二至天癸方对高龄妇女体外受精技术中优质胚胎率的影响  

Effect of Erzhi Tiangui Recipe on High Quality Embryo Rate and Follicular Fluid Proteomics of Elderly IVF Women

作　　者：连方[1] 孙金龙[1] 孙振高[1] 吴海萃[1] 张楠[1] 于艺 LIAN Fang;SUN Jin-long;SUN Zhen-gao;WU Hai-cui;ZHANG Nan;YU Yi(Reproductive and Genetic Center of Integrated Traditional and Western Medicine,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan（250011)

机构地区：[1]山东中医药大学附属医院中西医结合生殖与遗传中心,济南250011

出　　处：《中国中西医结合杂志》2018年第11期1306-1311,共6页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：山东省重点研发计划项目(No.2015GSF119018)

摘　　要：目的观察补肾益阴中药二至天癸方对高龄肾气阴两虚证妇女体外受精(IVF)结局的影响及卵泡液相关蛋白表达的改变。方法 100例均为肾气阴两虚证的高龄妇女,采用随机数字+信封法双盲分为两组,对照组(50例)和试验组(50例),启动日分别给予安慰剂、二至天癸颗粒冲剂联合拮抗剂方案,观察治疗前后证候积分、促性腺激素(Gn)天数、Gn量、获卵数、2原核(PN)数、卵裂数、Ⅰ级胚胎数、Ⅰ+Ⅱ级胚胎数,采用LC-MS/MS技术筛选鉴定差异蛋白并检索其生物信息学功能。结果两组Ⅰ级胚胎数分别为0.64±1.03 vs. 2.11±2.05、优质胚胎率分别为17.1%vs. 51.1%,对照组均低于试验组(P<0.05)。LC-MS/MS质谱分析结果显示,与对照组比较,试验组有11个差异蛋白,在对照组中高表达4个(RBP4、FCGR3A、IGFBP6、IGFBP3),低表达7个(TIMP1、TGFBI、TNFRSF1A、IGFALS、GTF3C1、CCDC112、POLE),总体趋势提示试验组卵泡液中细胞凋亡效应下调。结论高龄肾气阴两虚证妇女经予中药二至天癸方治疗后可提高IVF中优质胚胎率,其机制可能与卵泡液中的凋亡效应蛋白表达下调有关。Objective To observe the effect of Erzhi Tiangui Recipe （ETR） on the outcome of elderly in vitro fertilization （IVF） women with Shen qi-yin deficiency syndrome （SQYDS）, and to study the biological mechanism of follicular fluid proteomics. Methods Totally 100 elderly women with SQYDS were equally assigned to the control group and the test group by random digit table plus envelop doubleblinded method. Patients in the control group received placebo plus antagonist regimen, while those in the test group received ETR plus antagonist regimen on the day of starting ovarian stimulation（OS） treatment. Syndrome integrals, Gn days, Gn amount, the number of retrieved oocytes, 2PN number, and cleavage number, the number of grade I embryos and grade （ Ⅰ ＋ Ⅱ） embryos were observed before and after treatment. The differentially expressed proteins were identified by LC-MS/MS technique, and bioinformatics function retrieved. Results The number of grade Ⅰ embryos in both groups were 0.64 ± 1.03 and 2.11 ±2.05, and the high-grade embryo rate were 17.1% and 51.1%. They were much lower in the control group than in the test group （P 〈0.05）. LC-MS/MS showed, as compared with the control group, there were 11 differentially expressed proteins in the test group. In the control group, four proteins were up-regulated （RBP4, FCGR3A, IGFBP6, IGFBP3）, and seven were down-regulated （TIMP1, TGFBI, TNFRSF1A, IGFALS, GRF3C1, CCDC 112, POLE）. The overall trend indicated that apoptosis effect was down-regulated in the follicular fluid of the test group. Conclusion After treated with ETR, high quality embryo rate could be elevated in elderly IVF women with SQYDS, which might be associated with down- regulated expression of apoptosis protein in the follicular fluid.

关 键 词：二至天癸方 高龄妇女 蛋白质组学 卵泡液 优质胚胎率 

分 类 号：R714.8[医药卫生—妇产科学]