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目的:探索卵丘颗粒细胞早期凋亡和骨形态蛋白-15(bone morphogenetic protein-15,BMP-15)对子宫内膜异位症(EMs)患者IVF结局的影响。方法:行体外受精-胚胎移植(IVF-ET)的不孕患者,根据不孕指征分为EMs组及对照组。分别记录患者一般情况、获卵数、正常受精卵数、卵裂数、优质胚胎数、胚胎种植数和临床妊娠率。流式细胞仪测定所有对象卵丘颗粒细胞的早期凋亡率,Western blotting检测卵泡液中BMP-15蛋白的表达量。结果:获卵率、受精率、卵裂率、优质胚胎率差异无统计学意义(P>0.05);EMs组与对照组相比,获卵数分别为8.2±5.7个和12.0±5.8个,着床率分别为29.73%和47.31%,临床妊娠率分别43.37%和69.32%,差异均有统计学意义(P<0.05)。EMs组卵丘颗粒细胞的早期凋亡率为37.82±15.81%,对照组为8.85±5.58%,差异具有统计学意义(P<0.01)。卵泡液中BMP-15蛋白相对表达量EMs组为0.67±0.18,对照组0.94±0.33,差异有统计学意义(P<0.05)。结论:EMs患者IVF着床率及临床妊娠率降低,可能与卵母细胞分泌较少的BMP-15、颗粒细胞早期凋亡率增加,影响卵母细胞质量和胚胎的正常发育有关。
Objective: To explore the effect of early apoptosis of cumulus granulosa cells and bone morphogenetic protein-15 (BMP-15) on IVF outcome in patients with endometriosis (EMs). Methods: Infertility patients undergoing in vitro fertilization-embryo transfer (IVF-ET) were divided into EMs group and control group according to infertility indications. Patients were recorded in general, the number of oocytes, the number of normal fertilized eggs, the number of cleavage, the number of high-quality embryos, the number of embryos implanted and clinical pregnancy rate. Flow cytometry was used to determine the early apoptotic rate of all the cumulus cells. Western blotting was used to detect the expression of BMP-15 protein in follicular fluid. Results: There were no significant differences in the rate of oocyte retrieval, fertilization rate, cleavage rate and high quality embryos (P> 0.05). The number of oocytes retrieved in the EMs group was 8.2 ± 5.7 and 12.0 ± 5.8, respectively, The implantation rates were 29.73% and 47.31% respectively, and the clinical pregnancy rates were 43.37% and 69.32% respectively, with significant differences (P <0.05). The early apoptosis rate of cumulus granulosa cells was 37.82 ± 15.81% in EMs group and 8.85 ± 5.58% in control group, the difference was statistically significant (P <0.01). The relative expression of BMP-15 protein in follicular fluid was 0.67 ± 0.18 in EMs group and 0.94 ± 0.33 in control group, the difference was statistically significant (P <0.05). Conclusions: The IVF implantation rate and clinical pregnancy rate of EMs patients decreased, which may be related with the less secretion of BMP-15 from oocytes. The early apoptosis rate of granulosa cells was increased, which affected the quality of oocytes and the normal development of embryos.