì)胚胎率和臨床受孕率。2.收集上述兩組患者取卵日的卵泡液,應(yīng)用酶聯(lián)免疫吸附法(Enzyme Linked Immunosorbent Assay,Elisa)測定卵泡液中RBP-4的水平。3.收集顆粒細(xì)胞,應(yīng)用蛋白免疫印跡(Western blot)技術(shù)測定Annexin A5的表達(dá)。結(jié)果:(1)實(shí)驗(yàn)組與對照組相比,其腎氣陰兩虛的癥候得到明顯的改善,差異有統(tǒng)計(jì)學(xué)意義(P0.05);(2)實(shí)驗(yàn)組患者Gn的用量以及天數(shù)少于對照組,孕酮(P)水平明顯低于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);(3)HCG日單個(gè)卵泡雌二醇(E2/卵泡數(shù))水平相比,實(shí)驗(yàn)組高于對照組,差異有統(tǒng)計(jì)學(xué)差異(P0.05);(4)與對照組相比,實(shí)驗(yàn)組的獲卵數(shù)、優(yōu)質(zhì)卵率、受精率、優(yōu)質(zhì)胚胎率均較高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);(5)臨床妊娠率方面,兩組相比無統(tǒng)計(jì)學(xué)意義(P=0.1860.05),但實(shí)驗(yàn)組的妊娠率有明顯升高的趨勢;(6)實(shí)驗(yàn)組與對照組相比,卵泡液中RBP-4及顆粒細(xì)胞Annexin A5的表達(dá)水平均增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.中藥二至天癸顆粒可明顯改善高齡不孕患者的腎氣陰兩虛狀態(tài),聯(lián)合Gn治療不孕癥可明顯減少Gn的用量,縮短用藥天數(shù),在提高優(yōu)質(zhì)卵率、優(yōu)質(zhì)胚胎率方面療效顯著。2.二至天癸顆�？赡苁峭ㄟ^上調(diào)卵泡液中RBP-4的含量,抑制顆粒細(xì)胞Annexin A5的凋亡來改善卵母細(xì)胞的成熟,從而提高卵細(xì)胞質(zhì)量,有效改善高齡腎氣陰兩虛不孕患者的IVF治療結(jié)局。
[Abstract]:Objective: to observe the effect of Erzhi Tiangui granule, a traditional Chinese medicine for tonifying the kidney, on the quality of oocyte in the elderly infertility patients with deficiency of kidney qi and yin during in vitro fertilization and embryo transfer. The expression of retinol binding protein 4 (RBP-4) and ovarian granular cell membrane binding protein (A5(Annexin A5) in follicular fluid was detected. From the point of view of cell apoptosis, the possible mechanism of improving the oocyte quality of senile infertility patients with deficiency of kidney qi and yin was discussed from the point of view of cell apoptosis. Method 1: 1. Sixty-six elderly infertile patients who received IVF-ET to help pregnancy due to the deficiency of kidney qi and yin in TCM were divided into experimental group (Erzhi Tiangui granule combined with western medicine) and control group (placebo combined with western medicine) according to random number table method. Two groups of patients were given 2-to-Tiangui granule and placebo pretreatment 3 menstrual cycle. To compare the changes of kidney qi and yin deficiency symptom score before and after treatment, to compare the dosage of gonadotropin (Gnn) and the days of administration of gonadotropin, and to record the serum progesterone, progesterone and luteinizing hormone (LH) levels of the two groups on the day of HCG injection. To calculate and compare the estrogen level of single follicle and compare the number of eggs, the rate of high quality eggs, the rate of fertilization, the rate of high quality embryo and the rate of clinical conception of the two groups. The follicular fluid of the above two groups was collected on the day of egg taking. The level of RBP-4 in the follicular fluid was measured by enzyme linked immunosorbent assay (enzyme-linked immunosorbent assay). Granulosa cells were collected and the expression of Annexin A 5 was detected by Western blotting. Results (1) compared with the control group, the symptoms of deficiency of kidney qi and yin were significantly improved in the experimental group (P 0.05) the dosage of Gn and the number of days in the experimental group were lower than those in the control group, and the level of progesterone was significantly lower than that in the control group. The level of estradiol E _ 2 / E _ 2 / follicle in the experimental group was higher than that in the control group, and the difference was statistically significant (P 0.05). Compared with the control group, the number of eggs obtained, the rate of good quality eggs, the rate of fertilization in the experimental group were higher than those in the control group. The pregnancy rate of the experimental group was significantly higher than that of the control group, but the pregnancy rate of the experimental group was higher than that of the control group, and there was no significant difference in the clinical pregnancy rate between the two groups. The expression of RBP-4 and Annexin A 5 in granulosa cells were increased in follicular fluid, and the difference was statistically significant (P 0.05). Conclusion 1. Erzhi Tiangui granule can obviously improve the state of deficiency of kidney qi and yin in elderly infertility patients. Combined with Gn treatment of infertility can obviously reduce the dosage of Gn, shorten the days of medication, and improve the rate of high quality eggs and high quality embryo rate. Erzhi Tiangui granule may improve the maturation of oocytes by upregulating the content of RBP-4 in follicular fluid and inhibiting the apoptosis of granulosa cells Annexin A5, thus improving the quality of oocytes and effectively improving the outcome of IVF treatment in elderly patients with deficiency of both qi and yin of kidney qi and yin.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R271.9

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