兰州大学机构库 >学院待认领
针刺疗法降低IVF-ET中OHSS发生的机制研究
Alternative TitleMechanism of Acupuncture on decreasing the OHSS incidence in IVF-ET Treatment
杨婷
Thesis Advisor张学红
2013-05-28
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword针刺疗法 IVF/ICSI-ET OHSS VEGF β-EP 代谢组学
Abstract目的 本研究针对在体外受精-胚胎移植过程中,具有发生中重度卵巢过度刺激综合症(OHSS)高危风险的PCOS/PCO患者辅助传统针刺疗法,评价针刺疗法降低中重度OHSS发生的有效性,探讨针刺疗法降低卵巢过度刺激综合症发生的分子生物学机制,观察针刺疗法影响卵泡液中代谢组学的变化。 方法 在于兰大一院生殖中心行IVF/ICSI-ET治疗的患者中,选取符合本实验纳入排除标准的具有高危OHSS发生风险的PCOS/PCO患者102人,随机分为针灸+促排卵组(实验组)和单纯促排卵组(对照组)。两组患者均采取标准GnRH-a长方案促排卵治疗,实验组于促排卵第一天开始辅助传统针刺治疗,直至停药日结束,应用ELISA法测量两组>1.6cm卵泡的卵泡液中血管内皮生长因子(VEGF),白介素-6(IL-6),β-内啡肽(β-EP)等指标;应用生化分析仪测量两组卵泡液中代谢组学指标。观察两组临床治疗用药即GnRH-a用量、促性腺激素(Gn)用量等差异;比较两组临床结局获卵数、MⅡ卵数、临床妊娠率、流产率等差异;及两组OHSS发生情况OHSS发生率、中重度OHSS比例、促排卵全过程雌激素变化等差异。 结果 1.实验组中重度OHSS发生率为28.85%,对照组中重度OHSS发生率率为48%,有统计学意义(p<0.05);实验组的妊娠率、流产率与对照组相比没有显著性差异(73.33% vs.71.05%,6.06% vs.3.70%,p>0.05);2.移植日实验组血清E2低于对照组(2452.66±642.76 vs. 2538.13±647.37,p<0.05); 3.实验组移植日血清白细胞数,中性粒细胞绝对数低于对照组(14.42±3.85vs. 16.98±4.20,10.81±3.26vs.12.89±3.97,p<0.05);4,实验组血清β-EP浓度、卵泡液β-EP浓度均高于对照组(409.62±335.51vs.203.09±350.13,1311.1±416.2 vs.1046.6±458.3,p<0.05),实验组卵泡液VEGF浓度低于对照组(257.3±103.10 vs. 265.1±96.91,p<0.05);5.实验组卵泡液中K+、Na+离子浓度低于对照组(3.75±0.15 vs.3.83±0.23,136.68±3.51vs.138.47±3.87,p<0.05),Ca2+离子浓度高于对照组(1.86±0.08 vs.1.82±0.09,p<0.05)。 结论 传统针刺辅助治疗能够降低IVF/ICSI-ET治疗过程中中重度OHSS的发生率,可能是通过减弱机体炎性反应及炎性因子的分泌,降低血清中E2分泌对心血管的副作用,改善卵巢局部微环境及新陈代谢,增加β-EP浓度调节GnRH分泌来综合发挥抑制OHSS发生的作用。
Other AbstractObjective This Study focused on the infertile patient with PCOS/PCO who had primary risk factors for predicting moderate or severe Ovarian Hyper-stimulation Syndrome (OHSS), aimed to these patient under in vitro fertilization-embryo transfer (IVF-ET) treatment with acupuncture treatment, to evaluate the efficacy and investigated the molecular biological mechanism of acupuncture in reducing the incidence of OHSS, and to observe the changes of follicular fluid metabonomics. Methods 102 PCOS/PCO patients under the treatment of IVF/ICSI-ET were randomized allocated to COH+Acupuncture group (experimental group) or Simply COH group (control group). The patients in each group were treated with the standard long protocol with GnRH-a. Especially the patients in experimental group received traditional acupuncture from the first day of controlled ovarian hyperstimulation to the drug withdrawal day .Levels of VEGF, IL-6, β-EP of follicular fluid were detected by ELSIA Kit, levels of follicular fluid metabonomics were detected by Biochemical Analyzer. And compare the drug of COH as Dose of GnRH-a, gonadotropin (Gn); and the outcome of IVF as the number of oocytes, MⅡoocytes, clinical pregnancy rate, miscarriage rate; and the related data of OHSS as incidence of OHSS, the rate of moderate/severe OHSS, serum estradiol in COH process. Results 1.Compared with the control group, the incidence of OHSS significantly reduced in acupuncture group (28.85% vs.48%, p<0.05), and no difference in pregnancy rate and miscarriage rate; 2. Serum E2 of the embryo transfer day was significantly lower in the acupuncture group (2452.66±642.76 vs. 2538.13±647.37, p<0.05); 3.Serum WBC and GRA(granulocyte reckon absolute) was significantly lower in the acupuncture group (14.42±3.85 vs. 16.98±4.20, 10.81±3.26 vs. 12.89±3.97, p<0.05); 4.The levels of serum and follicular fluid(FF) β-EP was significantly higher in the acupuncture group (409.62±335.51 vs. 203.09±350.13, 1311.1±416.2 vs.1046.6±458.3, p<0.05), and the levels of VEGF in FF was significantly lower in the acupuncture group (257.3±103.10 vs. 265.1±96.91, p<0.05); 5 .The concentration of Na+、K+ in FF was significantly lower in the acupuncture group (3.75±0.15 vs.3.83±0.23, 136.68±3.51vs. 138.47±3.87, p<0.05), and The concentration of Ca2+ in FF was significantly higher in the acupuncture group (1.86±0.08 vs. 1.82±0.09, p<0.05). Conclusion Acupuncture is a safe and effective way to prevent OHSS in IVF/ICSI...
URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/222252
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
杨婷. 针刺疗法降低IVF-ET中OHSS发生的机制研究[D]. 兰州. 兰州大学,2013.
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