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目的探讨PCOS患者卵泡液中骨形成蛋白BMP6、BMP15、GDF9的异常改变与颗粒细胞凋亡的相关性及对IVF结局的影响。方法将138例研究对象分为PCOS组与正常排卵组,对两组患者的临床及IVF批标进行对比分析,同时对两组患者的卵泡液行BMP6、BMP15、GDF9检测,且检测了两组颗粒细胞的Bcl-2及Caspase-3的表达情况,进而就卵液中的BMP6、BMP15、GDF9水平与颗粒细胞内的Bcl-2及Caspase-3表达量之间进行相关性分析。结果 PCOS组与对照组相比,患者的年龄、初潮年龄、Gn用量、获卵数、MⅡ卵率、受精率、优质胚胎率及临床妊娠率均无显著差别(P>0.05),而BMI指数及可移植胚胎率均小于对照组,且差异具有统计学意义(P<0.05)。PCOS组与对照组相比,患者卵丘颗粒细胞内Bcl-2 m RNA及蛋白水平显著降低,而Caspase-3m RNA及蛋白水平升高,且差异具有统计学意义(P<0.05)。卵泡液中卵源性蛋白BMP6、BMP15与颗粒细胞内凋亡调控因子Bcl-2有呈正相关,与Caspase-3呈负相关性(P<0.05)。GDF9与Caspase-3呈负相关性(P<0.05),与Bcl-2有一定相关性,但无统计学意义。结论 PCOS患者不仅卵泡液中存在BMP6、BMP15、GDF9的异常体变,且存在颗粒细胞内凋亡调控因子的异常改变,同时二者之间存在一定的相关性。
Objective To investigate the relationship between abnormal changes of bone morphogenetic protein BMP6, BMP15 and GDF9 in follicular fluid and apoptosis of granulosa cells in patients with PCOS and its effect on IVF outcome. Methods 138 cases were divided into PCOS group and normal ovulation group. The clinical and IVF batch standard of the two groups were compared and analyzed. BMP6, BMP15 and GDF9 were detected in follicular fluid of the two groups. The expression of Bcl-2 and Caspase-3 in granulosa cells, and then analyzed the correlation between the levels of BMP6, BMP15 and GDF9 in ovarian follicles and the expression of Bcl-2 and Caspase-3 in granulosa cells. Results Compared with the control group, there was no significant difference in age, menarche age, Gn dosage, number of oocytes retrieved, M Ⅱ egg rate, fertilization rate, good embryo rate and clinical pregnancy rate between PCOS group and control group (P> 0.05) And the rate of transplantable embryos were less than that of the control group, and the difference was statistically significant (P <0.05). Compared with the control group, the Bcl-2 mRNA and protein levels were significantly decreased in the PCOS group and the Caspase-3m RNA and protein levels were significantly increased in the PCO group (P <0.05). Follicular fluid egg gene protein BMP6, BMP15 and granulosa cell apoptosis regulatory factor Bcl-2 was positively correlated with Caspase-3 was negatively correlated (P <0.05). There was a negative correlation between GDF9 and Caspase-3 (P <0.05), but not with Bcl-2. Conclusions In PCOS patients, there are not only abnormal morphological changes of BMP6, BMP15 and GDF9 in follicular fluid, but also abnormal changes of granulosa cell apoptosis regulators, and there is a certain correlation between the two.