钙离子载体激活卵母细胞对胚胎发育和妊娠结局的影响  

The effect of calcium ionophore on embryo development and clinical pregnancy outcome

作　　者：白银阳 熊芳[1] 张昀[1] 汪敏 陈洁[1] Bai Yinyang;Xiong Fang;Zhang Yun(Centre for Reproductive Medicine,Wuxi Maternity and Child Health Hospital,Wuxi 214002)

机构地区：[1]无锡市妇幼保健院生殖医学中心,无锡214002

出　　处：《现代妇产科进展》2022年第10期731-734,740,共5页Progress in Obstetrics and Gynecology

基　　金：国家自然科学基金(No:31801218)。

摘　　要：目的:探讨Ca^(2+)载体A23817激活对既往ICSI助孕中出现胚胎结局不良的患者胚胎发育和临床妊娠结局的影响。方法:募集2019年1月至2021年7月于无锡市妇幼保健院生殖医学中心行ICSI助孕中出现胚胎发育缓慢或停滞、囊胚形成率低的患者60例,再次ICSI助孕时采用相同的促排方案,并给予Ca^(2+)载体进行激活。患者前次周期的胚胎情况和妊娠结局作为对照组,比较前后两个周期的胚胎卵裂率、优质胚胎率、囊胚形成率及临床妊娠结局。结果:前后两周期的受精卵率无明显差异(78.5%vs 76.2%),激活组的胚胎卵裂率(95.4%vs 88.1%)、可移植胚胎率(54.8%vs 26.5%)、优质胚胎率(30.3%vs 16.7%)和囊胚形成率(30.8%vs 5.8%)均较对照组显著增加,差异均有统计学意义(均P<0.01)。激活组的种植率(42.9%vs 8.9%)、血HCG阳性率(69.2%vs 28.1%)、临床妊娠率(53.8%vs 12.5%)和活产率(46.2%vs 0)均较对照组显著提高,而流产率较对照组明显下降(14.3%vs 100%),差异均有统计学意义(均P<0.01)。激活组活产的25例新生儿均未见出生缺陷。结论:Ca^(2+)载体激活能明显改善患者的胚胎质量,促进胚胎卵裂和囊胚形成,改善患者的临床妊娠结局并提高活产率。Objective:To investigate the effect of calcium ionophore(A23187,calcimycin)on embryo development and pregnancy outcome in patients with a history of developmental problems in previous ICSI.Methods:A total of sixty patients with embryo development arrest or low blastocyst formation in the ICSI cycles of Wuxi Maternity and Child Health Hospital from January 2019 to July 2021 were recruited in this prospective research.The patients recruited in the study were conducted oocyte activation with A23817.The sixty immediately preceding ICSI cycles in the same patients constituted the control group.The embryo development and blastocyst formation,as well as clinical pregnancy outcome were observed.Results:There was no significant difference in fertilization rate between the two groups(78.5%vs 76.2%).The cleavage rate(95.4%vs 88.1%)and the rate of transferable embryos(54.8%vs 26.5%)as well as the high-quality embryos(30.3%vs 16.7%)were significantly higher in the ionophore group compared to the control group(P<0.01).In addition,more blastocysts formed in the ionophore group(30.8%vs 5.8%)(P<0.01)and this was associated with a significant increase(P<0.01)in the rate of implantation(42.9%vs 8.9%),the HCG positive(69.2%vs 28.1%),clinical pregnancy(53.8%vs 12.5%)and live birth(46.2%vs 0).While,the rate of abortion was obviously decreased in the ionophore group(14.3%vs 100.0%,P<0.01).In addition,no birth defects were observed in all of the 25 neonates.Conclusion:Activation of oocytes with A23187 can significantly improve the quality of embryos,promote embryo cleavage and blastocyst formation,with the improvement in the clinical pregnancy outcomes and the live birth.

关 键 词：Ca^(2+)载体 卵胞质内单精子注射 胚胎发育阻滞 囊胚形成 

分 类 号：R714.4[医药卫生—妇产科学]