植入前遗传学非整倍体筛查对反复种植失败患者疗效的观察  

Clinical research of preimplantation genetic testing for aneuploidies in patients with recurrent implantation failure

作　　者：陈虹 郑锦霞 孙子莉 伍园园 陈智勤 Chen Hong;Zheng Jinxia;Sun Zili;Wu Yuanyuan;Chen Zhiqin(Centre of Assisted Reproduction,Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine,Shanghai 201204,China;Nursing Department,Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine,Shanghai 201204,China;Department of Obstetrics&Gynaecology,Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine,Shanghai 201204,China)

机构地区：[1]同济大学附属第一妇婴保健院生殖医学科,上海201204 [2]同济大学附属第一妇婴保健院护理部,上海201204 [3]同济大学附属第一妇婴保健院妇产科,上海201204

出　　处：《中华生殖与避孕杂志》2022年第6期557-565,共9页Chinese Journal of Reproduction and Contraception

基　　金：上海市卫健委临床医学科研专项面上项目(202040127);上海市卫生和计划生育委员会科研课题面上项目(201540237)。

摘　　要：目的探讨基于二代测序(next-generation sequencing,NGS)技术的胚胎植入前遗传学非整倍体筛查(preimplantation genetic testing for aneuploidies,PGT-A)对反复种植失败(recurrent implantation failure,RIF)患者的临床疗效。方法回顾性队列研究分析2018年12月至2020年1月期间在同济大学附属第一妇婴保健院生殖医学科接受PGT-A治疗的63例RIF患者为研究组;选取同期采用常规体外受精(in vitro fertilization,IVF)治疗的179例RIF患者为对照组,采用倾向性得分匹配的方法(propensity score matching,PSM)对女方年龄进行匹配,分析比较两组患者一般资料、促排卵结果和妊娠结局等,并采用logistic回归分析影响每移植周期累计活产率的因素。结果最终203例患者纳入分析,其中研究组61例,对照组142例,匹配了年龄差异后两组间患者的年龄、体质量指数、不孕因素、不孕年限、既往移植失败次数、基础卵泡刺激素(follicle-stimulating hormone,FSH)、窦卵泡计数和卵巢刺激方案差异均无统计学意义(均P>0.05)。研究组的无可用胚胎数比例[45.90%(28/61)]高于对照组[13.38%(19/142)],而可移植胚胎数[1(0,2)个]低于对照组[2(1,4)个],差异均有统计学意义(均P<0.001)。研究组的胚胎种植率[61.54%(24/39)]、每移植周期临床妊娠率[61.54%(24/39)]、每移植周期持续妊娠率[61.54%(24/39)]和每移植周期活产率[61.54%(24/39)]均高于对照组[27.47%(75/273),P<0.001;41.51%(66/159),P=0.024;37.11%(59/159),P=0.006和37.11%(59/159),P=0.006];但其累计活产率[39.34%(24/61)]与对照组[41.55%(59/142)]相比差异无统计学意义(P=0.770)。多因素logistics回归分析显示是否采用PGT-A治疗为影响每移植周期活产率的独立危险因素[OR(95%CI)=2.71(1.32~5.58),P=0.007],而对累计活产率没有显著影响[OR(95%CI)=2.49(0.87~7.13),P=0.089]。结论相较常规IVF治疗,NGS-PGT策略虽然能提高RIF患者的每移植周期活产率,但不会提高其累计活产率。因此,NGObjective To investigate the effect of preimplantation genetic testing for aneuploidies(PGT-A)based on next-generation sequencing technology(NGS)on the clinical outcomes of patients with recurrent implantation failure(RIF).Methods A retrospective cohort study was conducted and the outcomes of patients with a history of RIF were analyzed,of which 63 women underwent PGT-A strategy(study group)and 179 women who underwent conventional in vitro fertilization(IVF)treatment(control group)at the Centre of Assisted Reproduction in Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine from December 2018 to January 2020.Propensity score matching(PSM)was conducted by female age.Baseline characteristics,stimulation characteristics and pregnancy outcomes were analyzed between the two groups.Logistic regression model was used to evaluate the relative prognostic significance of independent variables in relation to the live birth rate(LBR)and cumulative live birth rate(CLBR).Results Totally 203 patients including 61 patients in study group and 142 patients in control group remained in each group after PSM,there were no significant differences in female age,body mass index,cause of infertility,duration of infertility,number of previous embryo transfer failures,basal follicle-stimulating hormone(bFSH),antral follicle count and ovarian stimulation protocols after matching(all P>0.05).More patients had unavailable embryos in study group than in control group[45.90%(28/61)vs.13.38%(19/142),P<0.001],while the number of transferable embryos was significantly lower than that in control group[1(0,2)vs.2(1,4),P<0.001].The implantation rate[61.54%(24/39)],the clinical pregnancy rate[61.54%(24/39)],the ongoing pregnancy rate[61.54%(24/39)]and the live birth rate[61.54%(24/39)]per embryo transfer cycle in study group were significantly higher than those in control group[27.47%(75/273),P<0.001;41.51%(66/159),P=0.024;37.11%(59/159),P=0.006 and 37.11%(59/159),P=0.006,respectively].However,there was no significant diff

关 键 词：反复种植失败 活产率 回顾性队列研究 不孕因素 临床疗效 二代测序 

分 类 号：R714[医药卫生—妇产科学]