PPOS促排卵方案对颗粒细胞芳香化酶CYP19A1和ERβ受体表达的自身对照研究  

A comparative study of the expression of aromatase CYP19A1 and ERβreceptor in granulosa cells under different ovulation induction protocols:PPOS versus long protocol

作　　者：谭小方[1] 刘霖 马薇薇 李浩[1] 丁家怡[1] TAN Xiao-fang;LIU Lin;MA Wei-wei;LI Hao;DING Jia-yi(Reproductive Medicine Center,Affiliated Maternity and Child Health Care Hospital of Nantong University,Nantong 226018,Jiangsu,China;不详)

机构地区：[1]南通大学附属南通妇幼保健院生殖医学中心,江苏南通226018 [2]南通大学医学院,江苏南通226018

出　　处：《广东医学》2024年第4期494-498,共5页Guangdong Medical Journal

基　　金：江苏省卫生创新团队项目;2020年度南通市市级科技计划(指导性)立项项目(MSZ20007);南通大学临床医学专项项目(2022LY014)。

摘　　要：目的研究第一周期行黄体期减量长方案行体外受精-胚胎移植(IVF-ET)促排卵过程中黄体生成素(LH)偏低(扳机日LH<1.2 mIU/mL)的反复种植失败(RIF)患者,第2周期改用高孕激素状态下促排卵(PPOS)方案。检测两种促排卵方案中颗粒细胞中芳香化酶CYP19A1和ERβ受体的mRNA和蛋白质表达水平,以探讨不同促排卵方案对卵泡颗粒细胞发育的影响。方法对2020年1月至2022年1月在南通大学附属南通妇幼保健院生殖医学中心行IVF-ET的RIF患者进行研究,第1周期采用黄体期减量长方案RIF患者,第2周期改采用PPOS方案患者共36例。同时收集两种方案促排卵卵泡液中壁层颗粒细胞,检测颗粒细胞中芳香化酶CYP19A1和ERβ受体的mRNA和蛋白质表达水平,自身对照分析两种促排卵方案的临床和实验室指标,研究不同促排卵方案对卵泡颗粒细胞发育的影响。结果PPOS方案和长方案平均获卵数、成熟卵母细胞数的比较差异无统计学意义(P>0.05),而PPOS方案的扳机日LH水平、正常受精(2PN)数、正常受精率、优质胚胎率显著高于长方案(P<0.05)。PPOS组中CYP19A1和ERβ受体的mRNA表达水平均高于对照组,差异有统计学意义(P<0.001)。与mRNA表达水平结果相一致,PPOS组中CYP19A1和ERβ受体的蛋白表达水平均高于对照组,差异有统计学意义(P<0.05)。结论第1周期行长方案促排卵过程中LH偏低的RIF患者中,第2周期改用PPOS方案组后,扳机日的LH水平明显上升,同时壁层颗粒细胞ERβmRNA水平和蛋白水平均显著高于长方案组,CYP19A1 mRNA水平和蛋白水平均也显著高于长方案组,改用PPOS方案后,LH水平有所提高,改善了患者的卵子质量,进而提高了胚胎质量。Objective To investigate the impact of the PPOS(progestin-primed ovarian stimulation)protocol on the mRNA and protein expression levels of aromatase CYP19A1 and ERβreceptor in granulosa cells compared to the conventional long protocol in patients with repeated implantation failure(RIF)experiencing low LH levels during in vitro fertilization-embryo transfer(IVF-ET)procedures.Methods A total of 36 RIF patients who underwent IVF-ET at the Reproductive Medicine Center of the Affiliated Maternity and Child Health Hospital of Nantong University from January 2020 to January 2022 were enrolled in the study.In the first cycle,the long protocol was used,and in the second cycle,the PPOS protocol was adopted.Granulosa cells from follicular fluid were collected from both protocols for the analysis of mRNA and protein expression levels of CYP19A1 and ERβreceptors.Clinical and laboratory parameters were compared between the two protocols for a self-controlled analysis to investigate the impact on granulosa cell development.Results The comparison of the average number of retrieved oocytes and mature oocytes showed no statistically significant differences between the PPOS and long protocols(P>0.05).However,the PPOS protocol demonstrated significantly higher LH levels on the trigger day,normal fertilization(2PN)numbers,normal fertilization rates,and high-quality embryo rates compared to the long protocol(P<0.05).The mRNA expression levels of CYP19A1 and ERβreceptors in the PPOS group were significantly higher than those in the control group(P<0.001).Consistent with the mRNA expression results,the protein expression levels of CYP19A1 and ERβreceptors in the PPOS group were also significantly higher than those in the control group(P<0.05).Conclusion In RIF patients with low LH levels during the ovulation induction process in the first cycle using the long protocol,switching to the PPOS protocol in the second cycle resulted in a significant increase in LH levels on the trigger day.Simultaneously,mRNA and protein levels of ERβand

关 键 词：孕激素 促排卵 颗粒细胞 体外受精-胚胎移植 

分 类 号：R711.6[医药卫生—妇产科学] R713.7[医药卫生—临床医学]