PCOS合并代谢综合征患者卵泡液激肽谱与卵子质量的关系

摘要

目的 探讨PCOS合并代谢综合征患者卵泡液内脂质代谢模式与卵泡液内激肽系统表达谱及胚胎发育的关系. 方法 前瞻性队列研究,选取年龄匹配的体外受精助孕患者共90例,其中单纯PCOS 30例,PCOS合并代谢综合征患者30例,正常对照组30例.所有患者均采用拮抗剂方案促排卵,取卵日收集单个优势卵泡(直径18~21 mm)卵泡液,采用悬液芯片技术检测卵泡液内激肽表达谱,比较各组患者卵泡液内脂代谢指标、激肽表达谱及相关的胚胎质量. 结果 (1)三组患者基础性激素(FSH,LH,E2,P)水平、HCG扳机日和取卵日激素(LH,E2,P)水平,及收集卵泡液的卵泡直径大小均无统计学差异(P>0.05).(2)PCOS合并代谢综合征组患者的体重指数、血清和卵泡液内甘油三酯水平均显著高于其他两组患者(P<0.05),而高密度脂蛋白水平显著下降(P<0.05);PCOS合并代谢综合征患者卵泡液内胆固醇水平和TNF-α水平均显著高于其他两组患者(P<0.05),而G-CSF水平显著降低(P<0.05);其他15种激肽水平各组间无统计学差异(P>0.05).(3)卵泡液G-CSF水平与其内胆固醇(TG)和甘油三酯(TC)水平存在负相关(相关指数分别为0.29和0.25),而TNF-α则与TG水平正相关(相关指数0.26).(4)三组患者间受精率、胚胎可用率均无统计学差异(P>0.05),优质胚胎率在PCOS合并代谢综合征组(20.0%)显著低于PCOS组(38.4%)及对照组(34.6%)(P<0.05). 结论 PCOS合并代谢综合征患者卵泡液内脂代谢异常指标主要与激肽表达谱中的G-CSF和TNF-α有关;由于激肽系统对卵子的发生存在直接影响,我们推断PCOS合并代谢综合征患者的卵子发育潜能下降的原因很可能涉及这一机制.%Objective:To provide insights into the correlation between lipid metabolic pattern and cytokine profile in follicular fluid (FF) and embryo quality in women with polycystic ovary syndrome (PCOS) & metabolic syndrome (MS).Methods:Ninety women undergoing IVF treatment,including 60 PCOS patients and 30 age-matched controls,were recruited in this prospective cohort study.The PCOS patients were divided into PCOS non MS (n=30) and PCOS & MS (n=30) groups.All patients received controlled ovarian stimulation by using GnRH antagonist protocol.The follicular fluid of single dominant follicle with diameter 18-21 mm was collected on the day of oocyte retrieval.The cytokine expression in follicular fluid was detected by suspension array technique (SAT).The lipid metabolism,follicle expression and related embryonic quality in follicular fluid were compared among the groups.Results:The basic hormone levels of LH,E2,progesterone on HCG triggering day and the levels of LH,E2,progesterone on the day of oocyte retrieval,and the follicular diameter were not statistically different (P>0.05).PCOS & MS group had significantly increased BMI,TG and decreased serum HDL concentrations in serum and FF compared with the other two groups(P<0.05).The PCOS & MS group was associated with significantly higher TC & TG and lower HDL concentrations in FF compared with the control group (P<0.05).The levels of cholesterol and TNF-α in follicular fluid of PCOS patients with metabolic syndrome were significantly higher than those of the other two groups (P<0.05),while G-CSF level was significantly decreased (P<0.05).There were no significant differences in the other 15 cytokine levels (P>0.05).The G-CSF level in FF was negatively correlated with TG (R2=0.29) and TC (R2=0.25),while TNF-α concentration was positively associated with TG (R2=0.26).The percentage of the high-quality embryo significantly decreased in the PCOS & MS group (20.0%) than in the PCOS group (38.4%) and control group (34.6%)(P<0.05).Conclusions:The abnormal indexes of lipid metabolism in follicular fluid of patients with PCOS complicated with metabolic syndrome were mainly related to G-CSF and TNF-α in the cytokine expression profile.Since the kinin system has a direct effect on oocyte development,the reasons for the decline in oocyte development potential in PCOS patients with metabolic syndrome are likely to involve this mechanism.