GM-CSF及性激素水平对卵泡和早期胚胎发育的影响

目的 探讨超促排卵周期取卵日（OPU）卵泡液中粒细胞巨噬细胞集落刺激因子（GM-CSF）及性激素水平对卵泡发育、卵子受精、卵裂及胚胎质量的影响.方法 用控制性超促排卵进行体外受精-胚胎移植（IVF-ET）治疗60例因输卵管因素不孕病人,在取卵时留取第一管清亮卵泡液,分别用酶联免疫吸附试验法（ELISA）和酶免疫分析法（EIA）测定60例卵泡液中GM-CSF浓度和促黄体生成素（LH）、孕酮（P）和雌二醇（E2）的含量,卵泡液按相应卵母细胞的成熟度、受精情况、卵裂和胚胎质量分组分析.结果 成熟卵泡组卵泡液中GM-CSF、LH和P水平均高于未成熟组（t=2.35～5.05,P〈0.05）,受精组卵泡液中GM-CSF、LH、P水平均高于未受精组（t=2.36～4.01,P〈0.05）;卵裂组与未卵裂组、高质量胚胎组与低质量胚胎组卵泡液中GM-CSF、P和LH水平无显著性差异（t=0.97～1.64,P〉0.05）;妊娠组GM-CSF和LH浓度高于未妊娠组（t=25.83、2.36,P〈0.05）,而孕酮含量无显著性差异（t=1,68,P〉0.05）;雌二醇浓度在各组间无明显差异（t=0.03～0.70,P〉0.05）.卵泡液GM-CSF与E2水平呈正相关（r=0.321,P〈0.01）,与P和LH水平无相关性（r=0.145、0.147,P〉0.05）.结论 OPU卵泡液中GM-CSF和LH浓度与相应卵泡的卵母细胞成熟及其后的受精有关,而与卵裂及胚胎质量无关, 卵泡液中适量黄体生成素和P促进卵母细胞的成熟.卵泡液中GM-CSF与E2有相关性,提示E2对卵泡液中的GM-CSF水平有调节作用.

EFFECTS OF GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR AND SEX HORMONE ON DEVELOPMENT OF OVARIAN FOLLICLES AND EMBRYOGENESIS IN EARLIER PERIOD

Objective To investigate the influence of granulocyte-macrophage colony-stimulating factor(GM-CSF) and the sex hormone in the follicular fluid(FF) on the day of ovum pick-up(OPU) during controlled ovarian hyper-stimulation(COH) cycles on follicle development,fertilization,cleavage,and the quality of embryo. Methods Sixty women with tubal infertility were treated with IVF-ET under controlled hyper-stimulation with GnRHa/FSH/HMG/HCG.The first tube of FF was kept while collecting oocytes.GM-CSF in the FF and serum were measured by enzyme-linked immunosorbent assay(ELISA) and estradiol(E_2),progesterone(P) and luteinizint hormone(LH) concentrations measured by an enzyme immunoassay(EIA).The maturity and fertilization of the oocytes were observed,and ultrasonography was performed to confirm clinical pregnancies four weeks after the embryo transfer. Results In mature-oocyte group,its FF contained higher levels of GM-CSF,P,and LH than those in the immature-oocyte group(t=2.35-5.05,P<0.05);in fertilized group,the levels of GM-CSF,P,and LH in FF were obviously higher than those in non-fertilized(t=2.36-4.01,P<0.05);no significant differences were seen in terms of GM-CSF,P,and LH between the cleavage and non-cleavage group,as well as the high-and low-embryo grade group(t=0.97-1.64,P>0.05).GM-CSF and LH in pregnant group were higher than non-pregnant(t=25.83,2.36;P<0.05),but no difference was found in P(t=1.68,P>0.05).Estradiol concentrations in the FF showed no significant differences among the groups(t=0.03-0.70,P>0.05).GM-CSF was positively correlated to E_2(r=0.321,P<0.01),but not to P and LH(r=0.145,0.147;P>0.05). Conclusion The levels of GM-CSF and LH in FF on OPU are related to the corresponding maturation of the oocyte and the then fertilization,and not related to cleavage and the quality of embryo.Adequate LH and P promote oocyte maturation.The correlation between GM-CSF and E_2 in FF indicates that E_2 regulates the level of GM-CSF in FF.