滋肾填精法对肾阴虚型IVF-ET患者子宫内膜Hox 10 mRNA表达的影响

The Effects of Kidney-nourishing Essence-replenishing Method on the Expressions of Endometrial Hox 10 mRNA in IVF-ET Patients of Kidney Yin Deficiency Pattern

目的:观察滋肾填精中药对肾阴虚型体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)患者子宫内膜同源框基因10(Hox 10)mRNA表达的影响,从基因层面探讨滋肾填精法对子宫内膜容受性的作用机理。方法:收集120例进入IVF-ET周期的不孕症患者,其中80例为肾阴虚型患者,随机分为观察组40例和对照组40例,另外40例单纯因输卵管因素者为空白组。3组患者均采用常规长方案进行超促排卵治疗,观察组在此基础上于降调节前1周期的月经第3-21天、降调节当月月经第3-14天及降调节后月经第3天服用二至天癸颗粒至取卵日。于降调节当天(监测排卵后第7天)采用RT-PCR法检测注射人绒毛膜促性腺性激素(human chorionic gonadotropin,HCG)日3组患者子宫内膜中Hox 10 mRNA的表达;比较观察组、对照组患者中医证候积分变化情况,评定3组患者注射HCG日子宫内膜厚度及分型、子宫内膜容积、子宫动脉搏动指数(pulsatility index,PI)和阻力指数(resistance index,RI)、血清激素水平及临床妊娠率等。结果:1)观察组肾阴虚证候积分低于对照组(P<0.05),肾阴虚症状改善。2)HCG日子宫内膜厚度、容积观察组高于对照组(P<0.05),与空白组比较差异无统计学意义(P>0.05),对照组低于空白组(P<0.05)。3)子宫内膜分型中A型+B型比例观察组高于对照组(P<0.01),略高于空白组,但差异不明显(P>0.05),对照组低于空白组(P<0.05)。4)观察组HCG日PI和RI均低于对照组(P<0.05),与空白组相比PI无明显差异,与对照组相比空白组PI和RI均降低(P<0.05)。5)3组患者HCG日血清雌二醇(estradiol,E2)、血清黄体生成素(luteinizing hormone,LH)及孕酮(progesterone,P)相比差异无统计学意义(P>0.05)。6)临床妊娠率观察组高于对照组(P<0.05),与空白组比较差异无统计学意义(P>0.05),对照组低于空白组(P<0.05)。7)3组患者HCG日子宫内膜中Hox 10mRNA均有表达,空白组表达最强,与观察组比较差异无统计学意义(P>0.05);对照组表达最弱,与观察组及空白组比较差异有统计学意义(P<0.05)。结论:滋肾填精法可有效提高子宫内膜容受性,提升不孕患者临床妊娠率,其机理可能与增强子宫内膜中Hox 10 mRNA表达有关。

Objective: To explore the effects of kidney-nourishing essence-replenishing herbs on the expressions of endometrial Hox 10 mRNA of the patients of kidney Yin deficiency pattern who accepted IVF-ET and investigate the mechanism of the method acting on endometrial receptivity from gene level. Methods: All 120 patients who entered in IVF-ET cycle were collected, among them, eighty patients were of kidney yin deficiency pattern, and they were allocated to the observation group and the control group randomly, 40 cases each group;another 40 patients only induced by fullopian tube factor were chosen as the blank group. The patients in three groups adopted conventional long program to perform superovulation therapy, the observation group took Erzhi Tiangui granules from 3 rd to 21 st day of menstrual cycle before down-regulation, from 3 rd to 14 th day of down-regulation menstrual cycle and the 3 rd day of menstrual cycle after down-regulation. RT-PCR method was used at the day of down-regulation to detect the expressions of endometrial Hox 10 mRNA of the patients in three groups at HCG day;to compare TCM syndrome integrals between the observation group and the control group, to evaluate endometrial thickness and patterns, endometrial receptivity, uterine artery PI, RI, the levels of serum hormone and clinical pregnancy rate in three groups. Results: 1) the observation group was lower than the control group in the integrals of kidney Yin deficiency pattern(P<0.05), and the symptoms of kidney Yin deficiency improved. 2)the observation group was higher than the control group in endometrial thickness and receptivity at HCG day(P <0.05), the difference had no statistical meaning compared with the blank group(P>0.05), the control group was lower than the blank group(P<0.05). 3)the proportion of A type and B type of endometrial types of the observation group were higher than these of the control group(P<0.05), slightly higher than these of the blank group, while the difference was not obvious(P>0.05), the control group was lower than the blank group(P<0.05). 4) the observation group was lower than the control group in PI and RI at HCG day(P <0.05), compared with the blank group, PI showed no significant difference, when the blank group was compared with the control group, PI and RI reduced(P<0.05).5)the difference had no statistical meaning in E2, LH and P at HCG day between three groups(P>0.05). 6)clinical pregnancy rate of the observation group was higher than that of the control group(P<0.05), the difference had no statistical meaning when it was compared with that of the blank group(P>0.05);the control group was lower than the blank group(P<0.05). 7)Hox 10 mRNA expressed in endometria at HCG day in three groups, the expressions in the blank group the strongest, the difference had no statistical meaning compared with these of the observation group(P >0.05);the expressions in the control group the weakest, the difference showed statistical meaning when the control group was compared with the observation group and the blank group(P<0.05). Conclusion: Kidney-nourishing essence-replenishing method could effectively raise endometrial receptivity and lift clinical pregnancy rate of the patients, and its mechanism might be related to enhancing the expressions of endometrial Hox 10 mRNA.