血管内皮生长因子的特性及其与女性卵泡发育的关系(2)
超排卵治疗可能会增加卵巢对hCG的反应，有学者发现hCG注射前IVF-ET患者血清VEGF浓度并无差别，但是hCG注射后发生OHSS的患者卵巢分泌VEGF功能明显增强，血清VEGF浓度明显升高，hCG可以上调OHSS患者黄体颗粒细胞VEGF mRNA的表达，对照组黄体颗粒细胞VEGF mRNA的表达没有增加，OHSS患者血清和卵泡液VEGF水平和对照组相比都明显升高[16]。IVF-ET后发生OHSS的患者卵泡液中VEGF浓度是血清VEGF浓度的数倍以上，严重者可达10倍以上，OHSS患者较OHSS高危人群但未发生OHSS的患者卵泡液中VEGF浓度明显增高[17]。McElhinney等[18]检测了IVF-ET患者血清VEGF及其抑制剂α2-巨球蛋白[alpha(2)-Macroglobulin]的水平，发现取卵日OHSS患者和未发生OHSS患者血清VEGF水平无差异；相反，未发生OHSS的患者血清α2-巨球蛋白水平较OHSS组明显增高，提示α2-巨球蛋白可以灭活或去除VEGF，从而减少OHSS发生几率。另外，有人发现，OHSS患者腹水中VEGF水平明显升高，而使用结合VEGF抗血清可明显降低腹水中的VEGF活性，减少腹水量，因此，检测VEGF水平不仅可预测OHSS的严重程度又为其治疗提供了新的途径。
, 百拇医药
综上所述，VEGF是血管生成的先决条件，因而与女性卵巢卵泡的发生和成熟密切相关。在IVF-ET过程中，其在卵泡液中的水平与卵巢的反应性可能有一定关系，卵泡液和血清VEGF水平过高也可能对OHSS具有一定的预测性。但是，VEGF与卵泡生成的具体关系和相互作用机制尚未完全阐明，在辅助生殖领域如何理解VEGF与COH治疗效果的关系，还有待研究工作的进一步深入。
[参考文献]
[1]Geva E，Jaffe R B.Role of vascular endothelial growth factor in ovarian physiology and pathology[J].Fertil Steril，2000，74(3)：429-438.
[2]Otani N，Minami S，Yamoto M，et al.The vascular endothelial growth factor/fms-like tyrosine kinase system in human ovary during the menstrual cycle and early pregnancy[J].J Clin Endocrinol Metab，1999，84(10)：3845-3851.
, 百拇医药
[3]Licht P，Neuwinger J，Fischer O，et al.Peripheral levels of vascular endothelial growth factor(VEGF) are higher in gonadotropin stimulated as compared to natural ovarian cycles[J]. Exp Clin Endocrinol Diabetes，2001，109(6)：345-349.
[4]Lee A，Christenson L K，Stouffer R L，et al.Vascular endothelial growth factor levels in serum and follicular fluid of patients undergoing in vitro fertilization[J].Fertil Steril，1997，68(2)：305-311.
, 百拇医药 [5]Tokuyama O，Nakamura Y，Muso A，et al.Vascular endothelial growth factor concentrations in follicular fluid obtained from IVF-ET patients：a comparison of hMG，clomiphene citrate，and natural cycle[J].J Assist Reprod Genet，2002，19(1)：19-23.
[6]Kim K H，Oh D S，Jeong J H，et al.Follicular blood flow is a better predictor of the outcome of in vitro fertilization-embryo transfer than follicular fluid vascular endothelial growth factor and nitric oxide concentrations[J].Fertil Steril，2004，82(3)：586-592.
, 百拇医药
[7]Manau D，Balasch J，Jimenez W，et al.Follicular fluid concentrations of adrenomedullin，vascular endothelial growth factor and nitric oxide in IVF cycles：relationship to ovarian response[J].Hum Reprod，2000，15(6)：1295-1299.
[8]Kawano Y，Zeineh-Hasan K，Fukuda J，et al.Production of vascular endothelial growth factor and angiogenic factor in human follicular fluid[J].Mol Cell Endocrinol，2003，202(1-2)：19-23.
[9]Balasch J，Guimera M，Martinez-Pasarell O，et al.Adrenomedullin and vascular endothelial growth factor producti on by follicular fluid macrophages and granulosa cells[J].Hum Reprod,2004，19(4)：808-814.
, 百拇医药
[10]Koos R D.Increased expression of vascular endothelial growth/permeability factor in the rat ovary following an ovulatory gonadotropin stimulus:potential roles in follicular rupture[J].Biol Reprod，1995,52(6):1426-1435.
[11]Friedman C I，Seifer D B,Kennard E A，et al.Elevated level of follicular fluid vascular endothelial growth factor is a marker of diminished pregnancy potential[J].Fertil Steril，1998,70(5):836-839.
[ 上 页 ] [ 下 页 ], 百拇医药(刘红梅 邢福祺)
, 百拇医药
综上所述，VEGF是血管生成的先决条件，因而与女性卵巢卵泡的发生和成熟密切相关。在IVF-ET过程中，其在卵泡液中的水平与卵巢的反应性可能有一定关系，卵泡液和血清VEGF水平过高也可能对OHSS具有一定的预测性。但是，VEGF与卵泡生成的具体关系和相互作用机制尚未完全阐明，在辅助生殖领域如何理解VEGF与COH治疗效果的关系，还有待研究工作的进一步深入。
[参考文献]
[1]Geva E，Jaffe R B.Role of vascular endothelial growth factor in ovarian physiology and pathology[J].Fertil Steril，2000，74(3)：429-438.
[2]Otani N，Minami S，Yamoto M，et al.The vascular endothelial growth factor/fms-like tyrosine kinase system in human ovary during the menstrual cycle and early pregnancy[J].J Clin Endocrinol Metab，1999，84(10)：3845-3851.
, 百拇医药
[3]Licht P，Neuwinger J，Fischer O，et al.Peripheral levels of vascular endothelial growth factor(VEGF) are higher in gonadotropin stimulated as compared to natural ovarian cycles[J]. Exp Clin Endocrinol Diabetes，2001，109(6)：345-349.
[4]Lee A，Christenson L K，Stouffer R L，et al.Vascular endothelial growth factor levels in serum and follicular fluid of patients undergoing in vitro fertilization[J].Fertil Steril，1997，68(2)：305-311.
, 百拇医药 [5]Tokuyama O，Nakamura Y，Muso A，et al.Vascular endothelial growth factor concentrations in follicular fluid obtained from IVF-ET patients：a comparison of hMG，clomiphene citrate，and natural cycle[J].J Assist Reprod Genet，2002，19(1)：19-23.
[6]Kim K H，Oh D S，Jeong J H，et al.Follicular blood flow is a better predictor of the outcome of in vitro fertilization-embryo transfer than follicular fluid vascular endothelial growth factor and nitric oxide concentrations[J].Fertil Steril，2004，82(3)：586-592.
, 百拇医药
[7]Manau D，Balasch J，Jimenez W，et al.Follicular fluid concentrations of adrenomedullin，vascular endothelial growth factor and nitric oxide in IVF cycles：relationship to ovarian response[J].Hum Reprod，2000，15(6)：1295-1299.
[8]Kawano Y，Zeineh-Hasan K，Fukuda J，et al.Production of vascular endothelial growth factor and angiogenic factor in human follicular fluid[J].Mol Cell Endocrinol，2003，202(1-2)：19-23.
[9]Balasch J，Guimera M，Martinez-Pasarell O，et al.Adrenomedullin and vascular endothelial growth factor producti on by follicular fluid macrophages and granulosa cells[J].Hum Reprod,2004，19(4)：808-814.
, 百拇医药
[10]Koos R D.Increased expression of vascular endothelial growth/permeability factor in the rat ovary following an ovulatory gonadotropin stimulus:potential roles in follicular rupture[J].Biol Reprod，1995,52(6):1426-1435.
[11]Friedman C I，Seifer D B,Kennard E A，et al.Elevated level of follicular fluid vascular endothelial growth factor is a marker of diminished pregnancy potential[J].Fertil Steril，1998,70(5):836-839.
[ 上 页 ] [ 下 页 ], 百拇医药(刘红梅 邢福祺)