Pellicer A, Albert C, Mercader A, Bonilla-Musoles F, Remohí J, Simón C
Instituto Valenciano de Infertilidad, Department of Pediatrics, Obstetrics and Gynecology, Valencia University School of Medicine, Spain.
Fertil Steril. 1999 Mar;71(3):482-9. doi: 10.1016/s0015-0282(98)00484-1.
To evaluate systemic and ovarian changes in levels of interleukin (IL)-1beta, IL-6, and vascular endothelial growth factor (VEGF) in response to hCG administration to determine which may be the potential initiator of vascular effects and to identify the main source of the substance; to evaluate serum and follicular fluid levels of these cytokines as markers of ovarian hyperstimulation syndrome (OHSS), and to compare levels of these cytokines under basal conditions in women with normal ovulation and those with polycystic ovary syndrome (PCOS).
Prospective controlled study.
In vitro fertilization program at the Instituto Valenciano de Infertilidad, Valencia, Spain.
PATIENT(S): Women undergoing IVF, in whom the first two study objectives were analyzed, and women with normal ovulation and patients with PCOS undergoing retrieval of immature oocytes in natural cycles or cycles stimulated for IUI but cancelled during induction of ovulation, in whom the third study objective was analyzed.
INTERVENTION(S): Serum was collected before and after hCG administration, and follicular fluid was collected at ovum pick-up.
MAIN OUTCOME MEASURE(S): Serum and follicular fluid levels of IL-1beta, IL-6, and VEGF.
RESULT(S): There was a significant increase in serum VEGF levels after hCG administration in patients who were at risk for OHSS compared with those who were not at risk for OHSS. Significantly lower VEGF levels were found in the follicular fluid of patients who were at risk; this decrease was the only useful marker to discriminate between the two groups. Moreover, both groups had similar cytokine production under basal conditions. An increase in serum E2 occurred coincident with a decrease in IL-1beta, IL-6, and VEGF in patients with PCOS.
CONCLUSION(S): Vascular endothelial growth factor seems to be the mediator of hCG on the vascular tree. There was an early systemic increase in VEGF that may have significance in the development of OHSS. A decrease in the follicular fluid VEGF concentration is a valid marker to identify women in whom OHSS will develop. The pattern of cytokine release in patients with PCOS under basal conditions was not different from that in women with normal ovulation.
评估人绒毛膜促性腺激素（hCG）给药后白细胞介素（IL）-1β、IL-6和血管内皮生长因子（VEGF）水平的全身及卵巢变化，以确定哪种因子可能是血管效应的潜在启动因子，并确定该物质的主要来源；评估这些细胞因子的血清和卵泡液水平作为卵巢过度刺激综合征（OHSS）的标志物，并比较正常排卵女性和多囊卵巢综合征（PCOS）女性在基础状态下这些细胞因子的水平。
前瞻性对照研究。
西班牙巴伦西亚不育症研究所的体外受精项目。
接受体外受精的女性（分析前两个研究目标），以及正常排卵女性和PCOS患者（在自然周期或刺激进行宫腔内人工授精但在促排卵诱导过程中取消的周期中采集未成熟卵母细胞，分析第三个研究目标）。
在hCG给药前后采集血清，在取卵时采集卵泡液。
IL-1β、IL-6和VEGF的血清和卵泡液水平。
与无OHSS风险的患者相比，有OHSS风险的患者在hCG给药后血清VEGF水平显著升高。有风险患者的卵泡液中VEGF水平显著降低；这种降低是区分两组的唯一有用标志物。此外，两组在基础状态下细胞因子产生相似。PCOS患者血清E2升高的同时，IL-1β、IL-6和VEGF降低。
血管内皮生长因子似乎是hCG作用于血管系统的介质。VEGF早期全身升高可能对OHSS的发生具有重要意义。卵泡液VEGF浓度降低是识别将发生OHSS女性的有效标志物。PCOS患者在基础状态下的细胞因子释放模式与正常排卵女性无异。
