胚胎种植前遗传学检测助孕妊娠结局的影响因素研究  

Factors Associated with the Outcomes of Preimplantation Genetic Testing in Assisted Reproduction

作　　者：王博雅 何英明 薛吟霜 向卉芬 WANG Boya;HE Yingming;XUE Yinshuang;XIANG Huifen(Department of Obstetrics and Gynecology,the Fourth Affiliated Hospital of Anhui Medical University,Hefei 230011,China;NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract(Anhui Medical University),Hefei 230022,China;Key Laboratory of Population Health Across Life Cycle(Anhui Medical University),Ministry of Education of the People's Republic of China,Hefei 230022,China;Anhui Province Key Laboratory of Reproductive Health and Genetics,Hefei 230022,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第四附属医院妇产科,安徽省合肥市230011 [2]国家卫生健康委配子及生殖道异常研究重点实验室,安徽省合肥市230022 [3]出生人口健康教育部重点实验室,安徽省合肥市230022 [4]生殖健康与遗传安徽省重点实验室,安徽省合肥市230022 [5]安徽医科大学第一附属医院妇产科,安徽省合肥市230022

出　　处：《中国全科医学》2023年第2期160-167,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(9021382202)。

摘　　要：背景育龄期女性胚胎着床失败及流产的最常见原因是胚胎异常,但移植经胚胎种植前遗传学检测(PGT)筛选后的正常胚胎后,仍出现种植失败或流产的原因目前并没有形成统一的结论。目的分析PGT助孕后种植失败及流产的影响因素。方法回顾性分析2018年12月至2021年2月在安徽医科大学第一附属医院生殖中心行PGT助孕的329例患者的临床资料,根据患者是否临床妊娠分为临床妊娠组(n=218)和种植失败组(n=111),并将临床妊娠组患者根据妊娠结局分为活产亚组(n=175)和流产亚组(n=43)。比较临床妊娠组和种植失败组,活产亚组和流产亚组的一般情况、促排卵及体外胚胎发育情况。采用多因素Logistic回归分析探讨PGT患者种植失败及流产的影响因素。绘制受试者工作特征(ROC)曲线分析多因素Logistic回归分析筛选出的影响因素对PGT患者发生种植失败及流产的预测价值。结果多因素Logistic回归分析显示,既往流产次数≥2次〔OR=4.0320,95%CI(2.4230,6.7100)〕、高密度脂蛋白胆固醇(HDL-C)水平低〔OR=3.8900,95%CI(1.4550,10.4030)〕是PGT患者种植失败的危险因素(P<0.05),低促性腺激素(Gn)用量〔OR=0.9995,95%CI(0.9992,0.9999)〕是PGT患者种植失败的保护因素(P<0.05);既往流产次数≥2次〔OR=2.2030,95%CI(1.0990,4.4170)〕、低胚胎活检正常率〔OR=5.6550,95%CI(1.2860,24.8650)〕是PGT患者流产的危险因素(P<0.05),低空腹胰岛素(FINS)水平〔OR=0.9120,95%CI(0.8350,0.9960)〕是PGT患者流产的保护因素(P<0.05)。ROC曲线分析结果显示,既往流产次数≥2次、HDL-C水平、Gn用量预测PGT患者发生种植失败曲线下面积分别为0.650、0.579、0.561,灵敏度分别为70.3%、33.3%、60.4%,特异度分别为59.6%、80.3%、56.9%,约登指数分别为0.299、0.136、0.173;既往流产次数≥2次、FINS水平、胚胎活检正常率预测PGT患者发生流产曲线下面积分别为0.648、0.629、0.641,灵敏度分别为66.2%、Background Embryo anomaly is the most common cause of implantation failure and abortion in women of reproductive age.However,there is controversy about the cause of implantation failure or miscarriage that occurs after the transfer of a normal embryo screened by preimplantation genetic testing(PGT).Objective To analyze the influencing factors affecting implantation failure and miscarriage after PGT assisted reproduction.Methods Three hundred and twenty-nine women who received PGT assisted reproduction in Reproductive Center,the First Affiliated Hospital of Anhui Medical University from December 2018 to February 2021 were enrolled,including 218 with clinical pregnancy〔175 of whom had a live birth(live birth subgroup),and 43 had an abortion(abortion subgroup)〕,and 111 with implantation failure.Clinical data,results of accessory examinations,ovulation induction and in vitro embryonic development were compared between women with clinical pregnancy and implantation failure,and between live birth and abortion subgroups.The influencing factors of implantation failure and abortion after PGT assisted reproduction were screened by multivariate logistic regression analysis,and predictive values of the determined factors for implantation failure and abortion were estimated using the receiver operating characteristic(ROC)analysis.Results Multivariate logistic regression analysis showed that,two or more previous abortions〔OR=4.0320,95%CI(2.4230,6.7100)〕and low level of high-density lipoprotein cholesterol(HDL-C)〔OR=3.8900,95%CI(1.4550,10.4030)〕were risk factors for implantation failure after PGT assisted reproduction(P<0.05),while the low gonadotropin(Gn)dosage〔OR=0.9995,95%CI(0.9992,0.9999)〕was associated with decreased risk of implantation failure after PGT assisted reproduction(P<0.05).Two or more abortions〔OR=2.2030,95%CI(1.0990,4.4170)〕and low normal rate of embryo biopsy〔OR=5.6550,95%CI(1.2860,24.8650)〕were associated with increased risk of abortion after PGT assisted reproduction(P<0.05),while lo

关 键 词：植入前诊断 种植前遗传学检测 妊娠结局 活产 流产 生殖技术 辅助 影响因素分析 

分 类 号：R71[医药卫生—妇产科学]