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目的观察二至天癸方干预调节PI3K/Akt信号通路关键效应分子p-Akt、PI3K及与通路相关的Bad水平对肾气虚体外受精-胚胎移植(IVF-ET)患者卵细胞质量的影响。方法选取行IVF-ET的肾气虚不孕症患者80例,按照随机数字表法分为治疗组(二至天癸方结合IVF-ET治疗),安慰剂组(安慰剂颗粒结合IVF-ET治疗),每组40例,另选取40名因男方因素行IVF-ET的女性志愿者为健康对照组(安慰剂颗粒结合IVF-ET治疗)。3组患者均于促性腺激素释放激素激动剂(GnRH-a)降调节的前一周期开始加服二至天癸方或安慰剂颗粒至人绒毛膜促性腺激素(HCG)注射日停药。观察3组患者临床妊娠率、颗粒细胞凋亡率。Western blot法检测PI3K/Akt信号转导通路p-Akt、PI3K、Bad蛋白水平。结果与健康对照组比较,安慰剂组PI3K、p-Akt蛋白表达量降低,Bad蛋白表达量升高(P<0.05,P<0.01);与安慰剂组比较,治疗组PI3K、p-Akt蛋白表达量升高,Bad蛋白表达量降低(P<0.05,P<0.01)。与安慰剂组比较,健康对照组及治疗组卵巢颗粒细胞凋亡率均降低,临床妊娠率增高(P<0.05,P<0.01)。结论二至天癸方可能是通过PI3K/Akt信号转导通路,下调Bad因子表达,抑制颗粒细胞凋亡,从而提高IVF-ET患者卵细胞质量,最终改善肾气虚不孕症患者的IVF-ET结局。
Objective To observe the effects of Erzhi tian decoction on the oocyte quality of patients with kidney deficiency syndrome (IVF-ET) after intervention of key factors p-Akt, PI3K and the path-related Bad in PI3K / Akt signaling pathway. Methods Eighty patients with IVF-ET were enrolled in this study. They were divided into treatment group (IVT-ET combined with Erzhong decoction) and placebo group (placebo granule combined with IVF-ET treatment) according to random number table. , 40 in each group. Forty female volunteers who underwent IVF-ET for male factor were selected as healthy control group (placebo granule combined with IVF-ET treatment). All three groups were given either dezeposil or placebo granules in the previous cycle of gonadotropin-releasing hormone agonist (GnRH-a) down-regulation until the day of human chorionic gonadotropin (HCG) injection. Clinical pregnancy rate and granulosa cell apoptosis rate were observed in 3 groups. PI3K / Akt signal transduction pathway p-Akt, PI3K, Bad protein levels by Western blot. Results Compared with the healthy control group, the protein expression of PI3K and p-Akt in placebo group was decreased and the expression of Bad protein was increased (P <0.05, P <0.01). Compared with placebo group, PI3K and p-Akt protein The expression of Bad protein was decreased (P <0.05, P <0.01). Compared with the placebo group, the apoptotic rates of ovarian granulosa cells in the healthy control group and the treatment group were decreased, and the clinical pregnancy rate was increased (P <0.05, P <0.01). Conclusion Erzhi tian decoction could reduce the expression of Bad factor and inhibit the apoptosis of granulosa cells through the PI3K / Akt signal transduction pathway so as to improve the quality of oocyte in IVF-ET patients and finally improve the outcome of IVF-ET in patients with renal insufficiency.