肾素活性、血管紧张素Ⅱ与卵巢过度刺激综合征的相关性研究

目的探讨肾素活性(RA)及血管紧张素Ⅱ(AⅡ)与卵巢过度刺激综合征(OHSS)发病的相关性.方法用放射免疫(RIA)法测定32例超排卵治疗患者、10例OHSS患者与5例自然周期不孕症患者的血浆,21例超排卵患者、7例OHSS患者的卵泡液,3例OHSS患者胸、腹水,5例自然周期不孕患者腹腔液,6例卵巢癌患者腹水中的RA及AⅡ水平.结果血浆RA、AⅡ水平在自然周期与超排卵后卵巢不同反应状态下,均呈从晚卵泡期至围排卵期、中黄体期逐渐递增趋势,晚黄体期未妊娠时二者水平则下降,妊娠则大多上升;OHSS患者中黄体期血浆RA与AⅡ水平分别为(19.9±19.0) μg*L-1*h-1 与(397.0±378.2) ng/L,均显著高于其他患者(P<0.01～0.05);超排卵患者中黄体期与晚卵泡期二者水平比较,差异有显著性(P<0.05);用与未用白蛋白预防OHSS的患者间,各期血浆二者水平差异均无显著性(P>0.05);OHSS患者治疗后血浆中二者水平呈非常显著性的下降趋势.卵泡液中AⅡ水平、卵巢高反应者与OHSS患者卵泡液中的RA水平,均显著高于同期血浆.3例OHSS患者胸、腹水中RA、AⅡ水平,高于同期血浆水平,但不孕患者腹腔液与卵巢癌患者腹水中的水平极低.结论 RA、AⅡ与OHSS的病理生理过程密切相关,可能是其发病的重要原因之一.

Association between renin activity, angiotensin II and ovarian hyperstimulation syndrome

OBJECTIVE: To investigate the association between renin-like activity (RA) and angiotensin II (A II) and the ovarian hyperstimulation syndrome (OHSS). METHODS: Blood samples were taken from 42 patients undergoing in vitro fertilization (IVF). According to the ovarian stimulating response, the patients were divided into 4 groups: group I, low responders, 7 cases; group II, moderate responders, 8 cases; group III a high responders without using albumin, 7 cases, group III b, high responders with albumin, 10 cases; group IV, severe and moderate OHSS, 10 cases. 5 patients for intrauterin insemination with natural cycle as control. Follicular fluid (FF) was collected at oocyte retrieval from 28 IVF patients (including 7 OHSS patients). Fluid from ascites and hydrothorax was obtained from 3 OHSS patients, and peritoneal fluid obtained from 5 infertility patients by laparoscopy and ascitic fluid obtained from 6 ovarian carcinoma patients served as control. RA and A II levels were measured by radioimmunoassay. RESULTS: Plasma RA and A II levels at mid-luteal phase from OHSS patients [(19.9 +/- 19.0) micrograms.L-1.h-1 and (397.0 +/- 378.2) ng/L] were significantly higher than those from the other patients (P < 0.01-0.05), also the levels at mid-luteal phase from IVF patients were significantly higher than those at late-follicular phase [(4.1 +/- 2.9)-(4.9 +/- 3.2) micrograms.L-1.h-1 Vs (1.5 +/- 0.9)-(1.9 +/- 1.0) micrograms.L-1.h-1, (85.5 +/- 49.5)-(109.4 +/- 46.0) ng/L Vs (33.6 +/- 15.9)-(37.0 +/- 17.1) ng/L, P < 0.01-0.05]. RA and A II levels in FF were significant higher than those in plasma (P < 0.01-0.05). A II in ascitic fluid in OHSS patients was 4 to 8 times higher than that in plasma, while RA in ascitic fluid was 1.5 to 3 times higher than that in plasma, but the levels of A II and RA in controls were very low. The plasma RA and A II levels dropped very significantly along with clinical improvement (P < 0.01). CONCLUSION: These findings suggest that RA and A II are associated with the pathogenesis of capillary leakage in OHSS.