子宫腔灌注人绒毛膜促性腺激素对多囊卵巢综合征患者植入窗期子宫内膜容受性的影响
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摘要
目的探讨子宫腔灌注人绒毛膜促性腺激素(h CG)对多囊卵巢综合征(PCOS)患者植入窗期子宫内膜容受性的影响。方法选择2016年4月至2018年4月新乡医学院第三附属医院收治的已婚PCOS患者31例为研究对象,对患者的连续2个月经周期进行自身对照试验,第1个月经周期为对照周期,第2个月经周期为灌注周期,其中对照周期28例(3例因无排卵予以排除),灌注周期29例(2例因无排卵予以排除)。患者2个月经周期的第5～9天均给予来曲唑2. 5 mg,口服;从月经周期第10天开始,连续阴道超声卵泡监测直至排卵,分别于第2个月经周期的排卵前2日及排卵日子宫腔灌注h CG 500 IU(0. 5 m L)。于排卵后第6～8天(植入窗期)检测患者血清雌激素(E2)和黄体酮(P)水平,并使用一次性S型子宫腔组织吸引管抽取少许子宫内膜组织,S-3500N扫描电子显微镜下观察子宫内膜胞饮突发育情况。结果对照周期与灌注周期的植入窗期患者血清E2水平比较差异无统计学意义(t=0. 501,P>0. 05);灌注周期的植入窗期患者血清P水平显著高于对照周期(t=3. 193,P <0. 05)。对照周期和灌注周期有子宫内膜成熟胞饮突的患者分别为9例(32. 14%)、17例(58. 62%),灌注周期有成熟胞饮突患者比例显著高于对照周期(χ2=4. 032,P <0. 05)。结论 PCOS患者植入窗期胞饮突发育不良,宫腔灌注h CG可增加成熟胞饮突数量,提高血清P水平,改善子宫内膜容受性。
Objective To investigate the effect of intrauterine perfusion of human chorionic gonadotropin( h CG) on endometrial receptivity in patients with polycystic ovary syndrome( PCOS) during implantation window. Methods Thirty-one married patients with PCOS admitted to the Third Affiliated Hospital of Xinxiang Medical University from April 2016 to April2018 were selected as subjects. A self-control trial was conducted for two consecutive menstrual cycles,the first menstrual cycle was the control cycle,and the second menstrual cycle was the perfusion cycle. There were 28 cases in the control cycle( 3 cases were excluded due to anovulation) and 29 cases in the perfusion cycle( 2 cases were excluded due to anovulation). The patients were given letrozole 2. 5 mg orally on the 5 thto 9 thday of the two menstrual cycles. From the 10 thday of the menstrual cycle,the follicles were monitored by continuous transvaginal ultrasound until ovulation,and 500 IU( 0. 5 m L) h CG was infused into uterine cavity on the 2 ndday before ovulation and the day of ovulation in the second menstrual cycle,respectively.On the 6 thto 8 thday after ovulation( implantation window),the levels of serum estrogen( E2) and progesterone( P) were detected,and a few endometrial tissues were extracted by disposable S-shaped suction tube,the development of endometrial pinopode was observed under S-3500 N scanning electron microscopy. Results There was no significant difference in serum E2 level between the control cycle and the perfusion cycle during implantation window( t = 0. 501,P > 0. 05). The level of serum P in the perfusion cycle was significantly higher than that in the control cycle during implantation window( t = 3. 193,P <0. 05). There were 9( 32. 14%) cases and 17( 58. 62%) cases with mature endometrial pinopode in the control cycle and the perfusion cycle,respectively. The proportion of patients with mature pinopode in the perfusion cycle was significantly higher than that in the control cycle( χ2= 4. 032,P < 0. 05). Conclusion PCOS patients have the dysplasia of endometrial pinopode during implantation window. Intrauterine infusion of h CG can increase the number of mature pinopode,increase serum P level and improve endometrial receptivity.
Objective To investigate the effect of intrauterine perfusion of human chorionic gonadotropin( h CG) on endometrial receptivity in patients with polycystic ovary syndrome( PCOS) during implantation window. Methods Thirty-one married patients with PCOS admitted to the Third Affiliated Hospital of Xinxiang Medical University from April 2016 to April2018 were selected as subjects. A self-control trial was conducted for two consecutive menstrual cycles,the first menstrual cycle was the control cycle,and the second menstrual cycle was the perfusion cycle. There were 28 cases in the control cycle( 3 cases were excluded due to anovulation) and 29 cases in the perfusion cycle( 2 cases were excluded due to anovulation). The patients were given letrozole 2. 5 mg orally on the 5 thto 9 thday of the two menstrual cycles. From the 10 thday of the menstrual cycle,the follicles were monitored by continuous transvaginal ultrasound until ovulation,and 500 IU( 0. 5 m L) h CG was infused into uterine cavity on the 2 ndday before ovulation and the day of ovulation in the second menstrual cycle,respectively.On the 6 thto 8 thday after ovulation( implantation window),the levels of serum estrogen( E2) and progesterone( P) were detected,and a few endometrial tissues were extracted by disposable S-shaped suction tube,the development of endometrial pinopode was observed under S-3500 N scanning electron microscopy. Results There was no significant difference in serum E2 level between the control cycle and the perfusion cycle during implantation window( t = 0. 501,P > 0. 05). The level of serum P in the perfusion cycle was significantly higher than that in the control cycle during implantation window( t = 3. 193,P <0. 05). There were 9( 32. 14%) cases and 17( 58. 62%) cases with mature endometrial pinopode in the control cycle and the perfusion cycle,respectively. The proportion of patients with mature pinopode in the perfusion cycle was significantly higher than that in the control cycle( χ2= 4. 032,P < 0. 05). Conclusion PCOS patients have the dysplasia of endometrial pinopode during implantation window. Intrauterine infusion of h CG can increase the number of mature pinopode,increase serum P level and improve endometrial receptivity.
引文
[1]孙晓玲,莫秋,王冬纳,等.多囊卵巢综合征不孕症患者着床窗期子宫内膜容受性情况及促排卵治疗对其的影响[J].吉林医学,2016,37(12):2843-2844.
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[9]于彩虹,刘梅梅,李肖肖,等.多囊卵巢综合征(PCOS)患者子宫内膜容受性的研究进展[J].中国优生与遗传杂志,2016,24(10):131-133.
[10]王会妍,张帅,张云山.胚胎移植前宫腔内灌注h CG在IVF-ET中的应用及hCG提高种植率和妊娠率的有关机制[J].生殖与避孕,2012,32(9):593-598.
[11]LICHT P,LOSCH A,DITTRICH R,et al.Novel insights into human endometrial paracrinology and embryo-maternal communication by intrauterine microdialysis[J].Hum Reprod Update,1998,4(5):532-538.
[12]MANSOUR R,TAWAB N,KAMAL O,et al.Intrauterine injection of human chorionic gonadotropin before embryo transfer significantly improves the implantation and pregnancy rates in in vitro fertilization/intracytoplasmic sperm injection:a prospective randomized study[J].Fertil Steril,2011,96(6):1370-1374.
[13]朱桂金.胞饮突与子宫内膜容受性[J].国外医学妇产科学分册,2000,27(3):131-134.
[14]何元曼.子宫内膜容受性的评估及其改善对策[A].中国中西医结合学会妇产科专业委员会.第9届中国中西医结合学会妇产科专业委员会第二次学术会议论文集[C].北京:中国学术期刊电子出版社,2017:431-433.
[15]黄建贞,王瑛,马建敏,等.宫内膜胞饮突及雌孕激素受体预测冻融胚胎种植窗[J].当代医学,2017,23(2):1-3.
[2]李友云,张丽,邢素娟,等.加味桂枝茯苓汤对多囊卵巢综合征血清抗苗勒管激素及子宫内膜容受性的影响[J].世界中医药,2018,13(12):3035-3038,3042.
[3]管海云,张炜.多囊卵巢综合征对子宫内膜容受性的影响[J].生殖医学杂志,2016,25(12):1122-1125.
[4]TSAMPALAS M,GRIDELET V,BERNDT S,et al.Human chorionic gonadotropin:a hormonewith immunological and angiogenic properties[J].Reprod Immunol,2010,85(1):93-98.
[5]KOL S,HUMAIDAN P.LH(as HCG)and FSH surges for final oocyte maturation:sometimes it takes two to tango[J].Reprod Biomed Online,2010,21(5):590-592.
[6]ROTTERDAM ESHRE/ASRM-SPONSORED PCOS CONSENSUSWORKSHOP GROUP.Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome(PCOS)[J].Hum Reprod,2004,19(1):41-47.
[7]AMJADI F,AFLATOONIAN R,JAVANMARD S H,et al.Apolipoprotein A1 as a novel anti-implantation biomarker in polycystic ovary syndrome:a case-control study[J].J Res Med Sci,2015,20(11):1039-1045.
[8]齐家,孙赟,陈子江.多囊卵巢综合征子宫内膜胰岛素抵抗的分子机制及生物学效应[J].中华生殖与避孕杂志,2018,38(6):513-516.
[9]于彩虹,刘梅梅,李肖肖,等.多囊卵巢综合征(PCOS)患者子宫内膜容受性的研究进展[J].中国优生与遗传杂志,2016,24(10):131-133.
[10]王会妍,张帅,张云山.胚胎移植前宫腔内灌注h CG在IVF-ET中的应用及hCG提高种植率和妊娠率的有关机制[J].生殖与避孕,2012,32(9):593-598.
[11]LICHT P,LOSCH A,DITTRICH R,et al.Novel insights into human endometrial paracrinology and embryo-maternal communication by intrauterine microdialysis[J].Hum Reprod Update,1998,4(5):532-538.
[12]MANSOUR R,TAWAB N,KAMAL O,et al.Intrauterine injection of human chorionic gonadotropin before embryo transfer significantly improves the implantation and pregnancy rates in in vitro fertilization/intracytoplasmic sperm injection:a prospective randomized study[J].Fertil Steril,2011,96(6):1370-1374.
[13]朱桂金.胞饮突与子宫内膜容受性[J].国外医学妇产科学分册,2000,27(3):131-134.
[14]何元曼.子宫内膜容受性的评估及其改善对策[A].中国中西医结合学会妇产科专业委员会.第9届中国中西医结合学会妇产科专业委员会第二次学术会议论文集[C].北京:中国学术期刊电子出版社,2017:431-433.
[15]黄建贞,王瑛,马建敏,等.宫内膜胞饮突及雌孕激素受体预测冻融胚胎种植窗[J].当代医学,2017,23(2):1-3.