胚胎形态学评分联合培养液铵离子浓度有助于预测低质量卵裂期胚胎的种植结局  

Embryo morphological score combined with ammonium concentration in culture medium may predict implantation outcome of poor-quality cleavage stage embryos

作　　者：赵海静[1] 邱绮[1] 区颂邦[1] 王文军[1] 张清学[1] ZHAO Hai-jing;QIU Qi;OU Song-bang;WANG Wen-jun;ZHANG Qing-xue(Sun Yat-Sen Memorial Hospital of Sun Yat-sen University,Reproductive center,Guangzhou 510120)

机构地区：[1]中山大学孙逸仙纪念医院生殖中心,广州510120

出　　处：《生殖医学杂志》2022年第6期758-764,共7页Journal of Reproductive Medicine

基　　金：默克雪兰诺中国生殖医学研究基金。

摘　　要：目的探究卵裂期胚胎形态学评分联合培养液中的铵离子浓度对胚胎种植结局的预测价值。方法回顾性分析2015年8月至2019年4月于本生殖中心行常规IVF助孕的258例患者临床资料;所有患者均在第3天移植2PN来源的胚胎,共441个。对比分析妊娠组(n=122)和非妊娠组(n=136)患者的基本资料、Gn总量、基础血清激素(FSH、LH、E2)水平、HCG日血清激素(FSH、LH、E2)水平、HCG日内膜厚度及获卵数的差异。在移植日采用干化学技术法测定废弃培养液中的铵离子浓度,并通过ROC曲线计算影响胚胎种植潜能的铵离子浓度截断值为6.79μmol/L,根据浓度截断值将所有移植胚胎分为铵离子浓度正常组(<6.79μmol/L,n=291)和铵离子浓度升高组(≥6.79μmol/L,n=150),比较两组间胚胎形态学评分、种植率、临床妊娠率及生化妊娠率的差异。结果妊娠组获卵数、平均移植胚胎数显著高于非妊娠组(P<0.05)。就移植胚胎的等级而言,妊娠组的A级胚胎比例显著高于非妊娠组(P<0.01),而C、D级胚胎比例显著低于非妊娠组(P<0.05)。多因素回归分析显示,在调整获卵数和平均移植胚胎数后,移植胚胎等级是妊娠结局的独立影响因素[OR(95%CI)=0.20(0.09,0.45),P<0.001]。与妊娠组相比,非妊娠组的培养液铵离子浓度略有升高[(5.82±0.95)μmol/L vs.(5.50±0.86)μmol/L,P>0.05]。铵离子浓度正常组与升高组间胚胎种植率、临床妊娠率及生化妊娠率均无统计学差异(P>0.05)。非妊娠组中C级和D级胚胎产生的平均铵离子浓度是妊娠组的1.4倍,但无统计学差异(P>0.05)。ROC曲线表明,C、D级胚胎联合培养液铵离子浓度对胚胎种植潜能有较高的预测价值[AUC=0.695,95%CI(0.578,0.812),P=0.005]。结论对于只获得低质量卵裂期胚胎的患者来说,胚胎等级联合培养液铵离子浓度有助于指导其胚胎移植的选择,并能够较好地预测胚胎种植结局。Objective:To explore the predictive value of morphological score of cleavage stage embryos combined with ammonium concentration in cultured medium on implantation outcome.Methods:The clinical data of 258 patients in conventional IVF cycles in our center from August 2015 to April 2019 were retrospectively analyzed.A total of 4412PN-derived embryos were transferred to patients on Day 3.The basic information,Gn dosage,basal hormone levels(FSH,LH,E2),the serum hormone levels(FSH,LH,E2)on HCG day,endometrial thickness on HCG day and the number of oocytes retrieved were compared between the pregnancy group(n=122)and the non-pregnancy group(n=136).Ammonium concentration in spent culture medium on implantation day was detected through dry chemistry technology.The cutoff value of ammonium concentration affecting embryo implantation potential was calculated by ROC curve,which was 6.79μmol/L.According to the cutoff value,all transferred embryos were divided into normal ammonium concentration group(n=291)or elevation ammonium concentration group(n=150).The embryo morphological score,implantation rate,clinical pregnancy rate and biochemical pregnancy rate were compared between the two groups.Results:The number of oocytes retrieved and the average number of embryos transferred in pregnancy group were significantly higher than those in the non-pregnancy group(P<0.05).In terms of the grade of transferred embryos,the proportion of grade A embryos in the pregnancy group was significantly higher than that in the non-pregnancy group(P<0.01),while the proportion of grade C and grade D embryos was significantly lower than that in the non-pregnancy group(P<0.05).Logistic regression model analysis showed that the grade of transferred embryos was the influencing factor of pregnancy outcome[OR(95%CI)=0.20(0.09,0.45),P<0.001].Ammonium concentration was slightly increased in non-pregnancy group compared to pregnancy group[(5.82±0.95)μmol/L vs.(5.50±0.86)μmol/L,P>0.05].There were no significant differences in embryo implantation rate,cl

关 键 词：胚胎质量 铵离子浓度 种植潜能 

分 类 号：R711.6[医药卫生—妇产科学]