控制性超排卵治疗过程中晚卵泡期高孕酮对卵巢中反应患者子宫内膜组织学及整合素αvβ3、LIF水平的影响
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摘要
目的 :探讨控制性超排卵治疗过程中晚卵泡期高孕酮(P)对卵巢中反应患者子宫内膜组织学及整合素αvβ3、白血病抑制因子(LIF)水平的影响。方法 :选取宝鸡市妇幼保健院2014年9月～2016年1月期间接受体外授精-胚胎移植(IVF-ET)或卵胞浆内单精子显微注射(ICSI)的不孕症患者(均采用控制性超排卵)60例,根据晚卵泡期血清P水平分为正常组(n=25,P<2.5ng/mL)、升高组(n=35,P≥2.5ng/mL)。于晚卵泡期起始日、取内膜日检测血清血清雌二醇(E2)、黄体生成激素(LH)、卵泡刺激素(FSH)浓度,内膜活检后采用免疫组化SP法检测子宫内膜中整合素αvβ3、LIF的表达情况。结果 :升高组晚卵泡期、取内膜日E2水平显著高于正常组,而FSH、LH与正常组相比差异不显著。整合素αvβ3、LIF多呈中等强度或强阳性表达,其中整合素αvβ3主要在内膜腺体表达,定位于细胞膜;LIF主要在内膜腺体表达,定位于细胞浆。升高组子宫内膜组织整合素αvβ3、LIF表达阳性率48.57%、42.86%略低于正常组的68.00%、64.00%,差异不显著,且两组子宫内膜组织整合素αvβ3、LIF表达情况分布比较无统计学意义。结论 :控制性超排卵治疗过程中晚卵泡期高P水平可能导致子宫内膜组织整合素αvβ3、LIF表达水平降低,一定程度降低子宫内膜容受性,但仅依靠此两项指标的表达来评估子宫内膜的容受性并不可靠。
Objective To explore the effects of high progesterone(P) in late follicular phase on endometrial histology and integrin αvβ3, leukemia inhibitory factor(LIF) levels in patients with ovarian response during the course of controlled ovarian hyperstimulation. Methods 60 cases of patients with infertility(by superovulation) treated with vitro fertilization-embryo transfer(IVF-ET) or intracytoplasmic sperm injection(ICSI) from September 2014 to January 2016 in Baoji Maternal and Child Health Hospital were selected and divided into the normal group(n=25, P<2.5 ng/mL) and the elevated group(n=35, P≥2.5 ng/m L) according to the serum level of P in the late follicular period. The concentrations of serum estradiol(E2), Luteinizing hormone(LH) and follicle stimulating hormone(FSH) in the serum in the onset date of the late follicular phase and the day of endometrium picking up were detected and the expressions of the integrin αvβ3 and LIF in the endometrium were tested by SP immunohistochemical method after the endometrial biopsy. Results The E2 levels in the late follicular phase and the endometrial day in the elevated group were significantly higher than those in the normal group, but there was no significant difference in the levels of the FSH and LH compared with the normal group. The integrin αvβ3, LIF were mostly expressed as moderate or strong positive. What's more the integrin αvβ3 was mainly expressed in the endometrial gland and located in the cell membrane while LIF was mainly expressed in the endometrial gland but located in the cytoplasm. The positive rates of the integrin αvβ3 and LIF expression with 48.57% and 42.86% respectively in endometrial tissue in the elevated group were slightly lower than those in the normal group with 68.00% and 64.00%, therefore there was no difference. The expression distributions of integrin αvβ3 and LIF in endometrial tissue were not statistically significant between the two groups. Conclusions In the process of controlled ovarian hyperstimulation the high P level in the follicular phase may decrease the expression levels of integrin αvβ3 and LIF in the endometrial tissue and to a certain extent reduce the endometrial receptivity, but it is not reliable that only relying on the expression of these two indexes evaluate the endometrial receptivity.
Objective To explore the effects of high progesterone(P) in late follicular phase on endometrial histology and integrin αvβ3, leukemia inhibitory factor(LIF) levels in patients with ovarian response during the course of controlled ovarian hyperstimulation. Methods 60 cases of patients with infertility(by superovulation) treated with vitro fertilization-embryo transfer(IVF-ET) or intracytoplasmic sperm injection(ICSI) from September 2014 to January 2016 in Baoji Maternal and Child Health Hospital were selected and divided into the normal group(n=25, P<2.5 ng/mL) and the elevated group(n=35, P≥2.5 ng/m L) according to the serum level of P in the late follicular period. The concentrations of serum estradiol(E2), Luteinizing hormone(LH) and follicle stimulating hormone(FSH) in the serum in the onset date of the late follicular phase and the day of endometrium picking up were detected and the expressions of the integrin αvβ3 and LIF in the endometrium were tested by SP immunohistochemical method after the endometrial biopsy. Results The E2 levels in the late follicular phase and the endometrial day in the elevated group were significantly higher than those in the normal group, but there was no significant difference in the levels of the FSH and LH compared with the normal group. The integrin αvβ3, LIF were mostly expressed as moderate or strong positive. What's more the integrin αvβ3 was mainly expressed in the endometrial gland and located in the cell membrane while LIF was mainly expressed in the endometrial gland but located in the cytoplasm. The positive rates of the integrin αvβ3 and LIF expression with 48.57% and 42.86% respectively in endometrial tissue in the elevated group were slightly lower than those in the normal group with 68.00% and 64.00%, therefore there was no difference. The expression distributions of integrin αvβ3 and LIF in endometrial tissue were not statistically significant between the two groups. Conclusions In the process of controlled ovarian hyperstimulation the high P level in the follicular phase may decrease the expression levels of integrin αvβ3 and LIF in the endometrial tissue and to a certain extent reduce the endometrial receptivity, but it is not reliable that only relying on the expression of these two indexes evaluate the endometrial receptivity.
引文
[1]唐亭亭,阳翎,禹虹,等.不同促排卵方案治疗多囊卵巢综合征的疗效分析[J].医学临床研究, 2017, 34(2):402-404.
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[9]李婷婷,方丛,贾磊,等.小鼠早期完整胚胎诱导子宫内膜白血病抑制因子和整合素β3表达并提高子宫容受性[J].中国病理生理杂志, 2012, 28(2):193-200.
[10] Bosch E, Labarta E, Crespo J, et al. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization:analysis of over 4000 cycles[J]. Hum Reprod, 2010,25(8):2092-2100.
[11]叶虹.控制性促排卵中过早血清孕酮升高的原因[J].生殖医学杂志, 2014, 23(12):933-936.
[12]王雪丽,刘雨生,季静娟,等.长方案控制性促排卵过程中晚卵泡期孕酮变化趋势对体外受精-胚胎移植结局的影响[J].现代妇产科进展, 2016, 25(3):199-202.
[13]李瑾,钟依平,张祖威,等.输卵管积水术后可改善种植窗期子宫内膜白血病抑制因子和整合素αvβ3的表达[J].中山大学学报(医学科学版), 2012, 33(1):94-98.
[14]林秀峰,伍畅,郑湘琼,等.控制性超排卵中hC G日孕酮水平与妊娠结局的关系[J].中国妇产科临床杂志, 2015, 16(6):538-540.
[15]林娜,马艳萍,武泽,等.超排卵周期中高雌、孕激素水平对着床期子宫内膜整合素αvβ3、骨桥蛋白表达及子宫内膜容受性的影响[J].中国妇幼保健, 2015, 30(9):1438-1442.
[2]张金玉,李海霞,郭新宇,等.益气血补肝肾方对子宫内膜整合素αvβ3表达的影响[J].武汉大学学报(医学版), 2013, 34(6):845-848.
[3]李蓉,乔杰,武泽,等.超促排卵周期中孕酮升高对胚胎植入的影响[J].生殖医学杂志, 2013, 4(22):230-234.
[4]Budwit Novotny DA, McCarty KS, Cox EB, et al. Immunohistochemical analyses of estrogen receptor in endometrial adenocarcinomausing a monoclonal antibody[J]. Cancer Res, 1986, 46(10):5419-5425.
[5]王琦,陈蔚清,陈朝军,等. LUFS患者子宫内膜容受性的主要影响因素及其冻融胚胎移植时机选择[J].广东医学, 2016, 37(6):885-888.
[6]Lessey BA. Endometrial receptivity and the window of implantation[J].Baillieres Best Pract Res Clin Obstet Gynaecol, 2000, 14(5):775-788.
[7]王丹瑾,牛志宏,冯云. PCOS与非PCOS患者在控制性超促排卵周期子宫内膜容受性差异的探讨[J].中国优生与遗传杂志, 2012,20(3):124-126.
[8]李瑞玉.宫腔镜子宫内膜微创术对子宫内膜容受性因子表达的影响[J].中国医药导刊, 2016, 18(6):569-571.
[9]李婷婷,方丛,贾磊,等.小鼠早期完整胚胎诱导子宫内膜白血病抑制因子和整合素β3表达并提高子宫容受性[J].中国病理生理杂志, 2012, 28(2):193-200.
[10] Bosch E, Labarta E, Crespo J, et al. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization:analysis of over 4000 cycles[J]. Hum Reprod, 2010,25(8):2092-2100.
[11]叶虹.控制性促排卵中过早血清孕酮升高的原因[J].生殖医学杂志, 2014, 23(12):933-936.
[12]王雪丽,刘雨生,季静娟,等.长方案控制性促排卵过程中晚卵泡期孕酮变化趋势对体外受精-胚胎移植结局的影响[J].现代妇产科进展, 2016, 25(3):199-202.
[13]李瑾,钟依平,张祖威,等.输卵管积水术后可改善种植窗期子宫内膜白血病抑制因子和整合素αvβ3的表达[J].中山大学学报(医学科学版), 2012, 33(1):94-98.
[14]林秀峰,伍畅,郑湘琼,等.控制性超排卵中hC G日孕酮水平与妊娠结局的关系[J].中国妇产科临床杂志, 2015, 16(6):538-540.
[15]林娜,马艳萍,武泽,等.超排卵周期中高雌、孕激素水平对着床期子宫内膜整合素αvβ3、骨桥蛋白表达及子宫内膜容受性的影响[J].中国妇幼保健, 2015, 30(9):1438-1442.