多囊卵巢综合征患者氧化应激水平对卵子和胚胎质量的影响

Effect of oxidative stress on the quality of oocytes and embryos in patients with polycystic ovary syndrome

目的探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者血清及卵泡液氧化应激水平与卵子及胚胎质量的关系。方法采用前瞻性随访研究分析2019年1月至2020年10月期间在浙江省人民医院生殖医学中心行体外受精治疗的67例PCOS患者(PCOS组)和66例单纯输卵管因素行体外受精的患者(对照组)的临床资料。采集患者取卵日血清及直径大于18 mm卵泡的卵泡液。比色法检测总抗氧化能力(total antioxidant capacity,TAC)、超氧化物歧化酶(superoxide dismutase,SOD)和丙二醛(malondialdehyde,MDA)水平,分析氧化应激指标与卵子质量、胚胎培养结局和移植后临床结局的相关性。结果PCOS组血清SOD水平[(22.11±3.70)U/mL)]显著低于对照组[(25.70±3.32)U/mL,P<0.001];PCOS组的卵泡液TAC水平[(0.62±0.05)mmol/L]、MDA水平[(16.64±3.85)nmol/mL]和血清MDA水平[(18.20±4.68)nmol/mL]显著高于对照组[(0.53±0.04)mmol/L,P<0.001;(13.74±2.28)nmol/mL,P<0.001;(15.37±5.34)nmol/mL,P=0.008];PCOS组优质胚胎率[34.1%(341/1000)]、着床率[49.5%(54/109)]、临床妊娠率[60.9%(39/64)]和活产率[50.0%(32/64)]均低于对照组[41.7%(306/733),P=0.013;58.7%(54/92),P=0.023;70.3%(45/64),P=0.006;59.4%(38/64),P=0.007],差异均有统计学意义;卵泡液TAC水平与优质胚胎率呈显著负相关(β=-1.83,P=0.012);各氧化应激指标与临床结局无显著相关性。结论PCOS患者卵泡液TAC水平升高,过高的卵泡液TAC水平可能是胚胎质量低下的危险因素之一。

Objective To investigate the relationship of oxidative stress levels in serum and follicular fluid of polycystic ovary syndrome(PCOS)patients with the quality of oocytes and embryos.Methods A prospective follow-up study was conducted to analyze 67 patients with PCOS(PCOS group)and 66 infertility patients with simple fallopian tube factors(control group)who underwent in vitro fertilization in Center for Reproductive Medicine,Zhejiang Provincial People's Hospital from January 2019 to October 2020.Serum and follicular fluid from the follicles with a diameter of more than 18 mm were collected on the oocyte retrieval day.Colorimetric method was used to detect the levels of total antioxidant activity(TAC),superoxide dismutase(SOD),and malondialdehyde(MDA),and the differences of those oxidative stress indicators between the two groups were compared and the correlation of those parameters with oocyte quality,embryo development and clinical outcomes were analyzed.Results The serum SOD level of the PCOS group[(22.11±3.70)U/mL]was significantly lower than that of control group[(25.70±3.32)U/mL,P<0.001].The follicular fluid TAC level[(0.62±0.05)mmol/L],MDA level[(16.64±3.85)nmol/mL]and serum MDA level[(18.20±4.68)nmol/mL]of the PCOS group were significantly higher than those of control group[(0.53±0.04)mmol/L,P<0.001;(13.74±2.28)nmol/mL,P<0.001;(15.37±5.34)nmol/mL,P=0.008].The good-quality embryo rate[34.1%(341/1000)],the implantation rate[49.5%(54/109)],the clinical pregnancy rate[60.9%(39/64)]and the live birth rate[50.0%(32/64)]in the PCOS group were statistically different from those in control group[41.7%(306/733),P=0.013;58.7%(54/92),P=0.023;70.3%(45/64),P=0.006;59.4%(38/64),P=0.007].There was a negative correlation between the TAC level in follicular fluid and the rate of good-quality embryo(β=-1.83,P=0.012).There was no significant correlation between oxidative stress indicators and clinical outcomes.Conclusion The TAC level of follicular fluid in PCOS patients is elevated,and increased TAC level in follicular fluid may be one of the risk factors for poor embryo quality.