胚胎植入前遗传学非整倍体检测在高龄和复发性流产患者中的应用  

Application of pre-implantation genetic testing for aneuploidy in the patients with advanced age and recurrent pregnancy loss

作　　者：孔娜娜 陈蕾[2] 王伟周 李敏[1] 闫玲[1] 沈玉良 刘斌[1] 左海洋 Kong Nana;Chen Lei;Wang Weizhou;Li Min;Yan Ling;Shen Yuliang;Liu Bin;Zuo Haiyang(Assisted Reproductive Centre,Department of Gynaecology and Obstetrics,Sixth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心妇产科辅助生殖中心,北京100048 [2]解放军总医院第六医学中心妇产科,北京100048

出　　处：《海军医学杂志》2021年第4期451-455,460,共6页Journal of Navy Medicine

基　　金：解放军总医院第六医学中心院内创新培育基金(CXPY201807)。

摘　　要：目的探究体外受精胚胎行植入前遗传学非整倍体检测(PGT-A)是否有助于改善高龄和复发性流产(RPL)患者的临床结局。方法本研究回顾性分析总结2017年1月至2019年6月来解放军总医院第六医学中心妇产科辅助生殖中心行PGT-A和未行PGT-A的相关病例。行PGT-A的116例患者共132个单囊胚冻融移植周期,其中高龄(≥35岁)患者74例,共完成85个冻融移植周期;RPL患者66例,共完成78个冻融移植周期。未行PGT-A的202例患者共216个单囊胚冻融移植周期,其中高龄(≥35岁)患者119例,共完成124个冻融移植周期;PRL患者23例,共完成32个冻融移植周期。根据女方年龄分为年龄≥38岁,年龄35~37岁,年龄<35岁3组。结果在年龄≥38岁组中,PGT-A可显著提高患者的临床妊娠率(P<0.01)和活产率(P<0.01),流产率有所下降但无统计学差异(P>0.05)。PGT-A并不能改善35~37岁和年龄<35岁组的临床结局。在RPL患者中,行PGT-A可降低早期流产率(P<0.05)和生化妊娠损失率(P<0.05),临床妊娠率和活产率有所升高但差异无统计学意义(P>0.05)。结论辅助生殖技术中,PGT-A有改善年龄大于38岁高龄患者妊娠结局的潜力,并能够降低RPL患者的早期流产率,减少妊娠损失。Objective To investigate whether pre-implantation genetic testing for aneuploidy(PGT-A)for the in vitro fertilization(IVF)embryo could help to improve clinical outcomes of the patients with advanced age and recurrent pregnancy loss(RPL).Methods The patients with or without PGT-A in the Reproductive Centre from January,2017 to June,2019 were analyzed retrospectively.In the 116 patients who received PGT-A,there were a total of 132 thawed single blastocyst plantation cycles,of which 74 patients were of advanced age(age≥35),and 85 thawed plantation cycles were completed.For the counterpart,there were 66 cases of RPL and 78 thawed plantation cycles were completed.In the 202 patients who did not undergo PGT-A,there were 216 thawed single blastocyst plantation cycles,of which 119 patients were of advanced age(age≥35),and 124 thawed plantation cycles were completed.On the other hand,there were 23 cases of RPL and 32 thawed plantation cycles were completed.Depending on age,the patients were divided into 3 groups,i.e.the≥38-year group,the 35-37-year group and the 35-year group.Results In the≥38-years group,PGT-A significantly improved clinical pregnancy rate(P<0.01)and live birth rate(P<0.01).The rate of pregnancy loss decreased to a certain extent,but without statistical significance(P>0.05).PGT-A did not improve the clinical outcomes in the patients of the 35-year group and the 35-37-year group.For the RPL patients,PGT-A could reduce the rates of early abortion(P>0.05)and biochemical pregnancy loss(P<0.05).The rates of clinical pregnancy and live birth elevated to a certain degree,but without statistical significance(P>0.05).Conclusion In the assisted reproductive technology,PGT-A seems to have the potential to improve pregnancy outcome in the patients older than 38 years and reduce early abortion rate and pregnancy loss in RPL patients.

关 键 词：植入前遗传学非整倍体检测 高龄 复发性流产 活产率 早期流产率 

分 类 号：R715[医药卫生—妇产科学]