發(fā)布時(shí)間：2018-02-24 20:38

  本文關(guān)鍵詞： 子宮內(nèi)膜異位癥 不孕癥 體外受精 生長(zhǎng)激素 胰島素樣生長(zhǎng)因子-I　出處：《福建醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：觀察并探討生長(zhǎng)激素對(duì)卵巢子宮內(nèi)膜異位癥術(shù)后不孕患者，在IVF-ET(體外受精-胚胎移植)助孕治療中的效果及可能的機(jī)制，為臨床應(yīng)用提供理論依據(jù)。 方法：來自2013年1月至2013年12月在我院就診行IVF-ET的不孕患者,選取其中卵巢子宮內(nèi)膜異位癥（EMS）術(shù)后不孕患者51例，輸卵管因素不孕患者61例，分兩部分；分別按照是否應(yīng)用GH再分研究組和對(duì)照組。所有患者均在我中心采用GnRH-a超長(zhǎng)/長(zhǎng)方案降調(diào)節(jié)，，達(dá)降調(diào)標(biāo)準(zhǔn)后予促性腺激素（Gn）啟動(dòng)。Gn啟動(dòng)日始應(yīng)用GH(注射用重組生長(zhǎng)激素,賽增)2.5IU/日至注射HCG（絨促性素）日為研究組，未用GH為對(duì)照組。觀察比較各組患者卵巢反應(yīng)、子宮內(nèi)膜的各項(xiàng)指標(biāo)及助孕結(jié)局。應(yīng)用化學(xué)發(fā)光法檢測(cè)患者血清及卵泡液中生長(zhǎng)激素（GH）、胰島素樣生長(zhǎng)因子-I(IGF-I)及胰島素樣生長(zhǎng)因子結(jié)合蛋白-3(IGFBP-3)的濃度。采用SPSS13.0行數(shù)據(jù)統(tǒng)計(jì)學(xué)分析。 結(jié)果： 1.GH對(duì)EMS術(shù)后不孕患者的卵巢反應(yīng)、子宮內(nèi)膜情況及IVF-ET結(jié)局的影響：EMS患者兩組間的各項(xiàng)臨床基本資料均無統(tǒng)計(jì)學(xué)差異(P0.05)。兩組間實(shí)驗(yàn)室及治療結(jié)局資料比較,達(dá)菲林用藥量、Gn天數(shù)、Gn總量、HCG日E2水平、獲卵數(shù)、受精率、2PN受精率、卵裂率、移植胚胎數(shù)目、周期取消率、子宮內(nèi)膜厚度及形態(tài)基本相似(P0.05)；研究組優(yōu)質(zhì)胚胎率、種植率、妊娠率較對(duì)照組在數(shù)值上有增高，但無統(tǒng)計(jì)學(xué)差異(P0.05)。 2.GH對(duì)輸卵管因素不孕患者的卵巢反應(yīng)、子宮內(nèi)膜情況及IVF-ET結(jié)局的影響:輸卵管因素不孕患者兩組間的各項(xiàng)臨床基本資料均無統(tǒng)計(jì)學(xué)差異(P0.05)。兩組間實(shí)驗(yàn)室及治療結(jié)局資料比較，達(dá)菲林用藥量、Gn天數(shù)、Gn總量、HCG日E2水平、獲卵數(shù)、受精率、2PN受精率、優(yōu)質(zhì)胚胎率、囊胚形成率、頂級(jí)囊胚形成率、種植率、妊娠率，子宮內(nèi)膜厚度及形態(tài),這些觀察指標(biāo)相近,均無統(tǒng)計(jì)學(xué)差異(P0.05)。 3.研究組與對(duì)照組間降調(diào)前、Gn啟動(dòng)前，血清GH、IGF-I、和IGFBP-3水平均無統(tǒng)計(jì)學(xué)差異(P0.05)。取卵日，GH組患者的血清及卵泡液IGF-I水平均高于對(duì)照組（P0.05），有統(tǒng)計(jì)學(xué)差異。血清及卵泡液中的GH及IGFBP-3水平與對(duì)照組相比無統(tǒng)計(jì)學(xué)差異(P0.05)。 結(jié)論： 1.生長(zhǎng)激素對(duì)卵巢子宮內(nèi)膜異位癥術(shù)后不孕患者的IVF-ET治療結(jié)局有改善趨勢(shì)，其機(jī)制可能與GH使IGF-I水平升高有關(guān)。認(rèn)為在EMS不孕患者中可考慮通過添加生長(zhǎng)激素改善妊娠結(jié)局。 2.生長(zhǎng)激素對(duì)輸卵管因素不孕患者的卵巢反應(yīng)及IVF-ET治療結(jié)局無影響。臨床不推薦其為內(nèi)分泌正常不孕患者的常規(guī)用藥。
[Abstract]:Objective: to observe the effect and possible mechanism of growth hormone (GH) in IVF-ET (in vitro fertilization-embryo transfer) assisted pregnancy in infertile patients with ovarian endometriosis, and to provide theoretical basis for clinical application. Methods: from January 2013 to December 2013, 51 infertile patients with ovarian endometriosis and 61 infertile patients with tubal factor were selected. According to whether GH was subdivided into study group and control group, all patients were treated with GnRH-a super long / long regimen down-regulation in our center, and then they were treated with GH (recombinant growth hormone for injection) on the start day after reaching the standard of lowering the modulation of gonadotropin. The ovarian reaction of patients in each group was observed and compared between 2.5 IUD / day and HCG injection day, while GH was not used as control group. Chemiluminescence assay was used to detect the concentrations of growth hormone (GH), insulin-like growth factor (IGF-I) and insulin-like growth factor binding protein (IGFBP-3) in serum and follicular fluid. Results:. 1. Effects of GH on ovarian response, endometrium and IVF-ET outcome in infertile patients after EMS. There was no significant difference in clinical data between the two groups (P 0.05). Total number of days of administration of Dafiline and total amount of Gn HCG E2, egg number, fertilization rate, fertilization rate, cleavage rate, number of embryos transferred, cycle cancelling rate, endometrial thickness and morphology were basically similar (P0.05); the rate of high quality embryos, the rate of implantation, the rate of implantation, The pregnancy rate was higher than that of the control group, but there was no statistical difference (P 0.05). 2. Effects of GH on ovarian response, endometrium and IVF-ET outcome in infertile patients with tubal factors: there was no significant difference in clinical data between the two groups (P 0.05). The total number of days of administration of Dafiline and the total amount of Gn were: E2 level of HCG day, number of eggs obtained, fertilization rate of 2PN, rate of high quality embryo, blastocyst formation rate, rate of top blastocyst formation, implantation rate, pregnancy rate, endometrial thickness and morphology, which were similar to each other. There was no statistical difference (P 0.05). 3. Between the study group and the control group, before Gn was started, There was no significant difference in serum GH, IGF-I and IGFBP-3 levels. The levels of IGF-I in serum and follicular fluid of GH group were significantly higher than those in control group (P 0.05). There was no significant difference in GH and IGFBP-3 levels in serum and follicular fluid compared with control group (P 0.05). Conclusion:. 1. Growth hormone has a tendency to improve the outcome of IVF-ET treatment in infertile patients with ovarian endometriosis after operation, and its mechanism may be related to the elevation of IGF-I level. It is suggested that in infertile women with EMS, it may be considered to improve the outcome of pregnancy by adding growth hormone. 2. Growth hormone has no effect on ovarian response and outcome of IVF-ET treatment in infertile patients with tubal factors, and is not recommended as a routine medication for infertile patients with normal endocrine function.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳瓊?cè)A;濮德敏;李天;周衛(wèi)東;王勤;陳清西;;子宮內(nèi)膜異位癥小鼠腹腔巨噬細(xì)胞吞噬功能的變化規(guī)律[J];中國(guó)組織化學(xué)與細(xì)胞化學(xué)雜志;2008年04期

2 項(xiàng)云改;譚麗;張潔;;生長(zhǎng)激素對(duì)小鼠子宮內(nèi)膜容受性的影響[J];醫(yī)藥論壇雜志;2006年24期

3 楊曉玲;楊潔;焦曉艷;;生長(zhǎng)激素在體外授精-胚胎移植卵巢低反應(yīng)患者中的應(yīng)用[J];昆明醫(yī)科大學(xué)學(xué)報(bào);2012年08期

4 李雪梅,朱文杰,陳秀敏,張黎;生長(zhǎng)激素在體外受精周期中的應(yīng)用初探[J];實(shí)用醫(yī)學(xué)雜志;2004年08期

5 吳瑞英;鄒淑花;張全;王海濤;;生長(zhǎng)激素對(duì)IVF-ET周期中子宮內(nèi)膜的影響[J];生殖與避孕;2007年03期

6 項(xiàng)云改;譚麗;董方莉;;生長(zhǎng)激素對(duì)小鼠子宮內(nèi)膜VEGF、LIF、MMP-9及TIMP-1表達(dá)的影響[J];生殖與避孕;2007年10期

7 宋慧玲;郭藝紅;孫瑩璞;蘇迎春;;生長(zhǎng)激素對(duì)不同年齡卵巢儲(chǔ)備功能趨于低下患者IVF-ET治療結(jié)局的影響[J];生殖與避孕;2013年01期

8 孫梅;陳子江;;子宮內(nèi)膜異位癥對(duì)婦女生育力的影響[J];實(shí)用婦產(chǎn)科雜志;2012年08期

9 陳華;孫海翔;胡婭莉;王玢;王俊霞;陳騫;;生長(zhǎng)激素在體外受精胚胎移植的作用[J];江蘇醫(yī)藥;2006年05期

10 劉義,羅麗蘭,趙海波;子宮內(nèi)膜異位癥患者腹腔液腫瘤壞死因子α和白細(xì)胞介素6的測(cè)定及其對(duì)人精子活動(dòng)力和鼠胚胎的影響[J];中華婦產(chǎn)科雜志;2000年06期

本文編號(hào)：1531633