促性腺激素释放激素激动剂对子宫内膜胞饮突的影响研究

Study on the changes of gonadotropin releasing hormone agonist in pinopodes

目的 研究黄体期使用促性腺激素释放激素激动剂（GnRH-a）后子宫内膜胞饮突的变化情况.方法 选取2016年1月至10月在苏州大学附属第一医院因男方因素拟行辅助生殖技术治疗的原发性不孕症妇女40例作为观察对象,按入组的先后顺序分为观察组和对照组（各20例）,在自然周期确定排卵后的第7天分别予观察组GnRH-a 0.1 mg和对照组安慰剂（0.9％生理盐水2ml）皮下注射,3d后复诊.测定用药前后血清雌、孕激素的水平,应用蛋白印迹法检测子宫内膜组织中ER 、PR的表达水平,并用扫描电镜观察胞饮突的变化情况.结果 （1）观察组和对照组妇女在用药前后同期的雌二醇水平无差异（P均＞0.05）;观察组用药后的孕酮水平[（66.8±14.9） nmol/L]显著高于其用药前（P＜0.05）,也明显高于同期的对照组（P＜0.05）.（2）观察组在用药前后ER蛋白的表达水平无差异（P＞0.05）;观察组用药后PR蛋白的表达水平较用药前显著下降（P＜0.05）,也显著低于同期的对照组（P＜0.05）.（3）观察组用药后胞饮突的表达量明显高于用药前[表达量丰富的比例分别为65％（13/20）、25％（5/20）,P＜0.05],且发育也更成熟[发育成熟的比例分别为75％（15/20）、35％（7/20）,P＜0.05];与同期对照组相比,胞饮突的表达量及其发育成熟的比例均显著增加（P＜0.05）.结论 黄体支持中的GnRH-a可能是通过黄体发挥作用的,其可通过促进孕激素的分泌,降调PR的表达,促进子宫内膜胞饮突的发育,从而改善子宫内膜的容受性.

Objective To study the changes of gonadotropin releasing hormone agonist （GnRH-a） in pinopodes during luteal phase and to explore the possible mechanism of GnRH-a in luteal phase support of assisted reproductive technology （ART）.Methods Totally 40 primary infertility women who were treated with ART due to male factors were enrolled,according to the order of the group they were randomly divided into experimental group and control group.On the 7th day after ovulation,the experimental group received a subcutaneous injection of 0.1 mg of GnRH-a,while the control group received a subcutaneous injection of placebo only （0.9% salinc 2 ml）,3 days later they came to the clinic again.Serum estradiol and progesterone levels were measured before and after treatment in each group.Pinopodes were collected for electron microscopic examination.Levels of ER and PR were detected by western blot.Results （1） There was no significant difference between the experimental group and the control group in the estrogen level before and after the treatment （all P〉0.05）.The level of progesterone in the experimental group after treatment [（66.8± 14.9） nmol/L] was significantly higher than that before treatment（P〈0.05）;also significantly higher than the same period of the control group （P〈0.05）.（2） There was no significant difference in the expression of ER protein in the experimental group before and after treatment （P〉0.05）.The expression of PR in the experimental group after treatment was significantly lower than that before treatment （P〈0.05）;also lower than the same period of the control group （P〈0.05）.（3） Expression amount of pinopodes in the experimental group after treatment was significantly higher than that before treatment [65% （13/20） versus 25% （5/20）,P〈 0.05],and the development trend was more mature [the percentage of maturation：75% （15/20） versus 35% （7/ 20）,P〈0.05].Expression amount of pinopodes after treatment and the percentage of maturation in the experimental group were significantly higher than those in the same period of control group （P〈0.05）.Conclusion GnRH-a in luteal phase support may play a role through the corpus luteum,which may promote the secretion of progesterone,downregulation of PR expression,promote the growth of pinopodes,and improve the endometrial receptivity.