六味地黄颗粒对肾阴虚高龄不孕患者IVF结局及卵巢颗粒细胞的影响

Effect of Liuwei Dihuang Granule on In Vitro Fertilization-Embryo Transfer Outcome and Ovarian Granulosa Cells in Patients with Infertility of Kidney Yin Deficiency

目的:观察六味地黄颗粒对肾阴虚不孕患者体外受精(IVF)结局及卵巢颗粒细胞PI3K、pAkt和FoxO3a的影响。方法:66例接受体外受精-胚胎移植(IVF-ET)治疗的高龄(≥35岁)肾阴虚不孕患者,随机分为治疗组和安慰剂组,每组33例。两组患者除接受相同的促排卵方案治疗外,治疗组与安慰剂组分别在IVF前接受六味地黄颗粒或安慰剂治疗3个月经周期,评估肾阴虚证候积分的变化,并观察获卵数、2PN受精率、成胚率和临床妊娠率。在取卵日收集卵泡液,提取颗粒细胞,观察颗粒细胞凋亡率,并通过qRT-PCR和Western Blot技术检测颗粒细胞中的PI3K、pAkt和FoxO3a的mRNA及蛋白表达水平。结果:治疗组肾阴虚证候评分从(14.82±1.16)分下降至(7.87±1.32)分,而安慰剂组变化不明显,两组评分比较差异有统计学意义(P<0.05)。治疗组患者卵巢颗粒细胞凋亡率与安慰剂组相比,明显降低(P<0.05)。治疗组的成胚率和临床妊娠率(57.35%和46.63%)均优于安慰剂组(48.48%和24.24%),差异有统计学意义(P<0.05)。两组之间的获卵数没有差异。与安慰剂组相比,2PN受精率变化没有统计学意义。与安慰剂组相比,治疗组PI3K和pAkt的mRNA和蛋白表达水平明显升高,FoxO3a表达下降。结论:对于接受IVF-ET的高龄肾阴虚证不孕患者,补肾中药可以缓解临床肾阴虚症状,提高成胚率及临床妊娠率,其机制可能与通过调节颗粒细胞中PI3K、pAkt和FoxO3a的表达来改善卵母细胞发育微环境、抑制颗粒细胞凋亡及提高卵母细胞质量有关。

Objective:To observe the effect of Liuwei Dihuang Granule on in vitro fertilization-embryo transfer(IVF-ET) outcome and on PI3K,pAK and FoxO3a in ovarian granulosa cells in patients with infertility of kidney yin deficiency. Methods:Sixty-six elderly patients(≥ 30 years old) with infertility of kidney yin deficiency treated with IVF-ET were randomly divided into treatment group and control group,33 patients in each group. Both groups were treated with ovulation induction. The treatment group was given Liuwei Dihuang Granule while the control group was given placebo for 3 menstrual cycles before IVF-ET. Traditional Chinese medicine(TCM) syndrome score of kidney yin deficiency was evaluated.The number of oocytes obtained,2 pronuclear(2PN) fertilization rate,available embryo rate,and clinical pregnancy rate were also detected. Follicular fluid was collected on the day of oocyte retrieval,granulosa cells were extracted,and the apoptosis rate of granulosa cells was observed. The mRNA and protein expression levels of PI3K,pAkt and FoxO3a in granulosa cells were detected by qRT-PCR and Western Blot. Results:TCM syndrome score of kidney yin deficiency in the treatment group decreased from(14.82±1.16) to(7.87±1.32),while the change in the control group was not obvious,with statistical difference between the two groups(P<0.05). The apoptotic rate of ovarian granulosa cells in the treatment group was significantly lower than that in the control group(P<0.05). The available embryo rate and clinical pregnancy rate of the treatment group(57.35% and 48.48%,respectively) were higher than those in the control group(46.63% and24.24%,respectively),with statistical difference(P<0.05). There was no difference in the number of oocytes obtained and change in 2PN fertilization rate between the two groups. Compared with the control group,the m RNA and protein expression levels of PI3K and pAkt were significantly increased in the treatment group,and the expression of FoxO3a decreased. Conclusion:For patients with infertility of kidney yin deficiency treated with IVF-ET,medicinals for tonifying kidney can relieve the symptoms of kidney yin deficiency,increase the rate of embryo formation and clinical pregnancy rate. The mechanism may be related to the regulation of PI3K,pAkt and FoxO3a in granulosa cells,and the improvement of oocyte development microenvironment,inhibition of granulosa cell apoptosis and improvement of oocyte quality.