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 探讨不同分期的子宫内膜异位症（EMs）患者行体外受精-胚胎移植（IVF-ET）助孕结局与成本效果分析。方法 回顾性分析2016年1月—2022年1月Ⅰ~Ⅱ期、Ⅲ~Ⅳ期EMs患者应用卵泡期长方案及同期因“输卵管因素”患者采用黄体期长方案行IVF-ET的助孕结局以及成本费用。结果 EMs各组的启动日LH、E₂以及hCG日E₂水平低于对照组（P<0.05）,Ⅲ~Ⅳ期EMs组的可利用胚胎数、着床率、临床妊娠率、活产率明显低于对照组及Ⅰ~Ⅱ期EMs组（P<0.05）,其流产率偏高,但组间比较差异无统计学差异（P>0.05）。各组间的Gn剂量、Gn天数、hCG日的LH水平、hCG日≥14 mm卵泡数、hCG日子宫内膜厚度、获卵数、受精率、卵裂率比较差异无统计学意义（P>0.05）。成本效果分析提示：各组平均周期总成本无明显差异,Ⅰ~Ⅱ期EMs组患者患者获得一例妊娠所花费的成本与对照组相当,而Ⅲ~Ⅳ期EMs组患者获得一例妊娠所花费的成本最高。结论 对于不同分期的EMs,Ⅰ~Ⅱ期患者应用卵泡期长方案的患者可获得良好的妊娠结局,其妊娠率及成本与传统方案相当,而Ⅲ-Ⅳ期的患者妊娠率偏低,获得妊娠的成本更高,可能与该疾病严重程度及方案选择有关。

Objective To analyze the outcome and cost-effectiveness of invitrofertilization-embryotransfer（IVF-ET）assisted pregnancy in endometriosis（EMs）patients with different stages．Methods The outcomes and costs of patients with stageⅠ-Ⅱ and Ⅲ-Ⅳ EMs treated with follicular phase long protocol and patients treated with luteal phase long protocol due to“tubal factors” during the same time from January 2016 to January 2022 were retrospectively analyzed．Results The levels of LH,E2 on initiation day and the levels of E2 on hCG day in EMs groups were lower than those in control group（P<0.05）,the number of available embryos,implantation rate,clinical pregnancy rate and live birth rate in stage Ⅲ-Ⅳ EMs group were significantly lower than those in control group and stageⅠ-Ⅱ EMs group（P<0.05）,and the abortion rate was higher．But there was no significant difference between groups（P>0.05）．There were no significant differences in the dosage of Gn,duration of Gn,the levels of LH on hCG day,the number of follicles with diamete≥14 mm on hCG day,endometrial thickness on hCG day,number of oocytes retrieved,fertilization rate and cleavage rate among the three groups（P>0.05）．Conclusions For different stages of endometriosis,patients in stageⅠ-Ⅱ who apply the follicular phase long protocol can achieve good pregnancy outcomes,and their pregnancy rate and cost are comparable to the traditional regimen,while patients in stage Ⅲ-Ⅳ have a low pregnancy rate,and the cost of pregnancy is higher,which should be related to the severity of the disease and the choice of regimen.