生长激素对卵巢低反应患者卵泡液生长激素、胰岛素样生长因子-I及胰岛素样生长因子结合蛋白-3水平的影响  

Growth hormone supplementation in poor responders: changes in the levels of growth hormone, insulin-like growth factor-I and IGF binding protein-3

作　　者：蔡贺[1] 张天真[1] 孔令晶[1] 沈浣[1] 

机构地区：[1]北京大学人民医院生殖医学中心,100044

出　　处：《中国妇产科临床杂志》2016年第4期328-332,共5页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨生长激素(GH)对卵巢低反应患者血清及卵泡液(FF)中GH、胰岛素样生长因子I(IGFI)和胰岛素样生长因子结合蛋白-3(IGFBP-3)水平的影响。方法采用前瞻性、自身对照研究方法,选择体外受精胚胎移植(IVF-ET)中低反应患者14例,连续两个卵巢刺激周期均采用微刺激方案。第1周期:氯米芬(CC)+促性腺激素(Gn组);如该周期仍为卵巢低反应者,第2周期添加GH(Gn+GH组)。结果 1 GH治疗后,患者的受精数由(1.36±1.01)个提高到(2.35±0.93)个(P<0.05);可利用胚胎数和冷冻胚胎数均由(1.94±1.03)个提高到(2.07±0.92)个(P<0.05)。2 GH治疗后,血清IGF-I值由基础值(161.57±44.83)ng/ml升高到(246.45±107.72)ng/ml(P<0.05)。3 Gn+GH周期卵泡液IGF-I水平(129.89±51.20)ng/ml明显高于Gn周期(99.82±40.52)ng/ml(P<0.1)。4 Gn+GH周期卵泡液中GH与IGF-I及IGFBP-3无线性相关性,仅IGF-I和IGFBP-3水平呈线性相关(r=0.598,P<0.05)。结论 GH改善卵巢低反应患者促排卵反应,可能与其明显升高卵泡液中IGF-I有关。Objective To evaluate the effects of adjunctive growth hormone（GH） on insulinlike factor-I（IGF-I）, IGF binding protein-3（IGFBP-3） levels in serum and follicular fluid（FF） among women with poor ovarian response（POR） during mildstimulation ovulation. It is a prospective, selfcontrolled study. Methods This is a prospective, selfcontrolled study. 14 patients with POR met the inclusion criteria and recruited in this study. They were treated with mild ovarian stimulation using clomiphene（CC） combined with gonadotropin（Gn） in the first cycle,, exogenous GH supplementation in the second mild stimulation cycle（Gn＋GH） was given to patient with poor response with CC＋Gn. Results（1） The number of fertilized oocytes increased from（1.36±1.01） to（2.35±0.93）（P 〈0.05） after treated by GH. Both the variable embryos and cryopreserved embryos were enhanced from（1.94±1.03） to（2.07±0.92）（P 〈0.05）.（2） Serum levels of IGF-I was increased from（161.57±44.83）ng/ml to（246.45±107.72）ng/ml（P 〈0.05） after GH treatment.（3） Gn＋GH cycle：the levels of IGF-I（99.82±40.52）ng/ml in FF were significantly higher than that levels in Gn cycle（129.89±51.20）ng/ml, P 〈0.1）.（4） Significant correlations were discovered between FF concentrations of GH and IGF-I, GH and IGFBP-3, IGF-I and IGFBP-3 in GH cycle. However, only the relationship between IGF-I and IGFBP-3 was remained in GH＋ cycle. Conclusions The efficacy of GH might be dependent on improved oocyte and subsequent embryo quality via enhanced IGF-I levels in the follicular zone.

关 键 词：生长激素 胰岛素样生长因子-I 胰岛素样生长因子结合蛋白-3 卵巢低反应 微刺激 卵泡液 

分 类 号：R714.8[医药卫生—妇产科学]