GDF-9、Ghrelin的表达与控制性排卵多囊卵巢综合征患者IVF-ET治疗结局的关系

Relationship between the expression of GDF-9 and Ghrelin and the outcome of IVF-ET in patients with controlled ovulation polycystic ovary syndrome

目的探讨卵巢颗粒细胞生长分化因子-9(GDF-9)、血清生长激素释放肽(Ghrelin)表达与控制性排卵多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)治疗结局的关系。方法回顾性选取2018年1月至2019年3月在上海交通大学附属第一人民医院接受IVF-ET助孕的PCOS患者72例(观察组),同时选取因输卵管因素不孕行IVF-ET助孕的女性70例(对照组)。检测两组卵巢颗粒细胞GDF-9 mRNA、血清Ghrelin表达,同时观察IVF-ET结局。分析取卵日GDF-9、Ghrelin表达水平与IVF-ET结局的相关性。根据观察组结局分为临床妊娠组和未妊娠组,比较临床妊娠组和未妊娠组患者取卵日GDF-9、Ghrelin表达水平,分析影响临床妊娠的单因素、多因素因素。结果观察组取卵日卵巢颗粒细胞GDF-9 mRNA相对表达量和血清Ghrelin分别为1.02±0.22和(733.54±170.26)pg/mL,均明显低于对照组[1.38±0.18、(1035.80±302.54)pg/mL],差异均有统计学意义(P<0.05)。观察组获卵率为81.34%,明显低于对照组(87.54%),差异有统计学意义(P<0.05)。观察组和对照组卵子成熟率、正常受精率、优质胚胎数和临床妊娠率比较差异无统计学意义(P>0.05)。取卵日卵巢颗粒细胞GDF-9 mRNA相对表达量与优质胚胎数呈正相关(r=0.305,P<0.05)。观察组临床妊娠患者取卵日卵巢颗粒细胞GDF-9 mRNA相对表达量为1.21±0.20,明显高于未妊娠患者(0.88±0.23),差异有统计学意义(P<0.05);观察组临床妊娠和未妊娠患者取卵日血清Ghrelin比较差异无统计学意义(P>0.05);观察组临床妊娠患者年龄、体重指数、基础促卵泡生成激素(FSH)、HCG日LH明显低于未妊娠患者,而HCG日内膜厚度明显高于未妊娠患者,差异均有统计学意义(P<0.05)。Logistic回归分析显示年龄、取卵日GDF-9表达水平、基础FSH是PCOS患者IVF-ET治疗结局的影响因素(OR=1.514、0.600和1.380,P<0.05)。结论取卵日卵巢颗粒细胞GDF-9 mRNA表达与控制性排卵PCOS患者IVF-ET治疗结局有一定关系,而血清Ghrelin与IVF-ET治疗结局无明显相关。

Objective To investigate the relationship between the expression of ovarian granulosa cell growth differentiation factor-9(GDF-9)and serum growth hormone releasing peptide(Ghrelin)and the outcome of IVF-ET treatment in patients with controlled ovulation polycystic ovary syndrome(PCOS).Methods From January 2018 to March 2019,72 PCOS patients(observation group)who received IVF-ET assisted pregnancy in the First People's Affiliated Hospital of Shanghai Jiao Tong University were retrospectively selected,and 70 women(control group)who received IVF-ET assisted pregnancy due to tubal infertility were selected.The expressions of GDF-9 mRNA and serum Ghrelin in ovarian granulosa cells of the two groups were detected,and the outcome of IVF-ET was observed.The correlation between the expression levels of GDF-9 and Ghrelin and the outcome of IVF-ET was analyzed.According to the outcome of the observation group,they were divided into clinical pregnancy group and non-pregnant group.The GDF-9 and Ghrelin expression levels of the clinical pregnancy group and the non-pregnant group were compared on the day of egg retrieval,and the single factor and multi-factor factors affecting clinical pregnancy were analyzed.Results The relative expression of GDF-9 mRNA and the serum Ghrelin of ovarian granulosa cells in the observation group on the day of ovum collection were(1.02±0.22)and(733.54±170.26)pg/mL,which were significantly lower than those in the control group[1.38±0.18,(1035.80±302.54)pg/mL],the differences were statistically significant(P<0.05).The egg capture rate of the observation group was 81.34%,which was significantly lower than that of the control group(87.54%),the difference was statistically significant(P<0.05).There were no significant difference between the observation group and the control group in egg maturation rate,normal fertilization rate,number of high-quality embryos and clinical pregnancy rate(P>0.05).The relative expression of GDF-9 mRNA on the day of ovum collection was positively correlated with the number of high-quality embryos(r=0.305,P<0.05).The relative expression of GDF-9 mRNA of ovarian granulosa cells in the observation group on the day of ovum collection was 1.21±0.20,which was significantly higher than that in non-pregnant patients(0.88±0.23),the difference was statistically significant(P<0.05);There was no significant difference in serum Ghrelin on the day of ovum collection between the clinical pregnant and non-pregnant patients in the observation group(P>0.05);Age,BMI,basal follicle stimulating hormone(FSH),human chorionic gonadotropin(HCG)day LH of the observation group were significantly lower than those of the non-pregnant patients,the intimal thickness of HCG was significantly higher than that of non-pregnant patients,the differences were statistically significant(P<0.05).Logistic regression analysis showed that age,the expression level of GDF-9 on the day of egg extraction and basal FSH were the influencing factors for the outcome of IVF-ET treatment in PCOS patients(OR=1.514,0.600 and 1.380,P<0.05).Conclusion GDF-9 mRNA expression of ovarian granulosa cells on the day of ovulation is correlated with the treatment outcome of IVF-ET in patients with controlled ovulation PCOS,while serum Ghrelin is not significantly correlated with the treatment outcome of IVF-ET.