基于TGFβ1-miRNA224探讨补肾促排卵汤治疗体外受精-胚胎移植助孕的多囊卵巢综合征肾虚证临床研究OA

Objective:To investigate the clinical efficacy of Bushen Cupailuan decoction in patients with polycys-tic ovary syndrome(PCOS)characterized by kidney deficiency syndrome undergoing in vitro fertilization-embryo transfer(IVF-ET),and to examine its effects on the expression of microRNA-224(miR-224)and transforming growth factor-β1(TGF-β1)in follicular fluid.Methods:Thirty patients with infertility due to isolated tubal factors undergoing IVF with a long protocol were enrolled as the blank group.In addition,60 PCOS patients with kidney de-ficiency syndrome undergoing IVF with the same long protocol were recruited and randomly assigned to a treatment group(n=30)and a control group(n=30).The treatment group received Bushen Cupailuan decoction combined with lifestyle guidance for three cycles before entering the IVF cycle,whereas the control group received lifestyle guidance alone for three cycles before IVF.Changes in serum testosterone(T),luteinizing hormone(LH),anti-Müllerian hormone(AMH),body mass index(BMI),and traditional Chinese medicine(TCM)syndrome scores were assessed before and after intervention.After completion of the IVF cycle,the number of gonadotropin(GN)days,total GN dosage,two-pronuclear fertilization rate(2PN rate),2PN cleavage rate,high-quality embryo rate,clin-ical pregnancy rate in frozen embryo transfer(FET)cycles,and early miscarriage rate were compared among the three groups.Levels of miR-224,TGF-β1,estradiol,and progesterone in follicular fluid were also measured.Results:After treatment,the treatment group showed significant decreases in serum T,LH,and AMH levels,as well as TCM syndrome scores,compared with baseline(all P＜0.05).In contrast,the control group showed no significant changes in sex hormone levels,BMI,or TCM syndrome scores after lifestyle intervention(P＞0.05).When clinical outcomes were compared between the treatment and control groups after intervention,no significant differences were found in total GN dosage or duration of GN use(all P＞0.05).However,the treatment group had significantly higher 2PN rate,2PN cleavage rate,and high-quality embryo rate than the control group(all P＜0.05).In follicular fluid,estradi-ol secretion was significantly higher in the treatment group,while miR-224,TGF-β1,and progesterone levels were significantly lower than those in the control group(all P＜0.05).The clinical pregnancy rate in FET cycles was sig-nificantly higher in the treatment group than in the control group(P＜0.05).The early miscarriage rate in FET cy-cles was lower in the treatment group,although the difference was not statistically significant(P＞0.05).Conclusion:Bushen Cupailuan decoction effectively improves baseline endocrine hormone secretion in PCOS patients.It may regu-late the expression of miR-224 and TGF-β1 in follicular fluid.By reducing pre-ovulatory miR-224 expression,the de-coction may enable TGF-β1-mediated regulation of granulosa cell proliferation and steroid hormone secretion,thereby improving oocyte quality,increasing the proportion of high-quality embryos,and ultimately enhancing clinical preg-nancy rates.