改良卵裂期胚胎评级标准的临床应用  

Clinical Application of Modified Embryonic Quality Rating Standard for Cleavage Stage

作　　者：薛石龙[1] 李红星[1] 景原雪[1] 刘梦伊[1] 刘琨[1] 宋德潇[1] 王乃辉[1] 孙亮[1] 

机构地区：[1]兰州大学第一医院生殖医学专科医院,甘肃兰州730000

出　　处：《实用妇产科杂志》2013年第12期913-917,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨改良卵裂期胚胎评级系统在常规体外受精-胚胎移植(IVF-ET)中的应用价值,验证其科学性和合理性。方法:回顾性分析应用改良卵裂期胚胎评级系统(1级、2级、2.5级、3级、4级)对正常受精第3天胚胎进行评级(1级为最高,4级为最低),并移植2枚胚胎,根据所移植胚胎评级的不同共分为A组(1级+1级)、B组(1级+2级)、C组(1级+2.5级)、D组(2级+2级)、E组(2级+2.5级)、F组(2级+3级)、G组(2.5级+2.5级)、H组(2.5级+3级)和I组(3级+3级)。比较各组间的种植率,同时采用化学发光法对不同评级胚胎培养液中的丙酮酸和可溶性人白细胞抗原-G(sHLA-G)进行分析,结果:在4434个常规IVF-ET周期中,总体上随着移植胚胎评级的递减,种植率呈现出下降趋势,A组最高,I组最低。至少包括1枚2级胚胎的B、D、E、F组种植率均显著高于两枚都是2级以下的胚胎(G、H、I组)(P<0.05),G组种植率(32.13%)显著低于D组(36.19%)和E组(36.47%),并且高于H组(29.97%)和I组(26.31%),差异均有统计学意义(P<0.05)。胚胎培养液中sHLA-G的阳性表达率和丙酮酸摄取量随着胚胎评级的增高,呈现出增加的趋势,并且其2.5级与其他各级之间比较,差异均有统计学意义(P<0.05)。结论:改良卵裂期胚胎评级标准是选择移植胚胎的有效方法,可以反映胚胎发育的潜能。Objective：To investigate the clinical application value of the modified embryonic quality score standard in vitro fertilization,and to verify itsscientificity and rationality. Methods：Modified cleavage embryon ic system to score the D3 embryo of normal fertilization （The highest was grade 1 and the lowest was grade 4） were used and then two embryos were transfered,according to the grade of each group can be divided in to A（grade 1 ＋grade 1 ） ,B（gradel ＋ grade2） ,C（grade 1 ＋grade 2.5） ,D（grade 2 ＋grade 2） ,E（grade 2 ＋ grade 2.5）, F（ grade 2 ＋ grade 3）, G （ grade 2.5 ＋ grade 2.5 ）, H （ grade 2.5 ＋ grade 3 ） and I （ grade 3 ＋ grade 3） ,and the clinical data were retrospectively analyzed. The implantation rate of embryo groups were compared,and pyruvate and sHLA-G were analyzed by chemiluminescence method. Results： In the 4434 consecutive IVF-ET cycles, generaUy as the decreasing of transferring embryo grade, the implantation rate presented a tendency of decline,among which group A was highest and group I was lowest. The implantation rates of embryo group B, D, E, F which contained at least one grade 2 embryo were obviously higher than those of the group G, H, I which contained the lower grade （ P 〈 0.05）. The implantation rate of group G （32. 13% ） was higher than group H （29.97% ） and group I （26.31% ）, the differences were all statistically significant（ P 〈0. 05）. It was found that with the improvement of embryo grade,the pyruvate absorption and sHLA-G positive rate had the tendency of increase., moreover , there was significant difference between grade 2.5 and the other grade（ P 〈0.05~）. Conclusions：The modified embryonic quality score can provide an ef fective clinical standard for embryo selection and predict the potential of developmental embryos.

关 键 词：体外受精 胚胎移植 胚胎评级 人白细胞抗原-G 

分 类 号：R715.2[医药卫生—妇产科学]