基于卵泡液代谢组学研究滋阴补阳序贯治疗多囊卵巢综合征机制

Mechanism of sequential treatment of polycystic ovary syndrome patients with nourishing yin and tonifying yang based on follicular fluid metabonomics

目的:从卵泡液代谢角度探讨多囊卵巢综合征(PCOS)在进入体外受精-胚胎移植(IVF-ET)周期使用滋阴补阳序贯治疗的物质基础。方法:采用代谢组学检测及正交偏最小二乘法-判别分析对肾虚证PCOS患者(对照组,30例)、使用滋阴补阳序贯治疗的肾虚证PCOS患者(治疗组,33例)以及仅因输卵管因素行IVF-ET的健康女性(正常组,31例)进行卵泡液代谢组学分析。同时记录患者的基础性激素及IVF结局指标。结果:与对照组比较,正常组2PN受精率、2PN卵裂率、优胚数/率升高(P<0.05);与治疗组比较,对照组2PN受精数/率、2PN卵裂数/率、优胚数/率均降低(P<0.05)。对照组和正常组之间存在38种差异化合物;治疗组与对照组之间存在26种差异代谢产物。8-姜烯酚在对照组中下调,在治疗组中上调。结论:PCOS患者与健康女性之间卵泡液差异代谢物对PCOS的诊断和治疗奠定了一定的物质基础,经过滋阴补阳序贯治疗后,8-姜烯酚上调可能是通过UDP-葡萄糖醛酸基转移酶2B7参与葡萄糖醛酸化途径促进雌二醇分泌,进而起到改善PCOS患者临床结局的效果。

Objective:To explore the material basis of sequential treatment of polycystic ovary syndrome(PCOS)by nourishing yin and yang in the cycle of in vitro fertilization and embryo transfer(IVF-ET)from the perspective of follicular fluid metabolism.Methods:Metabonomics detection and orthogonal partial least squares-discriminant analysis were used to analyze the follicular fluid metabonomics of PCOS patients with kidney deficiency syndrome(control group,30 patients),PCOS patients with kidney deficiency syndrome treated by nourishing yin and tonifying yang in sequence(treatment goup,33 patients),and healthy women who underwent IVF-ET only because of tubal factors(normal group,31 patients).At the same time,the basic hormones and IvF outcome indexes were recorded.Results:Compared with the control group,the fertilization rate,cleavage rate and excellent embryo number/rate of the normal group were higher(P<0.05).Compared with the treatment group,the fertilization number/rate,cleavage number/rate and excellent embryo number/rate of the control group were lower(P<0.05).There were 38 different compounds between the control group and the normal group,there were 26 different metabolites between the treatment group and the control group.8-gingerol was down-regulated in the control group and up-regulated in the treatment group.Conclusion:The differential metabolites in follicular fluid between PCOS patients and healthy women lay a certain material foundation for the diagnosis and treatment of PCOS.After the sequential treatment of nourishing yin and tonifying yang,the 8-gingerol up-regulates,and may promote the secretion of estradiol through UTG2B7,thus improving the clinical outcome of PCOS patients.