摘要
目的探讨卵泡液中叉头框转录因子O亚族1(Forkhead box transcription factor O1, FoxO1)mRNA、天冬氨酸蛋白水解酶-3(Caspase-3)mRNA、生长分化因子-9(growth differentiation factor-9, GDF-9)水平与优质胚胎数的相关性及其预测不孕患者体外受精-胚胎移植(in vitro fertilization-embryo transfer, IVF-ET)临床妊娠的效能。方法选取2017年2月至2020年1月期间驻马店市中心医院收治的468例接受IVF-ET治疗的不孕患者进行病例对照研究, 根据是否妊娠分为妊娠组(n=248)、未妊娠组(n=220), 比较两组一般资料、取卵日性激素水平、卵泡液FoxO1 mRNA、Caspase-3 mRNA、GDF-9水平。采用Pearson分析卵泡液FoxO1 mRNA、Caspase-3 mRNA、GDF-9之间及其与优质胚胎数的相关性, 采用logistic回归方程分析IVF-ET临床妊娠的相关因素并以受试者工作特征(receiver operating characteristic, ROC)曲线分析卵泡液FoxO1 mRNA、Caspase-3 mRNA、GDF-9预测临床妊娠的效能。结果妊娠组优质胚胎数多于未妊娠组[(2.59±0.68)枚比(1.78±0.62)枚, P<0.001], 基础卵泡刺激素(follicle-stimulating hormone, FSH)水平、基础黄体生成素(luteinizing hormone, LH)水平低于未妊娠组[(7.16±0.29)U/L比(6.21±0.34)U/L, (8.72±1.24)U/L比(10.65±1.01)U/L, 均P<0.001], 取卵日雌二醇高于未妊娠组[(848.18±50.68)ng/L比(605.35±46.79)ng/L, P<0.001]。妊娠组FoxO1 mRNA、GDF-9水平高于未妊娠组, Caspase-3 mRNA水平低于未妊娠组(均P<0.001);FoxO1 mRNA与Caspase-3 mRNA呈负相关, 与GDF-9呈正相关(均P<0.001);Caspase-3 mRNA与GDF-9呈负相关(均P<0.001);FoxO1 mRNA、GDF-9与优质胚胎数呈正相关, Caspase-3 mRNA与优质胚胎数呈负相关(均P<0.001)。多元线性回归分析显示, 在排除混杂因素后, FoxO1 mRNA、Caspase-3 mRNA、GDF-9水平与优质胚胎数相关(均P<0.001)。以IVF-ET临床妊娠为因变量, 纳入优质胚胎数、基础FSH、基础LH、取卵日雌二醇、FoxO1 mRNA、Caspase-3 mRNA、GDF-9为自变量进行logistic回归方程分析, 结果显示优质胚胎数、基础FSH、基础LH、取卵日雌二醇、FoxO1 mRNA、Caspase-3、GDF-9均与临床妊娠结局显著相关(均P<0.001)。FoxO1 mRNA、Caspase-3 mRNA、GDF-9水平联合预测IVF-ET临床妊娠的曲线下面积(area under curve, AUC)值为0.891, 大于FoxO1 mRNA指标单独检测(AUC=0.796, P=0.012)。结论 FoxO1 mRNA、Caspase-3 mRNA、GDF-9水平与胚胎发育及性激素水平有关, 且FoxO1 mRNA、GDF-9水平升高, Caspase-3 mRNA水平降低有利于临床妊娠, 三者联合检测可为评价IVF-ET临床妊娠提供参考。
Objective To explore the correlation between Forkhead box transcription factor O1(FoxO1)mRNA,Caspase-3 mRNA,growth differentiation factor-9(GDF-9)expression levels and the number of high-quality embryos and the efficacy of predicting in vitro fertilization-embryo transfer(IVF-ET)clinical pregnancy in infertile patients.Methods A case-control study of 468 infertile patients who received IVF-ET treatment from February 2017 to January 2020 in Zhumadian Central Hospital was performed.According to whether pregnant,patients were divided into pregnancy group(n=248)and non-pregnancy group(n=220).We compared the general data,sex hormone levels on the day of egg retrieval,FoxO1 mRNA,caspase-3 mRNA,and GDF-9 levels in follicular fluid between the two groups.Pearson was used to analyze the relationship between FoxO1 mRNA,Caspase-3 mRNA,and GDF-9 in follicular fluid and the number of high-quality embryos.The logistic regression equation was used to analyze the related factors of IVF-ET clinical pregnancy.The receiver operating characteristic(ROC)curve was used to analyzed the efficacy of follicular fluid FoxO1 mRNA,Caspase-3 mRNA,GDF-9 in predicting clinical pregnancy.Results The number of high-quality embryos in pregnancy group was higher than that in non-pregnancy group(2.59±0.68 vs.1.78±0.62,P<0.001),the basal follicle-stimulating hormone(FSH)and luteinizing hormone(LH)were lower than those in non-pregnancy group[(7.16±0.29)U/L vs.(6.21±0.34)U/L,(8.72±1.24)U/L vs.(10.65±1.01)U/L,all P<0.001]and the estradiol on the day of oocytes retrieved was higher than that of non-pregnancy group[(848.18±50.68)ng/L vs.(605.35±46.79)ng/L,P<0.001].FoxO1 mRNA and GDF-9 in pregnancy group were higher than those in non-pregnancy group,Caspase-3 mRNA was lower than that in non-pregnancy group(P<0.001).FoxO1 mRNA was negatively correlated with Caspase-3 mRNA and positively correlated with GDF-9(P<0.001),Caspase-3 mRNA was negatively correlated with GDF-9(P<0.001).FoxO1 mRNA and GDF-9 were positively correlated with the number of high-quality embryos,while Caspase-3 mRNA was negatively correlated with the number of high-quality embryos(all P<0.001).Multiple linear regression analysis showed that after excluding confounding factors,the levels of FoxO1 mRNA,Caspase-3 mRNA,and GDF-9 were still correlated with the number of high-quality embryos(all P<0.001).IVF-ET clinical pregnancy was taken as a dependent variable and the number of high-quality embryos,basic FSH,basic LH,estradiol,FoxO1 mRNA,Caspase-3 mRNA,and GDF-9 were included as independent variables for logistic regression analysis.The number of high-quality embryos,basic FSH,basic LH,estradiol on the day of oocytes retrieved,FoxO1 mRNA,Caspase-3 mRNA and GDF-9 were significantly correlated with clinical pregnancy(all P<0.001).The area under curve(AUC)value of FoxO1 mRNA,Caspase-3 mRNA and GDF-9 mRNA combined to predict IVF-ET clinical pregnancy was 0.891,which was larger than FoxO1 mRNA alone(AUC=0.796,P=0.012).Conclusion FoxO1 mRNA,Caspase-3 mRNA,and GDF-9 levels are related to embryonic development and sex hormone levels.Increased expression of FoxO1 mRNA and GDF-9 and decreased expression of Caspase-3 mRNA are beneficial to clinical pregnancy.Combined detection of FoxO1,Caspase-3 and GDF-9 can evaluate IVF-ET clinical pregnancy.
作者
张雪莹
曹海英
侯铁奇
刘秀玲
Zhang Xueying;Cao Haiying;Hou Tieqi;Liu Xiuling(Gynecology Department,Zhumadian Central Hospital,Zhumadian 463000,China;The Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华生殖与避孕杂志》
CSCD
北大核心
2022年第4期364-371,共8页
Chinese Journal of Reproduction and Contraception
关键词
受精
体外
胚胎移植
优质胚胎数
卵泡刺激素
叉头框转录因子O亚族
天冬氨酸蛋白水解酶-3
生长分化因子-9
Fertilization in vitro
Embryo transfer
Number of high-quality embryos
Follicle-stimulating hormone
Family O subgroup of fork-head frame transcription factor
Caspase-3
Growth differentiation factor-9
