控制性超促排卵对不育妇女肾素-血管紧张素-醛固酮系统的影响

The influence of controlled ovarian hyperstimulation on rennin-angiotensin-aldosterone system of the infertile women

目的观测控制性超促排卵(COH)技术对不育妇女肾素-血管紧张素-醛固酮系统(RAAS)的影响,探讨COH过程中RAAS的变化规律。方法48例接受体外受精-胚胎移植(IVF-ET)妇女,以自身自然周期作为对照,比较自然周期与促排卵周期在不同时点血清肾素活性、血管紧张素Ⅱ、醛固酮水平的变化。结果COH周期中血清雌二醇(E_2)和孕激素(P)水平在人绒毛膜促性腺激素(hCG)注射日明显升高,且显著高于自然周期(P<0.05);RAAS不同成分于自然周期各时点检测值差异无显著性(P>0.05);在hCG注射日后COH周期RAAS各成分各时点检测值均明显升高,且显著高于自然周期(P<0.05);未妊娠妇女间隔一个月后月经来潮日,血清RAAS各成分水平恢复至自然周期月经期水平;RAAS成分的变化与E_2水平均呈正相关(P<0.01),与P水平均无相关性(P>0.1);经二元回归统计显示RAAS成分与E_2+P呈正相关(P<0.01),且与E_2+P的相关系数较单纯E_2高。结论IVF-ET中,使用的COH技术普遍导致RAAS成分升高,且与E_2及E_2+P水平的变化相关,提示RAAS的浓度变化还依赖于性激素(尤其为E_2)水平的变化。

Objective： To observe the changes of rennin-angiotensin-aldosterone system （RAAS） in the infertile women during controlled ovarian hyperstimulation （COH）. Methods： Forty-eight infertility patients who underwent in vitro fertilization-embryo transfer （IVF-ET） cycles were studied. The serum levels of rennin, angiotensin II and aldosterone in these patients before COH （natural cycle） and during COH cycle were examined at different time points and compared. Results： In COH cycle, the serum estrogen （E2） and progesterone （P） levels were elevated on hCG injection day, significantly higher than those in the natural cycle （P〈0.05）. The levels of different RAAS components increased significantly after hCG injection when compared with those in the natural cycle （P〈0.05）. The elevated levels of RAAS components returned to the natural levels at the next menstruation in those non-pregnant women. The levels of RAAS components were positively correlated with serum E2 levels （P〈0.01）, but not with the P levels （P〉0.1）. The binary regression statistics showed that the levels of RAAS components were positively correlated with E2 ＋ P （P〈0.01）, and the coefficient of E2 ＋ P was higher than that of E2 alone. Conclusions： In IVF-ET cycles, the use of COH techniques generally leads to the elevated rennin, angiotensin and aldosterone levels, and the elevated levels of these RAAS components are associated with the changes of sex hormone levels.