标题：经皮穴位电刺激对高龄 IVF-ET妇女MDM2-p53反馈环的影响

      作者：帅振虹 1，杨卓欣 2，李天凤 1，李雪梅 1    1.南方医科大学附属深圳妇幼保健院生殖医学中心，广东 深圳 518017；2.广州中医药大学第四临床医学院针灸科，广东 深圳 518021

      卷次： 2019年30卷9期

      【摘要】 目的 观察经皮穴位电刺激(TEAS)对高龄体外受精-胚胎移植(IVF-ET)妇女MDM2-p53反馈环的影响。方法 选取2018年1月至2018年7月在南方医科大学附属深圳妇幼保健院生殖中心接受 IVF治疗的高龄妇女64例，采用随机数表法分为TEAS组和对照组，每组32例。TEAS组于月经干净后采用HANS仪治疗，每周3次，直至下次月经来潮前结束，每个月经周期为1个疗程，共治疗3个疗程。对照组采用外观与HANS仪相同但没有治疗作用的安慰HANS仪，治疗方案与TEAS组相同。采用TUNEL染色法观察两组患者卵巢颗粒细胞凋亡率，并应用实时定量荧光RT-PCR技术及Western-blot法分别测定两组颗粒细胞MDM2、p53 mRNA及蛋白的表达水平。结果 TEAS组颗粒细胞凋亡率为13.0%，明显低于对照组的19.0%，差异具有统计学意义(P<0.05)；治疗后，TEAS组和对照组的MDM2 mRNA分别为 1.87±1.64、5.68±3.95，p53 mRNA分别为 2.38±3.57、4.89±3.90，MDM2蛋白表达分别为0.51±0.10、0.67±0.11，p53蛋白表达分别为0.46±0.11、0.57±0.10，TEAS组MDM2、p53 mRNA及MDM2、p53蛋白表达均明显低于对照组，差异均有统计学意义(P<0.05)。结论 TEAS疗法可能通过降低MDM2-p53反馈环的活性抑制卵巢颗粒细胞过度凋亡，减少卵泡异常闭锁，从而提高高龄不孕妇女卵母细胞发育潜能。
      【关键词】 经皮穴位电刺激；高龄妇女；体外受精-胚胎移植；不孕；MDM2-p53反馈环
      【中图分类号】 R715 【文献标识码】 A 【文章编号】 1003—6350（2019）09—1144—04

Effect of transcutaneous electric acupoint stimulation on MDM2-p53 feedback loop in in senile womenundergoing in vitro fertilization-embryo transfer.
SHUAI Zhen-hong 1, YANG Zhuo-xin 2, LI Tian-feng 1, LI Xue-mei 1.1. Reproductive Medical Center, the Affiliated Shenzhen Maternity and Child Healthcare Hospital of Southern MedicalUniversity, Shenzhen 518017, Guangdong, CHINA; 2. Department of Acupuncture, the Fourth Clinical Medical College ofGuangzhou University of Chinese Medicine, Shenzhen 518021, Guangdong, CHINA
【Abstract】 Objective To observe the effect of transcutaneous electric acupoint stimulation (TEAS) onMDM2-p53 feedback loop in senile women undergoing in vitro fertilization-embryo transfer (IVF-ET). Methods Six-ty-four elderly women receiving IVF treatment at the Reproductive Medical Center, the Affiliated Shenzhen Maternityand Child Healthcare Hospital of Southern Medical University from January 2018 to July 2018 were selected and ran-domly divided into two groups, with 32 women in the TEAS group and 32 cases in the control group. The patients in theTEAS group were treated by HANS after menstruation, 3 times per week, until the next menstruation cycle, each men-strual cycle as one course of treatment, for a total of 3 courses. In the control group, patients were treated by a soothinginstrument with the same appearance as HANS but without therapeutic effect, in the same treatment regimen. The apop-tosis rate of ovarian granula cells in the two groups was observed by TUNEL staining, and the expressions of MDM2,p53 mRNA and protein were detected by real-time PCR and Western blot, respectively. Results The apoptosis rate ofgranula cells in the TEAS group was 13.0%, which was significantly lower than 19.0% in the control group. After treat-ment, the MDM2 mRNA, p53 mRNA, MDM2 protein, p53 protein in the TEAS group were 1.87±1.64, 2.38±3.57, 0.51±0.10, 0.46±0.11, significantly lower than 5.68±3.95, 4.89±3.90, 0.67±0.11, 0.57±0.10 in the control group (P<0.05).Conclusion TEAS treatment may reduce the activity of MDM2-p53 feedback loop, inhibit excessive apoptosis of ovar-ian granula cells, reduce abnormal follicular atresia, and then improve the oocyte development potential in senile infer-tile women.
      【Key words】 Transcutaneous electric acupoint stimulation (TEAS); Senile women; In vitro fertilization-embryotransfer (IVF-ET); Infertility; MDM2-p53 feedback loop