继发性不孕患者卵泡液25-（OH）D水平与IVF卵母细胞发育关系的研究#br#

目的　探讨继发性不孕患者卵泡液25-（OH）D水平与体外受精（IVF）卵母细胞发育及临床结局的关系。方法　选取继发性不孕且需行体外受精（IVF）的192例患者作为研究对象，根据继发性不孕原因分为4组：输卵管因素组58例、子宫内膜异位症组45例、多囊卵巢综合征组47例、卵巢储备不足组42例。根据卵泡液25-（OH）D水平聚类分析分为2组，A组121例，B组71例。采用酶联免疫吸附测定（ELISA）法检测卵泡液25-（OH）D水平；采用化学发光免疫分析法测定外周血激素水平，包括雌二醇、孕酮、黄体生成素（LH）、卵泡刺激素（FSH）；行阴道彩超测量卵泡数及卵泡直径；在培养第3天（D3）及第5天（D5）进行胚胎评估。分析A组和B组卵泡液中25-（OH）D水平与IVF卵母细胞发育（IVF正常受精率、D3优质胚胎形成率、D5优质囊胚形成率）及临床结局（临床妊娠率）的关系。结果　4个不同病因组间年龄、体质量指数（BMI）、雌二醇、孕酮、LH、FSH及卵泡液25-（OH）D水平比较差异无统计学意义。B组卵泡液25-（OH）D水平显著高于A组（P＜0.05）；B组HCG日大卵泡数及雌二醇、孕酮水平较A组显著升高（P＜0.05）；B组IVF正常受精率、D3优质胚胎形成率、D5优质囊胚形成率、临床妊娠率均显著高于A组（P＜0.05）。结论　在继发性不孕行IVF治疗的女性中，卵泡液25-（OH）D高水平更易产生大卵泡及优质胚胎，其临床妊娠率也较高。

Study on the relationship between follicular fluid 25-(OH) D level and in vitro fertilization oocyte development and clinical outcome in secondary infertile women

Objective　To explore the relationship between follicular fluid 25-(OH) D level and in vitro fertilization (IVF) oocyte development and clinical outcome in secondary infertile women. Methods　The total of 192 women with secondary infertility undergoing IVF were selected as the research objects. According to the causes of secondary infertility, patients were divided into four groups: tubal factor group (58 cases), endometriosis group (45 cases), polycystic ovary syndrome group (47 cases) and ovarian reserve deficiency group (42 cases). The level of 25-(OH) D in follicular fluid was measured by ELISA. One hundred and ninety-two subjects were divided into two groups according to the cluster analysis of 25-(OH) D levels in follicular fluid, including 121 cases in group A and 71 cases in group B. The levels of hormones in peripheral blood including estradiol, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) were measured by chemiluminescence immunoassay. The number and diameter of follicles were measured by vaginal ultrasound. Embryo evaluation was performed on the 3rd day (D3) and the 5th day (D5) of culture. The relationship between 25-(OH) D level in follicular fluid and IVF oocyte development (the normal fertilization rate, D3 quality embryo formation rate, D5 quality blastocyst formation rate) and clinical outcome (clinical pregnancy rate) was analyzed. Results　There were no significant differences in follicular fluid 25-(OH) D levels between four groups of patients. The level of 25-(OH) D in follicular fluid was significantly higher in group B than that of group A (P＜0.05). The number of large follicles and the levelsof estradiol and progesterone were significantly higher in group B than those in group A (P＜0.05). The normal fertilization rate, D3 quality embryo formation rate, D5 quality blastocyst formation rate and clinical pregnancy rate were significantly higher in group B than those in group A (P＜0.05). Conclusion　In secondary infertility women treated with IVF, the high level of follicular fluid 25-(OH) D is more likely to produce large follicles and high-quality embryos, and their clinical pregnancy rate is also higher.