二至天癸颗粒对体外受精-胚胎移植患者卵泡液代谢组学及Ca^(2+)浓度的影响

Effect of Er'zhi Tiangui Granule on Metabonomics and Level of Ca^(2+)in Follicle Fluid in Patients after in vitro Fertilization and Embryo Transfer

目的从人卵泡液代谢组学及Ca^(2+)浓度,探讨二至天癸颗粒提高卵细胞质量的机制。探讨体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)周期人卵泡液代谢组学及钙离子(Ca^(2+))浓度、胆碱脂酶(ChE)、肌酐(Cr)对卵细胞质量及妊娠结局的影响。方法57例IVF-ET患者随机分为试验组(二至天癸颗粒加IVF-ET常规用药组,27例)和对照组(六味地黄颗粒合IVF-ET常规用药组,30例)。观察患者取卵日肾阴虚证候较垂体降调节后的改善情况,比较两组患者卵泡液Ca^(2+)浓度、胆碱脂酶、肌酐的差异及两组卵泡液代谢组学的变化,取卵数、受精率、卵裂率、优质胚胎率和妊娠率的差异。结果试验组治疗后肾阴虚证候积分为8.30±1.46,受精率0.82±0.09,卵裂率0.97±0.07,优质胚胎率0.51±0.18,对照组分别为9.16±1.15,0.74±0.18,0.91±0.10,0.41±0.09,试验组优于对照组(P<0.05)。主成分分析法分析两组卵泡液代谢组学,试验组主要分布在Ⅰ区;对照组主要分布在Ⅱ区。两组卵泡液代谢组学有明显差异。妊娠组卵泡液主要分布在Ⅰ区。试验组Ca^(2+)浓度显著高于对照组(P<0.05)。ChE、Cr高于对照组,但差异无统计学意义。结论在调节卵泡液代谢组学和Ca^(2+)浓度,提高卵细胞、胚胎质量,提高IVF-ET妊娠率方面,二至天癸颗粒优于六味地黄颗粒。

Objective To explore the mechanism of action of Er＇zhi Tiangui Granule （ETG） in improving quality of oocytes by observing metabonomics and level of calcium ion in follicle fluid, and to investigate the impacts of calcium ion, cholinesterase （ChE） and creatinine （CCr） levels in human follicle fluid on the quality of oocytes and outcome of pregnancy in patients after in vitro fertilization and embryo transfer （IVF-ET）. Methods Fifty-seven patients after IVF-ET were randomly assigned to two groups： the trial group （27 patients） and the control group （30 patients）, both were treated with conventional Western medical treatment, but ETG and Liuwei Dihuang Granule （LDG） was given respectively to the two groups additionally. Changes of Shen-asthenia syndrome, amount of oocyte obtained, fertilization rate, cleavage rate, high-quality embryo rate and pregnancy rate, levels of calcium ion, ChE and Cr in follicle fluid, and metabonomics in the two groups were observed and compared. Results After treatment, scores of Shen-asthenia syndrome 8.30 ± 1.46, fertilization rate 0.82 ± 0.09, cleavage rate 0.97 ±0.07 and high-quality embryos rate 0.51 ±0. 18 in the trial group were all better than those in the control group（9.16 ±1. 15, 0.74±0.18, 0.91 ±0. 10, 0.41 ±0.09, respectively, P〈0.05）; metabonomics principal component analysis showed that in the trial group, the principal component in follicle fluid distributed mainly in the section Ⅰ, and that in the control group distributed mainly in the section Ⅱ, showing significant difference between the two groups; while in most pregnant patients, it distributed in the section Ⅰ. The Ca2＋ concentration in the trial group was significantly higher than that in the control group （P 〈0.05）. Levels of ChE and Cr in the trial group were higher than those in the control group, but the difference between them was insignificant. Conclusion ETG is better than LDG in regulating metabonomics, Ca2＋ concentration, improving the quality of oocyte and embryo, and increasing pregnant rate in patients after IVF-ET.