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目的:探讨不同控制性超促排卵(controlled ovarian hyperstimulation,COH)方案中血清及卵泡液(follicular fluid,FF)中抑制素B(inhibin B,INHB)的动态变化及其与COH结局的相关性。方法:收集因输卵管因素和/或男方因素首次接受体外受精/卵细胞质内单精子注射-胚胎移植(IVF/ICSI-ET)助孕患者COH过程各时间节点的血清及取卵(ovum pick up,OPU)日不同大小卵泡的FF,按筛选要求选取长方案组(A组,n=38)及非降调节方案组(B组,n=38)患者,对其血清及FF中INHB水平进行检测并行相关性分析。结果:①降调节过程中,血清INHB水平显著下降(P<0.01),且Gn启动日A组血清INHB水平较B组明显下降(P=0.000)。②A组和B组Gn启动后血清INHB水平呈上升趋势,至h CG注射日达高峰后下降,OPU后2 d显著下降(P<0.01);A组和B组基础及Gn启动后的血清INHB水平无统计学差异(P>0.05)。③ Gn第5日血清INHB水平与COH结局相关性最强,且Gn启动日血清INHB水平与Gn用量呈高度负相关(P<0.01)。④A组和B组FF中血清INHB水平随卵泡直径增大而升高,大卵泡的FF中INHB水平无统计学差异(P>0.05),但A组中小卵泡的FF中INHB水平显著高于B组(P<0.01);且大卵泡的FF中INHB水平与COH结局相关性最好。结论:①降调节后血清INHB水平预示降调节对卵泡同步化作用较好;②COH过程中血清及大中卵泡的FF中INHB水平能很好地预测卵巢反应性及COH结局。
Objective: To investigate the dynamic changes of inhibin B (INHB) in serum and follicular fluid (FF) in different controlled ovarian hyperstimulation (COH) regimens and its correlation with the outcome of COH. Methods: The ovum pick up and ovum pick up were collected at different time points during the COH process in ovulation-induced and / or male factor co-implantation in IVF / ICSI-ET. (OPU) day FF of different size follicles, according to the screening requirements, select the patients in the long-term group (group A, n = 38) and non-down-regulation group (group B, n = 38) Parallel correlation analysis. Serum INHB levels were significantly decreased (P <0.01), and serum INHB levels in group A were significantly lower than those in group B (P = 0.000). ② In group A and group B, serum INHB levels increased after initiation of Gn, and reached a peak at h CG injection day and decreased significantly 2 d after OPU (P <0.01); basal level of group A and group B and serum INHB No significant difference (P> 0.05). ③ The serum INHB level on the 5th day of Gn was the strongest correlation with the outcome of COH, and the serum INHB level on Gn start-up day was highly negatively correlated with the dosage of Gn (P <0.01). (4) INHB serum levels of FF in group A and group B increased with the increase of follicle diameter, and there was no significant difference of INHB level in FF of large follicles (P> 0.05), but the level of INHB in group FF was significantly higher than that of group B Group (P <0.01), and the correlation between INHB level and FFH in the large follicles was the best. Conclusion: (1) The down regulation of serum INHB indicates that the down regulation of follicle synchronization is better; (2) The INHB level of FF in serum and large follicle of COH can predict ovarian response and COH outcome well.