经皮穴位电刺激对IVF中POI患者卵母细胞质量及FSHR表达的影响

Effect of transcutaneous electric acupoint stimulation on oocyte quality and follicle-stimulating hormone receptor expression in patients undergoing in vitro fertilization with premature ovarian insufficiency

目的观察经皮穴位电刺激(TEAS)对体外受精-胚胎移植(IVF-ET)中早发性卵巢功能不全(POI)患者卵母细胞质量及卵泡刺激素受体(FSHR)表达的影响。方法选取2018年5～10月在南方医科大学附属深圳妇幼保健院生殖医学中心接受IVF治疗的POI妇女66例,采用随机数表法分为TEAS组和对照组,每组33例。TEAS组自促性腺激素(Gn)启动日至绒促性素(hCG)注射日给予电子针疗仪治疗,隔日1次,对照组自Gn启动日起给予安慰针治疗,治疗时间、疗程及穴位选择均与TEAS组相同。比较两组患者的获卵数、受精率、优质胚胎率及临床妊娠率的差异,采用Western blot法检测取卵日颗粒细胞FSHR蛋白的表达。结果 TEAS组患者的临床妊娠率为51.52%,明显高于对照组的27.28%,差异有统计学意义(P<0.05);治疗后,TEAS组和对照组的获卵数分别为(3.33±1.05)个、(2.73±1.21)个,优质胚胎率分别为54.29%和34.15%,颗粒细胞FSHR蛋白表达分别为0.75±0.17、0.55±0.12,两组上述指标比较差异均有统计学意义(P<0.05);TEAS组和对照组的受精率分别为75.79%和73.23%,两组比较差异无统计学意义(P>0.05)。结论 TEAS疗法可能通过调控卵巢颗粒细胞FSHR的表达,促进卵母细胞发育,提高卵母细胞质量,改善IVF中POI患者的妊娠结局。

Objective To observe the effects of transcutaneous electric acupoint stimulation (TEAS) on oocyte quality and follicle-stimulating hormone receptor (FSHR) expression of premature ovarian insufficiency (POI) patients undergoing in vitro fertilization-embryo transfer (IVF-ET).Methods A total of 66 POI women receiving IVF treatment at Center for Reproductive Health of Shenzhen Maternity and Child Healthcare Hospital Affiliated to Southern Medical University from May 2018 to October 2018 were selected and randomly divided into the TEAS group and the control group,with 33 cases in each group.The patients in the TEAS group were treated by electronic acupuncture once every other day from the day of gonadotropin (Gn) injection to the day of hCG injection.The patients in the control group were treated with placebo as from the day of Gn injection to the day of hCG injection.The time,course of treatment and acupoint selection were the same as those in the TEAS group.The number of oocytes retrieved,rate of fertilization, high-quality embryos,and the clinical pregnancy between the two groups were observed and compared,and the expression of FSHR protein in the granulosa cells was detected by Western blot.Results The clinical pregnancy rate of the TEAS group was 51.52%,which was significantly higher 27.28% of the control group (P<0.05).After the treatment,the number of oocytes retrieved,rate of high-quality embryos,FSHR protein expression in granulosa cells of the TEAS group were 3.33±1.05,54.29%,0.75±0.17,versus 2.73±1.21,34.15%,0.55±0.12 of the control group (all P<0.05).The fertilization rates in the TEAS group and control group were 75.79% and 73.23%,respectively.There was no significant difference in the rate of fertilization between the two groups (P>0.05).Conclusion TEAS can regulate the expression of FSHR in granulosa cells,promote oocyte development,improve oocyte quality,and then improve the pregnancy outcome in IVF patients with POI.