经皮穴位电刺激对痰湿型多囊卵巢综合征患者卵细胞质量及KISS1R的影响

Effects of Transcutaneous Electrical Acupoint Stimulation on Oocyte Quality and Kiss1r in Phlegm-Dampness Type of PCOS

目的通过研究在体外受精(IVF)周期中经皮穴位电刺激对痰湿型多囊卵巢综合征患者卵细胞质量及Kiss1的影响,探讨经皮穴位电刺激影响痰湿型多囊卵巢综合征患者卵细胞质量的机理。方法将100例行IVF-ET的痰湿型多囊卵巢综合征患者随机分为两组,试验组(经皮穴位电刺激联合西药组)和对照组(伪针联合西药组),每组各50例。分别观察两组患者治疗前后证候积分及积分差值、促性腺激素(Gn)总量、取卵数、单卵雌激素水平、优卵率、受精率、优质胚胎率、临床妊娠率,取卵日卵巢颗粒细胞Kisspeptin/Kiss1r系统中Kiss1r mRNA水平的表达差异。结果试验组与对照组相比,治疗前后证候积分、积分差值、单卵雌激素水平改善明显(P<0.05);Gn总量、取卵数、受精率、临床妊娠率比较,差异无统计学意义;优卵率、优胚率显著提高(P<0.05);试验组患者颗粒细胞Kiss1r的表达水平较对照组有明显下调,差异具有统计学意义(P<0.05)。结论经皮穴位电刺激提高痰湿型多囊卵巢综合征患者卵细胞质量的机理与调控卵巢颗粒细胞Kisspeptin/Kiss1r系统,下调通路中关键因子Kiss1r的表达,促进颗粒细胞增殖、改善卵巢微环境有关,其作用机制尚需进一步探讨。

Objective To study the effect of transcutaneous electrical acupoint stimulation on the quality of oocytes and Kiss1 in patients with phlegm-dampness type of polycystic ovary syndrome(PCOS)during in vitro fertilization(IVF)cycle and explore the mechanism of transcutaneous electrical acupoint stimulation on the quality of oocytes in patients with phlegm-dampness type of PCOS.Methods A total of 100 patients with phlegm-dampness type of PCOS who received IVF-embryo transfer(ET)were randomly divided into the test group(transcutaneous electrical acupoint stimulation combined with western medicine group)and the control group(sham acupuncture combined with western medicine group),with 50 cases in each group.The syndrome score and score difference,the total amount of gonadotropin(Gn),the number of oocytes taking out,the level of single oocyte estrogen,the rate of excellent oocytes,the rate of fertilization,the rate of high-quality embryos,the clinical pregnancy rate and the expression difference of Kiss1r mRNA in ovarian granulosa cells on the day of taking oocyte were observed respectively in the two groups before and after treatment.Results Compared with the control group,the score of syndrome,the difference of score and the level of monoovoestrogen in the test group were improved after treatment(P<0.05).There was no significant difference in total amount of Gn,number of oocytes taking out,fertilization rate or clinical pregnancy rate.The rate of excellent oocytes and embryos was significantly increased(P<0.05).The expression level of Kiss1r in granulosa cells of patients in the test group was significantly lower than that in the control group(P<0.05).Conclusion The mechanism of transcutaneous electrical acupoint stimulation to improve the quality of oocytes in patients with phlegm-dampness type of PCOS is related to regulating the Kissleptin/Kiss1r system of ovarian granulosa cells,down-regulating the expression of Kiss1r,a key factor in the pathway,promoting the proliferation of granulosa cells,and improving the ovarian microenvironment.Its mechanism needs further discussion.