目的 观察雌二醇片/雌二醇地屈孕酮片对早发性卵巢功能不全（POI）患者卵巢储备功能及血清免疫指标的影响。方法 选取2022年2月—2023年8月福建中医药大学附属第三人民医院妇科收治的早发性卵巢功能不全患者60例,按随机数字表法分为对照组和研究组,对照组（30例）予常规激素替代疗法,研究组（30例）予雌二醇片/雌二醇地屈孕酮片。比较两组血清抗缪勒管激素（AMH）、卵泡刺激素（FSH）、雌二醇（E₂）、抗心磷脂抗体（ACA）、抗卵巢抗体（AOA）、抗β2糖蛋白1 IgM抗体（β2GP1-IgM）水平。结果 研究组治疗总有效率高于对照组,治疗后两组患者血清AMH、E₂水平均升高,血清FSH、ACA、AOA和β2GP1-IgM水平均降低（均P<0.05）,研究组临床疗效优于对照组,且不良反应发生率较低（P<0.05）。结论 雌二醇片/雌二醇地屈孕酮片可改善POI患者的卵巢储备功能,纠正机体自身免疫紊乱,其作用机制可能与免疫调节有关。

Objective To observe the effects of Complex Packing Estradiol Tablets/Estradiol and Dydrogesterone Tablets on ovarian reserve function and serum immune indicators in patients with premature ovarian insufficiency. Methods Sixty patients with early-onset ovarian insufficiency admitted to the gynecology department of the Third People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from February 2022 to August 2023 were selected and randomly divided into a control group（CG）and a study group（SG）using a random number table method．The CG（30 cases）received Complex Packing Estradiol Tablets/Estradiol and Dydrogesterone Tablets．while the SG（30 cases）received Femoston．Compare two groups of serum anti-Müllerian hormone（AMH）,follicle stimulating hormone（FSH）,estradiol（E₂）,anticardiolipin antibody（ACA）,anti ovarian antibody（AOA）,and anti β2 Glycoprotein 1 IgM antibody（β2GP1 IgM）level. Results The total effective rate of the SG was higher than that of the control group（P<0.05）;Compared with before treatment,the serum levels of AMH and E₂ increased in both groups of patients after treatment,while serum levels of FSH,ACA,AOA and β The level of 2GP1 IgM decreased（P<0.05）,and the clinical efficacy of the SG was better than that of the CG,with a lower incidence of adverse reactions. Conclusions Complex Packing Estradiol Tablets/Estradiol and Dydrogesterone Tablets can regulate the levels of sex hormones in patients with premature ovarian insufficiency,improve ovarian reserve function,correct autoimmune disorders in the body,and its mechanism of action may be related to immune regulation．

目的 探讨骨髓间充质干细胞源性微泡(BMSC-MV)修复大鼠早发性卵巢功能不全的自噬机制。方法 大鼠骨髓分离培养骨髓间充质干细胞;超速离心法从骨髓间充质干细胞培养液中分离微泡;腹腔注射顺铂溶液制备早发性卵巢功能不全(POI)模型,制备后3 d尾静脉取血ELISA检测血清雌二醇(E2)及卵泡刺激素(FSH);尾静脉注射BMSC-MV移植治疗POI大鼠模型,移植后28 d尾静脉取血ELISA检测E2、FSH及抗苗勒管激素(AMH),同时取卵巢组织检测自噬相关蛋白LC3及P62。结果 模型对照组及微泡移植组在模型制备后3 d的E2 含量低于正常对照组,FSH 含量高于正常对照组(P<0.001);微泡移植组在移植后28 d的E2、AMH含量高于模型对照组(P<0.001),FSH含量低于模型对照组(P<0.001);微泡移植组的LC3较模型对照组表达升高,而P62表达降低(P<0.001)。结论 BMSC-MV介导自噬修复大鼠早发性卵巢功能不全。

Objective To investigate the autophagy mechanism of bone marrow mesenchymal stem cell-derived microvesicle (BMSC-MV) in repairing premature ovarian dysfunction in rats. Methods The whole bone marrow adherence method was used to isolate,culture and identify BMSCs of SD rats. Microvesicles were isolated from bone marrow mesenchymal stem cell by ultracentrifugation. Premature ovarian insufficiency (POI) model was prepared by intraperitoneal injection of cisplatin solution,and serum estradiol (E2) and follicular stimulating hormone (FSH) were detected by ELISA from tail vein 3 days after preparation. Rat model of POI was treated with BMSC-MV transplantation by tail vein. Blood from tail vein was collected 28 days after transplantation to detect E2,FSH and AMH by ELISA. Meanwhile,ovarian tissues were collected to detect autophagy-related proteins LC3 and P62. Results The E2 content of the model control group and the microvesicle transplantation group was lower than that of the normal control group,and the FSH content was higher than that of the normal control group (P<0.001). The content of E2 and AMH in the microvesicle transplantation group at 28 days after transplantation was higher than that in the model control group (P<0.001),and the content of FSH was lower than that in the model control group (P<0.001). Compared with the model control group,LC3 expression in the microvesicle transplantation group was increased,while P62 expression was decreased (P<0.001). Conclusion BMSC -MV mediate autophagy to repair premature ovarian insufficiency in rats.