单纯性肥胖患者卵泡液中骨形态发生蛋白-15水平对胚胎质量的影响和初步预测价值  

Effects of bone morphogenetic protein-15 levels in follicular fluid of patients with simple obesity on embryo quality and preliminary predictive value

作　　者：王祁 梁慧 WANG Qi;LIANG Hui(Xuzhou Maternal and Child Health Care Hospital,Jiangsu 221000,China)

机构地区：[1]徐州市妇幼保健院,江苏徐州221000 [2]徐州医科大学附属徐州妇幼保健院,江苏徐州221009

出　　处：《现代医学》2024年第10期1526-1534,共9页Modern Medical Journal

摘　　要：目的:探究单纯性肥胖患者取卵日卵泡液中骨形态发生蛋白-15(BMP-15)水平对体外受精/胞浆内单精子注射(IVF/ICSI)胚胎质量的影响和预测价值。方法:选取2022年6月至2023年6月于我院生殖医学中心行IVF/ICSI助孕的118例不孕症患者为研究对象,按身体质量指数(BMI)分为对照组(18.5 kg·m^(-2)≤BMI<24 kg·m^(-2))、超重组(24 kg·m^(-2)≤BMI<28 kg·m^(-2))、肥胖组(BMI≥28 kg·m^(-2),)3组。所有患者均采用拮抗剂方案促排卵,收集月经第3天静脉血清,采用酶联免疫吸附试验法(ELISA)检测取卵日卵泡液中BMP-15含量。结果:与对照组相比,肥胖组抗苗勒氏管激素(AMH)和基础黄体酮(bP)显著降低,肥胖组基础促卵泡生成素(bFSH)较对照组和超重组均降低,超重组bP较对照组明显降低(P<0.05)。随着BMI增加,患者促性腺激素(Gn)用量显著增加,卵泡液BMP-15水平显著降低(P<0.05)。与对照组和超重组相比,肥胖组获卵总数、MetaphaseⅡ(MⅡ)率、囊胚形成率和优质胚胎率均减少(P<0.05)。非肥胖患者BMP-15高水平组受精率、优质胚胎率和囊胚形成率较低水平组均升高(P<0.05)。肥胖患者BMP-15高水平组MⅡ率、受精率、优质胚胎率和囊胚形成率较低水平组均升高(均P<0.05)。肥胖患者卵泡液BMP-15水平与MⅡ率、受精率、优质胚胎率和囊胚形成率均呈正相关。多因素逻辑回归分析显示BMP-15、AMH和bFSH是肥胖患者胚胎质量的独立影响因素(P<0.05)。BMP-15、AMH和bFSH对肥胖患者胚胎质量结局均具有较好的预测价值,且BMP-15联合bFSH组的检测效能明显高于单独检测(P<0.05)。结论:肥胖会降低育龄期妇女的卵泡液BMP-15表达,对胚胎质量产生负面影响,卵泡液BMP-15联合血清bFSH检测对单纯性肥胖女性胚胎质量的预测有较好效能。Objective:To investigate the impact and predictive value of bone morphogenetic protein-15(BMP-15)levels in follicular fluid on the quality of embryos in patients with simple obesity undergoing in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI).Methods:A total of 118 infertile patients who underwent IVF/ICSI at the Reproductive Medicine Center of our hospital from June 2022 to June 2023 were enrolled.Based on body mass index(BMI),patients were divided into 3 groups:control group(18.5 kg·m^(-2)≤BMI<24 kg·m^(-2)),overweight group(24 kg·m^(-2)≤BMI<28 kg·m^(-2)),and obese group(BMI≥28 kg·m^(-2)).All patients underwent ovarian stimulation using the antagonist protocol.Serum was collected on day 3 of menstruation,and BMP-15 levels in follicular fluid on the day of oocyte retrieval were measured using enzyme-linked immunosorbent assay(ELISA).Results:Compared to the control group,anti-Müllerian hormone(AMH)and baseline progesterone(bP)levels were significantly lower in the obese group,while baseline follicle-stimulating hormone(bFSH)levels were lower in both the obese and overweight groups(P<0.05).The amount of gonadotropins(Gn)required significantly increased with BMI,and BMP-15 levels in follicular fluid significantly decreased(P<0.05).The total number of retrieved oocytes,MetaphaseⅡ(MⅡ)rate,blastocyst formation rate,and high-quality embryo rate were all lower in the obese group compared to the control and overweight groups(P<0.05).In non-obese patients,the high BMP-15 group had higher fertilization,high-quality embryo,and blastocyst formation rates compared to the low BMP-15 group(P<0.05).Among obese patients,the high BMP-15 group had higher MⅡ,fertilization,high-quality embryo,and blastocyst formation rates than the low BMP-15 group(all P<0.05).In obese patients,BMP-15 levels in follicular fluid were positively correlated with MⅡrate,fertilization rate,high-quality embryo rate,and blastocyst formation rate.Multivariate Logistic regression analysis showed that BMP-15,AMH,and bFSH were

关 键 词：骨形态发生蛋白-15 身体质量指数 卵泡液 体外受精/胞浆内单精子注射 胚胎质量 

分 类 号：R714.8[医药卫生—妇产科学]