成熟卵泡比例与HCG注射时机的选择及对卵子发育潜能的影响  

Proportion of Dominant Follicles as the Guidance of HCG Triggering and Its Effect on the Oocyte Developmental Competence

作　　者：李轶[1] 李瑞岐[1] 区颂邦[1] 张宁锋[1] 王文军[1] 李予[1] 张清学[1] 杨冬梓[1] 

机构地区：[1]中山大学孙逸仙纪念医院生殖医学中心,广东广州510120

出　　处：《中山大学学报（医学科学版）》2014年第4期552-558,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81200417);教育部博士点新教师基金(20120171120093);广东省自然基金博士启动项目(S2012040007621);广东省医学科研基金(B201204);中山大学青年教师培育项目(B002012002);中山大学孙逸仙纪念医院"逸仙医学人才"培养计划;广州市珠江科技新星专项基金(2014J2200044)

摘　　要：【目的】探讨采用成熟卵泡比例来决定HCG注射时机的可行性,研究在不同成熟卵泡比例的情况下注射HCG对卵子发育及妊娠结局的影响,摸索最适合的成熟卵泡比例。【方法】本回顾性研究共纳入198例需行单精子胞浆注射(ICSI)助孕治疗的女性不孕患者。按照HCG日成熟卵泡(≥18 mm)的不同比例将患者分成3组:1低比例组:成熟卵泡比例≤20%;2中比例组:20%<成熟卵泡比例≤40%;3高比例组:成熟卵泡比例>40%,注射HCG后36h取卵,将获得的卵丘复合物剥除卵丘颗粒细胞用于检测GREM1和HAS2基因的mRNA表达水平。分别统计和比较3组患者卵子成熟、受精、胚胎发育及临床妊娠情况。【结果】卵子成熟率在低比例组显著低于中比例组和高比例组(P<0.05)。正常受精率在3组间无显著差异(P>0.05)。异常受精率在低比例组显著低于中比例组和高比例组(P<0.05)。卵裂率、可利用胚胎数在低比例和中比例组之间无显著差异,但均高于高比例组(P<0.05)。优质胚胎率、种植率、妊娠率在低比例组均显著高于中比例组和高比例组(P<0.05)。卵丘颗粒细胞GREM1和HAS2基因mRNA表达水平在低比例组显著高于中比例组和高比例组(P<0.05)。【结论】采用成熟卵泡比例决定HCG的注射时机可以更全面地反映卵泡的整体发育状态,并为把握HCG注射时机提供更为准确的依据。随着成熟卵泡比增加卵子的发育潜能逐渐降低,因此注射HCG时应将成熟卵泡的比例控制在一定范围较合适。[Objective]To discuss the feasibility of using proportion of dominant follicles as the guidance of HCG triggering,and investigate the effect of HCG triggering by different proportion of dominant follicles on the oocyte developmental competence and pregnancy outcome so as to investigate the suitable proportion for HCG triggering.[Methods]In the present retrospective study,one hundred and ninety-eight women who underwent intracytoplasmic sperm injection （ICSI） were divided into three groups according to the proportion of dominant follicles：（1） low proportion：〈 20%; （2） middle proportion：20%-40%; （3） high proportion：〉 40%.The collection of cumulus-oocyte complexes （COCs） was conducted 36 h after HCG injection.The cumulus granulosa cells were stripped off for detecting the mRNA expression of GREM1 and HAS2.The parameters of occyte developmental and pregnancy outcome were compared between the three groups.[Results]Oocyte maturation rate in the low proportion group was lower than that in the middle and high proportion group （P 〈 0.05）.The normal fertilization rate was not different between the three group （P 〉 0.05）.The abnormal fertilization rate in the low proportion group was lower than that in the middle and high proportion group （P 〈 0.05）.The cleavage rate and availible embryo number in the low proportion group were not significantly different from those in the middle proportion group,and were higher than those in the high proportion group （P〈0.05）.The high-quality embryo rate,implantation rate and pregnancy rate in the low proportion group were higher than those in the middle and high proportion group （P 〈 0.05）.The mRNA expression level of GREM1 and HAS2 in the low proportion group were higher than that in the middle and high proportion group （P 〈 0.05）.[Conclusion]The proportion of dominant follicle number may reflect thoroughly the global state of all the follicles in ovaries and serve as the objective basis for HCG triggering.The oocyte deve

关 键 词：HCG注射 卵泡经线 促排卵刺激 体外受精-胚胎移植 

分 类 号：R711.6[医药卫生—妇产科学]