单纯性肥胖患者卵泡液中骨形态发生蛋白-15水平对胚胎质量的影响和初步预测价值-现代医学

单纯性肥胖患者卵泡液中骨形态发生蛋白-15水平对胚胎质量的影响和初步预测价值

作者：王祁梁慧

单位：徐州市妇幼保健院, 江苏徐州 221000

关键词：骨形态发生蛋白-15 身体质量指数卵泡液体外受精/胞浆内单精子注射胚胎质量

分类号：R714.8

出版年·卷·期（页码）：2024·52·第十期（1526-1534）

摘要：

目的： 探究单纯性肥胖患者取卵日卵泡液中骨形态发生蛋白-15(BMP-15)水平对体外受精/胞浆内单精子注射(IVF/ICSI)胚胎质量的影响和预测价值。方法： 选取2022年6月至2023年6月于我院生殖医学中心行IVF/ICSI助孕的118例不孕症患者为研究对象，按身体质量指数(BMI)分为对照组(18.5 kg·m^-2≤BMI＜24 kg·m^-2)、超重组(24 kg·m^-2≤BMI＜28 kg·m^-2)、肥胖组(BMI≥28 kg·m^-2，)3组。所有患者均采用拮抗剂方案促排卵，收集月经第3天静脉血清，采用酶联免疫吸附试验法(ELISA)检测取卵日卵泡液中BMP-15含量。结果： 与对照组相比，肥胖组抗苗勒氏管激素(AMH)和基础黄体酮(bP)显著降低，肥胖组基础促卵泡生成素(bFSH)较对照组和超重组均降低，超重组bP较对照组明显降低(P＜0.05)。随着BMI增加，患者促性腺激素(Gn)用量显著增加，卵泡液BMP-15水平显著降低(P＜0.05)。与对照组和超重组相比，肥胖组获卵总数、MetaphaseⅡ(MⅡ)率、囊胚形成率和优质胚胎率均减少(P＜0.05)。非肥胖患者BMP-15高水平组受精率、优质胚胎率和囊胚形成率较低水平组均升高(P＜0.05)。肥胖患者BMP-15高水平组MⅡ率、受精率、优质胚胎率和囊胚形成率较低水平组均升高(均P＜0.05)。肥胖患者卵泡液BMP-15水平与MⅡ率、受精率、优质胚胎率和囊胚形成率均呈正相关。多因素逻辑回归分析显示BMP-15、AMH和bFSH是肥胖患者胚胎质量的独立影响因素(P＜0.05)。BMP-15、AMH和bFSH对肥胖患者胚胎质量结局均具有较好的预测价值，且BMP-15联合bFSH组的检测效能明显高于单独检测(P＜0.05)。结论： 肥胖会降低育龄期妇女的卵泡液BMP-15表达，对胚胎质量产生负面影响，卵泡液BMP-15联合血清bFSH检测对单纯性肥胖女性胚胎质量的预测有较好效能。

Objective: To investigate the impact and predictive value of bone morphogenetic protein-15(BMP-15) levels in follicular fluid on the quality of embryos in patients with simple obesity undergoing in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI). Methods: A total of 118 infertile patients who underwent IVF/ICSI at the Reproductive Medicine Center of our hospital from June 2022 to June 2023 were enrolled. Based on body mass index(BMI), patients were divided into 3 groups: control group(18.5 kg·m^-2≤BMI＜24 kg·m^-2), overweight group(24 kg·m^-2≤BMI＜28 kg·m^-2), and obese group(BMI≥28 kg·m^-2). All patients underwent ovarian stimulation using the antagonist protocol. Serum was collected on day 3 of menstruation, and BMP-15 levels in follicular fluid on the day of oocyte retrieval were measured using enzyme-linked immunosorbent assay(ELISA). Results: Compared to the control group, anti-Müllerian hormone(AMH) and baseline progesterone(bP) levels were significantly lower in the obese group, while baseline follicle-stimulating hormone(bFSH) levels were lower in both the obese and overweight groups(P<0.05). The amount of gonadotropins(Gn) required significantly increased with BMI, and BMP-15 levels in follicular fluid significantly decreased(P<0.05). The total number of retrieved oocytes, Metaphase Ⅱ(MⅡ) rate, blastocyst formation rate, and high-quality embryo rate were all lower in the obese group compared to the control and overweight groups(P<0.05). In non-obese patients, the high BMP-15 group had higher fertilization, high-quality embryo, and blastocyst formation rates compared to the low BMP-15 group(P<0.05). Among obese patients, the high BMP-15 group had higher MⅡ, fertilization, high-quality embryo, and blastocyst formation rates than the low BMP-15 group(all P<0.05). In obese patients, BMP-15 levels in follicular fluid were positively correlated with MⅡ rate, fertilization rate, high-quality embryo rate, and blastocyst formation rate. Multivariate Logistic regression analysis showed that BMP-15, AMH, and bFSH were independent influencing factors for embryo quality in obese patients(P<0.05). The combined detection of BMP-15 and bFSH demonstrated better predictive performance for embryo quality outcomes than individual detection(P＜0.05). Conclusion: Obesity reduces BMP-15 expression in follicular fluid of women of reproductive age, negatively affecting embryo quality. The combined detection of follicular fluid BMP-15 and serum bFSH has reliable predictive value for embryo quality in women with simple obesity.

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