胚胎发育形态学和动力学特征在胚胎选择中的应用价值  

Application value of morphological and dynamic parameters in embryo selection

作　　者：郑爱燕[1] 王玮[1] 蒲艳[1] 廖桂芝 孟庆霞[1] 偶健[1] 王馥新[1] 李红[1] 丁洁[1] ZHENG Ai-yan;WANG Wei;PU Yan;LIAO Gui-zhi;MENG Qing-xia;OU Jian;WANG Fu-xin;LI Hong;DING Jie(Center for Reproduction and Genetics,Suzhou Municipal Hospital,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou215002)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院生殖与遗传中心,苏州215002

出　　处：《生殖医学杂志》2021年第5期588-593,共6页Journal of Reproductive Medicine

基　　金：江苏省妇幼健康科研项目(F201820,F201913);江苏省妇幼健康重点人才项目(FRC201725)。

摘　　要：目的探索胚胎发育形态学和动力学特征对胚胎整倍性和整倍体胚胎种植结局的影响。方法回顾性分析2016年1月至2018年12月于我院生殖与遗传中心就诊的植入前遗传学检测(PGT)193个周期患者的临床资料,根据胚胎整倍性分为整倍体囊胚组(整倍体组,共351个囊胚)和非整倍体囊胚组(非整倍体组,共491个囊胚),又根据囊胚是否种植将整倍体组再分为种植胚胎组(种植组,共110例患者)和非种植胚胎组(非种植组,共51例患者),比较各组胚胎发育动力学参数的差异。分析囊胚发育天数(D5、D6)、内细胞团(ICM)评分、滋养层(TE)细胞评分和胚胎特殊分裂[直接分裂(AC)、逆分裂(RC)]对囊胚整倍性及整倍体胚胎种植率的影响。结果与整倍体组比较,非整倍体组的部分胚胎动力学指标[原核消失、2细胞、3细胞、4细胞、5细胞、桑椹胚融合、开始出现囊腔、囊腔充满整个透明带的时间(tPNf、t2、t3、t4、t5、tM、tSB、tB)以及桑椹胚融合到开始出现囊腔的时间(tSB-tM)]均存在显著性差异(P<0.05),而8细胞(t8)、2细胞到3细胞的发育时间(cc2)、3细胞到5细胞的发育时间(cc3)、3细胞到4细胞的发育时间(s2)、5细胞到8细胞的发育时间(s3)和开始出现囊腔到囊腔充满整个透明带的时间(tB-tSB)组间均无显著性差异(P>0.05)。与非种植组比较,种植组的动力学指标tSB-tM显著升高(P<0.05),而t2、t3、t4、t5、t8、tM、tSB、tB、cc2、cc3、s2、s3和tB-tSB均无显著性差异(P>0.05)。囊胚发育天数(D5、D6)、ICM评分、TM细胞评分对囊胚整倍体率存在显著影响(P<0.05),而对整倍体囊胚的种植率无显著影响(P>0.05);胚胎特殊分裂(AC、RC)对囊胚整倍体率和整倍体囊胚种植率均无显著影响(P>0.05)。结论整倍体囊胚的发育速度比非整倍体囊胚更快;桑椹胚形成到开始出现囊腔的时间不仅在整倍体囊胚与非整倍体囊胚间有差异,在移植的整倍体囊胚中�Objective:To explore the effects of morphological and dynamic parameters on the embryo euploidy and implantation outcome of euploid embryo.Methods:The clinical data of 193 cycles of preimplantation genetic testing(PGT)in our hospital from January 2016 to December 2018 were retrospectively analyzed.According to the euploidy of embryos,they were divided into euploid blastocyst group(euploid group,351 blastocysts)and aneuploid blastocyst group(aneuploid group,491 blastocysts).The differences of morphological and dynamic parameters of embryos were compared between euploid and aneuploid embryos.The euploid group was further divided into implantation group(implantation group,110 patients)and non-implantation group(51 patients)according to whether blastocysts were implanted or not.The dynamic parameters of embryo development were compared between implantation group and non-implantation group.The effects of blastocyst development days(Day 5,Day 6),intracellular mass(ICM)score,trophoblast(TE)cells score and special division[direct division(AC),reverse division(RC)]on blastocyst euploidy and implantation rate of euploid embryos were analyzed.Results:There were significant differences in embryo dynamics index[time of pronuclear disappearance,2 cells,3 cells,4 cells,5 cells,morula fusion,sac cavity began to appear,and sac cavity filled with the whole zona pellucida(tPNf,t2,t3,t4,t5,tM,tSB,tB and tSB-tM)]between euploid and aneuploid blastocysts(P<0.05),while there was no significant difference in 8 cells(t8),the development time from 2 cells to 3 cells(cc2),from 3 cells to 5 cells(cc3),from 3 cells to 4 cells(s2),from 5 cells to 8 cells(s3)and tB-tSB between the two groups(P>0.05).Compared with non-implantation group,tSB-tM of implantation group was significantly increased(P<0.05),but there were no significant differences in t2,t3,t4,t5,t8,tM,tSB,tB,cc2,cc3,s2,s3 and tB-tSB between the two groups(P>0.05).The blastocyst development days(Day 5,Day 6),ICM score and TM cell score had significant effect on the blastocyst euploid

关 键 词：胚胎实时观测 植入前遗传学检测 囊胚 整倍体 

分 类 号：R711.6[医药卫生—妇产科学]