本文選題：卵巢過(guò)度刺激綜合征 + 解瘀滯中藥��； 參考：《南京中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的：1.臨床觀察從“瘀滯”論入手治療OHSS患者的有效性；2.探討解“瘀滯”中藥對(duì)OHSS大鼠模型血管通透障礙的作用及機(jī)制；3.篩選有較高特異性和靈敏度的OHSS血清診斷標(biāo)志物。方法：1.選擇68個(gè)符合標(biāo)準(zhǔn)的受試者作為研究對(duì)象,分為對(duì)照組、中藥組、西藥組,COS治療后,未患OHSS的受試者設(shè)為對(duì)照組,發(fā)生OHSS的受試者隨機(jī)分為中藥組、西藥組,分別給予中藥和西藥治療。中藥組給予解瘀滯中藥治療,西藥組則給予阿司匹林治療,治療時(shí)間一周。檢測(cè)周期妊娠結(jié)局、排卵率、周期放棄率、卵泡增大的數(shù)量以及各組受試者血清中E2、VEGF、IL-6水平。2.按照Ujioka報(bào)道的方法構(gòu)建OHSS大鼠病理模型。將66只大鼠隨機(jī)分為正常對(duì)照組、OHSS組、西藥組、中藥組低、中、高劑量組。按照人與動(dòng)物體表面積換算給藥劑量給予大鼠藥物,檢測(cè)大鼠血清、腹水NO、VEGF、IL-6等的水平,對(duì)大鼠體重和卵巢重量進(jìn)行檢測(cè),比較各組間的差異。3.對(duì)OHSS患者和非OHSS患者的血清進(jìn)行質(zhì)譜分析差異蛋白,對(duì)差異大且有涉及OHSS生物過(guò)程的蛋白進(jìn)一步通過(guò)蛋白免疫印跡和酶聯(lián)免疫吸附分析,篩選特異性強(qiáng)、準(zhǔn)確度高的血清診斷標(biāo)志物。結(jié)果：1.中藥組在周期放棄率和增大卵泡數(shù)都顯著低于西藥組。2.血清E2水平、血管內(nèi)皮生長(zhǎng)因子(VEGF)、腹圍、盆腔積液等臨床指標(biāo),中藥組都顯著低于西藥組。3. OHSS組大鼠血清E2、P、VEGF、IL-6水平顯著升高,腹腔和卵巢EB水平較其余各組都顯著升高。4.中藥中、高劑量組大鼠體重、卵巢重量、腹水量、EB、NO水平、VEGF、IL-6水平都顯著低于西藥組。5.質(zhì)譜結(jié)果篩選到57個(gè)表達(dá)差異蛋白,與對(duì)照組相比,OHSS組有29種蛋白表達(dá)上調(diào),而28種蛋白表達(dá)明顯下調(diào)。6.蛋白免疫印跡和酶聯(lián)免疫吸附試驗(yàn)驗(yàn)證得到三個(gè)高差異表達(dá)蛋白：結(jié)合珠蛋白、纖維蛋白原和脂蛋白脂酶,ROC曲線分析中,三種蛋白對(duì)OHSS預(yù)測(cè)都有較高敏感性和特異性。結(jié)論：1.從“瘀滯”論入手治療OHSS患者,能顯著降低患者的多項(xiàng)炎癥因子水平,并且提高排卵率、降低周期放棄率,而不影響臨床妊娠率,取得較好的療效。2.動(dòng)物實(shí)驗(yàn)證實(shí)解瘀滯中藥能夠明顯降低OHSS大鼠血清中相關(guān)炎癥因子水平,且對(duì)大鼠卵巢重量、腹水有明顯的改善作用。3.由質(zhì)譜篩選和進(jìn)一步驗(yàn)證得到結(jié)合珠蛋白、纖維蛋白原、脂蛋白脂肪酶可以作為血清診斷預(yù)測(cè)OHSS發(fā)生的生物標(biāo)志物,且具有較高特異性和準(zhǔn)確性。
[Abstract]:Purpose 1. Clinical observation on the effectiveness of treating OHSS patients from the view of "stagnation". To investigate the effect and mechanism of traditional Chinese medicine (TCM) on vascular permeability in OHSS rats. Screening OHSS serum diagnostic markers with high specificity and sensitivity. Method 1: 1. Sixty-eight subjects who met the criteria were divided into three groups: control group, traditional Chinese medicine group and western medicine group. The subjects who did not suffer from OHSS were randomly divided into Chinese medicine group and western medicine group. Chinese medicine and western medicine were given respectively. The traditional Chinese medicine group was treated with traditional Chinese medicine and the western medicine group with aspirin for one week. The pregnancy outcome, ovulation rate, cycle abandonment rate, the number of follicular enlargement and the level of E2VEGFN IL-6 in the serum of each group were measured. The pathological model of OHSS rats was established according to the method reported by Ujioka. 66 rats were randomly divided into three groups: normal control group, western medicine group, low, middle and high dosage groups. According to the conversion of human and animal body surface area, the drug was given to rats. The levels of serum and ascites VEGF IL-6 were detected. The body weight and ovarian weight of rats were measured, and the difference between each group was compared. The differential proteins in serum of OHSS patients and non-OHSS patients were analyzed by mass spectrometry, and the proteins involved in the biological process of OHSS were further screened by Western blot and enzyme-linked immunosorbent assay (Elisa). Serum diagnostic markers with high accuracy. The result is 1: 1. The rate of cycle abandonment and the number of follicles increased in the Chinese medicine group were significantly lower than those in the western medicine group. Serum E2 level, vascular endothelial growth factor (VEGF) VEGF, abdominal circumference, pelvic effusion and other clinical indexes were significantly lower in the Chinese medicine group than in the western medicine group. In OHSS group, the serum level of E _ 2P _ (2) P _ (VEGF) IL-6 was significantly increased, and the EB level in abdominal cavity and ovary was significantly higher than that in other groups. In Chinese medicine, the levels of body weight, ovarian weight and ascites volume of EBNO in high dose group were significantly lower than those in western medicine group (P < 0.05). 57 differentially expressed proteins were screened by mass spectrometry. 29 proteins were up-regulated in OHSS group and 28 proteins were down-regulated in OHSS group. Western blot and enzyme-linked immunosorbent assay (Elisa) showed that three highly differentially expressed proteins were highly sensitive and specific to OHSS prediction: globin, fibrinogen and lipoprotein lipase. Conclusion 1. Starting with the theory of "stagnation", the treatment of OHSS patients can significantly reduce the level of multiple inflammatory factors, and increase ovulation rate, reduce cycle abandonment rate, without affecting the clinical pregnancy rate, and obtain a better curative effect. 2. Animal experiments have proved that traditional Chinese medicine can significantly reduce the level of serum inflammatory factors in OHSS rats, and can significantly improve the weight of ovary and ascites in rats. 3. The binding globin, fibrinogen and lipoprotein lipase can be used as biomarkers for the diagnosis and prediction of OHSS by mass spectrometry.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R271.9

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張亞杰;OHSS與腎素-血管緊張素系統(tǒng)[J];國(guó)外醫(yī)學(xué).婦產(chǎn)科學(xué)分冊(cè);2003年04期

2 童曉嵋 ,張松英;血管內(nèi)皮生長(zhǎng)因子及受體的表達(dá)與OHSS[J];國(guó)外醫(yī)學(xué)(計(jì)劃生育分冊(cè));2005年02期

3 王芳;;可溶性血管內(nèi)皮生長(zhǎng)因子受體-1水平可預(yù)測(cè)卵巢過(guò)度刺激綜合征的發(fā)生[J];國(guó)外醫(yī)學(xué)(計(jì)劃生育/生殖健康分冊(cè));2007年03期

4 劉群;;卵巢過(guò)度刺激綜合征(OHSS)的治療和護(hù)理[J];湖南師范大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2008年02期

5 陶朝慧;范強(qiáng)芳;;重度OHSS 2例臨床分析[J];中國(guó)實(shí)用醫(yī)藥;2010年01期

6 EnskogA,高麗;卵巢過(guò)度刺激綜合征(OHSS)的臨床及實(shí)驗(yàn)參數(shù)的前瞻性研究[J];實(shí)用婦產(chǎn)科雜志;1999年06期

7 趙亞瓊;金銳;王瑩;楊芳;;全胚冷凍在預(yù)防OHSS中的價(jià)值探討[J];寧夏醫(yī)學(xué)雜志;2013年09期

8 陸英華,何成章,呂蓓,史懷,高世平;卵巢過(guò)度刺激綜合征相關(guān)因素探討[J];南京醫(yī)科大學(xué)學(xué)報(bào)(自然科學(xué)版);2004年03期

9 戚磊;劉軍;;超聲在卵巢過(guò)度刺激綜合征診斷和治療中的應(yīng)用價(jià)值[J];中國(guó)現(xiàn)代醫(yī)生;2008年10期

10 束澤寶;;卵巢過(guò)度刺激綜合征26例的護(hù)理[J];中國(guó)誤診學(xué)雜志;2009年20期

相關(guān)會(huì)議論文 前10條

1 毛舜英;;OHSS——卵巢過(guò)度刺激綜合癥之防治[A];中華醫(yī)學(xué)會(huì)第八次全國(guó)計(jì)劃生育學(xué)術(shù)會(huì)議論文匯編[C];2012年

2 任春娥;;中重度OHSS的臨床表現(xiàn)與治療[A];山東省第六次生殖醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2013年

3 程丹;徐望明;楊菁;;細(xì)胞因子與OHSS發(fā)病的關(guān)系[A];中南六省性學(xué)會(huì)第一次學(xué)術(shù)年會(huì)暨湖北省性學(xué)會(huì)第二屆第一次學(xué)術(shù)年會(huì)論文集[C];2003年

4 曹云霞;徐玉萍;胡晶晶;;再談重度OHSS的處理[A];中華醫(yī)學(xué)會(huì)第六次全國(guó)生殖醫(yī)學(xué)學(xué)術(shù)會(huì)議�？痆C];2012年

5 徐紅英;伍瓊芳;朱元;黃志輝;辛才林;;全胚冷凍預(yù)防卵巢過(guò)度刺激綜合征及護(hù)理對(duì)策[A];全國(guó)第七屆中西醫(yī)結(jié)合婦產(chǎn)科學(xué)術(shù)會(huì)議論文及摘要集[C];2007年

6 孫峗;;COH過(guò)程中OHSS預(yù)防策略[A];山東省第六次生殖醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2013年

7 陳士嶺;陳薪;葉德盛;何于夏;黎璞;牛靜;陶婷;許麗娟;陶婷;;對(duì)高危OHSS不孕患者應(yīng)用拮抗劑方案及兩次注射GnRHa誘導(dǎo)卵子最終成熟的初步研究[A];第七次全國(guó)婦科內(nèi)分泌學(xué)術(shù)會(huì)議論文匯編[C];2013年

8 柳青;談?dòng)?;卵巢過(guò)度刺激綜合征的中西醫(yī)防治進(jìn)展[A];第十次全國(guó)中醫(yī)婦科學(xué)術(shù)大會(huì)論文集[C];2010年

9 林敏;;中西醫(yī)結(jié)合治療卵巢過(guò)度刺激綜合征的初步體會(huì)[A];全國(guó)第六屆中西醫(yī)結(jié)合婦產(chǎn)科學(xué)術(shù)會(huì)議論文及摘要集[C];2002年

10 張松英;;卵巢過(guò)度刺激綜合征的研究進(jìn)展[A];2005年浙江省婦產(chǎn)科學(xué)暨計(jì)劃生育學(xué)術(shù)會(huì)議論文匯編[C];2005年

相關(guān)重要報(bào)紙文章 前1條

1 湖南省婦幼保健院主任醫(yī)師 徐漪舟;卵巢過(guò)度刺激綜合征[N];大眾衛(wèi)生報(bào);2004年

相關(guān)博士學(xué)位論文 前3條

1 烏蘭;卵巢過(guò)度刺激綜合征診斷標(biāo)志物的篩選及“瘀滯”論治療的臨床效應(yīng)評(píng)估[D];南京中醫(yī)藥大學(xué);2016年

2 徐鳳琴;強(qiáng)的松龍治療和預(yù)防卵巢過(guò)度刺激綜合征（OHSS）機(jī)理的研究[D];天津醫(yī)科大學(xué);2010年

3 MOHAMED ELPRINCE ADEL;預(yù)測(cè)和預(yù)防卵巢過(guò)度刺激癥以及低分子肝素在預(yù)防和治療卵巢過(guò)度刺激癥中的作用[D];浙江大學(xué);2013年

相關(guān)碩士學(xué)位論文 前10條

1 張曉玲;73例中重度卵巢過(guò)度剌激綜合征臨床病例分析[D];河北醫(yī)科大學(xué);2015年

2 韓琳;補(bǔ)腎健脾方對(duì)行IVF-ET肥胖型PCOS患者血清AMH與OHSS的影響[D];山東中醫(yī)藥大學(xué);2015年

3 支曉琴;養(yǎng)精種玉加味方對(duì)IVF-ET非肥胖型PCOS患者血清AMH與OHSS的影響[D];山東中醫(yī)藥大學(xué);2015年

4 成瀟s，

本文編號(hào)：1938600