体外受精-胚胎移植与自然妊娠后早期妊娠丢失的临床因素分析  

Analysis of clinical factors on early pregnancy loss during in vitro fertilization-embryo transfer treatment and natural pregnancy

作　　者：范蒙洁 田婵[1] 常亮[1] 王晓晔[1] 李蓉[1] Fan Mengjie;Tian Chan;Chang Liang;Wang Xiaoye;Li Rong(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科,100191

出　　处：《中华妇产科杂志》2018年第11期755-760,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的比较体外受精-胚胎移植(IVF-ET)后早期妊娠丢失与自然妊娠后早期妊娠丢失的临床因素差异。方法回顾性分析2015年12月至2016年5月363例因早期妊娠丢失且于北京大学第三医院行清宫手术患者的临床资料,其中173例为IVF-ET后妊娠(IVF-ET组),190例为自然妊娠(自然妊娠组)。结果IVF-ET组患者的年龄显著高于自然妊娠组[分别为(34.1±4.3)、(31.8±4.1)岁,P<0.01];体质指数高于自然妊娠组,分别为(22.9±3.2)、(22.3±3.1)kg/m^2,但两组比较,差异无统计学意义(P=0.06)。IVF-ET组有分娩史者所占的比例显著低于自然妊娠组[分别为5.8%(10/173)、12.6%(24/190);P=0.02],有胚胎停止发育史者所占的比例显著低于自然妊娠组[分别为13.9%(24/173)、36.8%(70/190);P<0.01]。IVF-ET组发现妊娠丢失时的妊娠天数显著小于自然妊娠组[分别为(59.8±9.2)、(69.9±11.1)d;P<0.01];胚胎染色体异常率显著低于自然妊娠组,分别为57.2%(99/173)和74.2%(141/190),两组比较,差异有统计学意义(X^2=11.661,P<0.01),其中以染色体数目异常为主,16号染色体三体最常见。两组患者的血清抗凝血酶Ⅲ、蛋白C、蛋白S、血小板聚集率、同型半胱氨酸值分别比较,差异均无统计学意义(P均>0.05)。结论早期妊娠丢失以染色体异常为主要原因;IVF-ET后早期妊娠丢失者染色体异常率不高于自然妊娠,目前的IVF-ET治疗有较为可靠的配子和胚胎安全性。Objective To compare differences of clinical factors related to early pregnancy loss between invitro fertilization-embryo transfer (IVF-ET) treatment and natural pegnancy. Methods A retrospective analysis was performed on the 363 cases of early pregnancy loss between Dec. 2015 to May 2016 in Peking University Third Hospital, during which 173 cases were after IVF-ET treatment(IVF-ET group), and others were natural pregnancies(natural group). Results The average age in IVF-ET group was significantly higher than that in the natural group [(34.1±4.3)versus(31.8±4.1)years old, P<0.01]. The terminating time of pregnancy loss in IVF-ET group was short than that in the natural group [(59.8±9.2) versus(69.9 ± 11.1)days, P<0.01]. The incidence of embryo abnormal chromosome in IVF-ET group was significantly lower than that in the natural group [57.2%(99/173)versus 74.2%(141/190), P<0.01], during which abnormal chromosome numbers were the most common. Conclusions The pregnancy loss of early pregnancy is mainly caused by chromosome abnormality. The proportion of chromosome abnormality in early pregnancy loss after IVF-ET is not higher than that of natural pregnancy, indicating that there are relatively reliable gametes and embryo safety in IVF treatment.

关 键 词：流产 自然 妊娠初期 体外受精 胚胎移植 染色体畸变 

分 类 号：R714.8[医药卫生—妇产科学]