补肾调周法对超排卵周期颗粒细胞CYP19A1 mRNA表达的影响

Effects of Reinforcing Kidney and Menstrual Cycle Regulation on the Expression of CYP19A1 mRNA in Granulocytes in Controlled Ovarian Hyperstimulation Cycle

目的:探讨补肾调周法对超体外受精与胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)控制性超排卵(controlled ovarian hyperstimulation,COH)周期中颗粒细胞CYP19A1 mRNA表达的影响。方法:将24例因输卵管因素不孕行IVFET的患者以随机数字表法分为治疗组(育泡组方联合COH治疗)和对照组(COH治疗)各12例。对比分析2组患者卵巢颗粒细胞CYP19A1 mRNA的相对表达量及其与IVF参数的相关性。结果:治疗组中2例患者未按规定用药而退出研究,对照组中1例患者降调后妊娠而取消周期。COH治疗后,2组患者肾虚证候积分的差异有统计学意义(P<0.05);2组患者重组人促卵泡激素(r FSH)使用时间、r FSH总用量、雌二醇/获卵数、MⅡ卵子数/获卵数及优质胚胎率的差异有统计学意义(P<0.05);治疗组患者卵巢颗粒细胞CYP19A1 mRNA相对表达量明显高于对照组,差异有统计学意义(P<0.05);CYP19A1 mRNA相对表达量与MⅡ卵子数/获卵数及雌二醇/获卵数呈正相关(P<0.05)。结论:在IVF-ET治疗周期,配合使用具有补肾益精作用的中药可明显改善患者所表现出的肾虚症状,减少r FSH用量,提高成熟卵子率及优质胚胎率。补肾益精类中药可提高颗粒细胞CYP19A1 mRNA的表达,改善颗粒细胞的分泌功能,这可能是补肾益精类中药改善IVF最终结果的机制之一。

OBJECTIVE： To explore the effect of reinforcing kidney and menstrual cycle regulation on CYP19A1 mRNA expression in granulocytes in controlled ovarian hyperstimulation（ COH） cycle in patients undergoing vitrofertiliazation embryo transfer（ IVF-ET）. METHODS： 24 patients with tubal problem-induced infertility undergoing IVFET treatment were randomly divided into two groups： study group（ ovarian follicle formula combined with controlled ovarian hyperstimulation） and control group（ controlled ovarian hyperstimulation）. The CYP19A1 mRNA level and its relationship with the IVF response parameters in the two groups were recorded and compared. RESULTS： Two cases in the study group were excluded from the study because of failure to take drug as indicated and one case in the control group had cycle withdrawal because of pregnancy after down-regulation（ shutting down of the pituitary-ovarian hormones）. Symptoms of kidney asthenia of the study group was significantly improved compared with control group after controlled ovarian hyperstimulation（ P〈0. 05）. The duration of using r FSH,total dose of r FSH,the level of E2 per ooctye,rate of M Ⅱ oocytes to retrieved oocytes and the rate of high quality embryos were significantly different between the groups（ P〈0. 05）. The level of CYP19A1 mRNA expression in study group was significantly higher than in the control group（ P〈0. 05）. CYP19A1 mRNA expression correlated positively with level of E2 per ooctye and therate of MⅡ oocytes to retrieved oocytes（ P〈0. 05）. CONCLUSIONS： Using Chinese herbs which have the effects of nourishing the kidney and strengthening the essence and western medicine can decrease the dosage of r FSH significantly and improve the kidney asthenia symptoms and the ratio of mature ooctyes during the IVF treatment.Chinese herbs with the effects of nourishing the kidney and strengthening the essence can also improve the secretory function of granule cell,the CYP19A1 mRNA expressing in granulosa cells. That maybe one of the mechanisms of this kind of Chinese herbs to improve the outcomes of IVF treatment.