目的 探讨子宫内膜异位症（EMT）患者卵泡液来源的外泌体差异微小RNA（miRNA）对卵母细胞质量的影响。方法 收集2021年12月—2022年3月在广州市第一人民医院生殖医学中心进行体外受精-胚胎移植/卵细胞浆内单精子注射助孕的20例不孕症患者的卵泡液,分为EMT组（EMT不孕症患者10例）和对照组（单纯男性因素不孕症患者10例）。采用高通量测序对卵泡液外泌体微小RNA（miRNA）谱进行分析,选出具有组间差异的miRNAs。结果 与单纯男性因素不孕患者相比,EMT组有18个外泌体miRNAs差异有统计学意义,其中上调9个、下调9个。靶基因预测并采用GO和KEGG富集分析发现,这些靶基因主要参与磷脂酰肌醇-3-激酶/蛋白激酶B（ PI3K-Akt）、核苷酸结合寡聚结构域NOD样受体、Ras等信号通路。结论 EMT患者卵泡液来源的外泌体miRNA存在差异,差异的外泌体miRNAs可能通过多个信号通路影响EMT患者卵母细胞质量。

Objective To investigate the effect of differential microRNA（miRNA）derived from follicular fluid exosomes on oocyte quality in patients with endometriosis（EMT）. Methods Follicular fluid was collected from 20 infertile patients undergoing IVF-ET / ICSI in the Reproductive Medicine Center of Guangzhou First People's Hospital from December 2021 to March 2022,including EMT group（10 patients with EMT infertility）and control group（10 patients with simple male factor infertility）．The miRNA spectrum in follicular fluid exosomes was analyzed by high-throughput sequencing and miRNAs with differences between groups were selected. Results Compared with patients with infertility due to simple male factors,there were significant differences in 18 exosomal miRNAs in the EMT group,of which 9 were up-regulated and 9 were down-regulated．GO and KEGG enrichment analysis showed that these target genes were mainly involved in phosphatidylinositol-3-kinase / protein kinase B,Nucleotide binding oligomerization domain-like receptor and other signaling pathways. Conclusions There are differences in follicular fluid-derived exosomal miRNAs in EMT patients．Differential exosomal miRNAs may affect oocyte quality in EMT patients through multiple signaling pathways．

目的 分析影响接受夫精宫腔内人工授精(IUI)助孕患者临床妊娠率的有关因素。方法 选择225例接受IUI助孕共400周期的不孕症患者,回顾分析女方年龄、治疗方案、hCG日子宫内膜厚度、IUI周期数与临床妊娠率的关系。结果 女方年龄>38岁的临床妊娠率(8.22%)低于年龄<30岁(21.74%)和30~38岁(17.48%),P<0.05;促排卵方案(CC、HMG、CC+HMG)临床妊娠率分别为19.05%、19.66%和14.71%,高于自然周期的临床妊娠率7.14%,P<0.05;hCG日子宫内膜厚度≥8 mm组的临床妊娠率(23.56%)高于内膜<8 mm组的临床妊娠率(13.27%),P<0.05;第1至第5周期的IUI临床妊娠率分别为21.30%、15.60%、9.38%、0%和0%,多次重复IUI周期数差异有统计学意义(P<0.05)。结论 女方年龄、hCG日子宫内膜厚度、治疗方案均会影响IUI的临床妊娠率,但增加IUI的治疗周期数并不能提高临床妊娠率,应综合各种因素再次评估患者的妊娠率,必要时进一步查找多次助孕失败的原因或改行IVF-ET助孕治疗。

Objective To analyze the relative factors which influence the clinical pregnancy rates of patients accepted intrauterine insemination with husband's sperm. Methods 225 cases of infertile patients accepted IUI treatment were selected, 400 cycles were included and the clinical data were analyzed retrospectively. Observing the relationship between the age of women, treatment options, endometrial thickness on hCG injection day, cycles of IUI and pregnancy rates. Results The clinical pregnancy rates of women less than 30 years old(21.74%) were higher than aged between 30 to 38 years old(17.48%) and more than aged 38 years old(8.22%), P<0.05.The clinical pregnancy rates of ovulation induction options(CC、HMG、CC+HMG) were 19.05%, 19.66% and 14.71%, higher than the pregnancy rates of natural cycle 7.14% significantly, P<0.05. The pregnancy rates of the group of endometrial thickness ≥8mm on hCG injection day were 23.56%, higher than the group of endometrial thickness <8 mm 13.27%, P<0.05. The clinical pregnancy rates of 1 to 5 cycles IUI were 21.30%, 15.60%, 9.38%, 0% and 0% respectively, the difference of repeating the IUI cycles’ number was statistical significance (P<0.05). Conclusion The ages of women, endometrial thickness on hCG injection days and treatment options can affect the clinical pregnancy rates. Extending the number of IUI treatment cycles can not increase the pregnancy rates of IUI. All the factors should be comprehensive to assess the patient's pregnancy rates again, to find more reasons further for the failure of assisted reproduction or turn to IVF-ET assisted reproduction treatment when it is necessary.