瘢痕子宫患者选择性单胚胎移植中胚胎级别对妊娠及新生儿结局的影响  

Effect of embryo grade on pregnancy and neonatal outcomes in patients with scar uterus undergoing elective single embryo transfer

作　　者：宛颖 张向阳[1] 宋文妍[1] WAN Ying;ZHANG Xiangyang;SONG Wenyan(Reproductive Medicine Center,the First Affiliated Hospital of Zhengzhou University,Henan Province,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院生殖医学中心,河南郑州450052

出　　处：《妇儿健康导刊》2023年第2期7-12,共6页JOURNAL OF WOMEN AND CHILDREN'S HEALTH GUIDE

基　　金：国家自然科学基金资助项目(81871206)。

摘　　要：目的探讨瘢痕子宫患者行选择性单胚胎移植(eSET)时胚胎级别对妊娠及新生儿结局的影响。方法采用回顾性队列研究分析2016年1月至2020年1月于郑州大学第一附属医院生殖医学中心接受体外受精/卵胞质内单精子显微注射-胚胎移植助孕治疗且在新鲜周期行eSET的883例瘢痕子宫患者的资料。首先根据年龄,将其分为两组(Ⅰ组,年龄<35岁;Ⅱ组,35~38岁),再根据移植胚胎的发育天数(D3、D5)及评分,进一步分为四个亚组:D3优质与非优质卵裂期胚胎亚组(D3A亚组、D3B亚组)和D5优质与非优质囊胚亚组(D5A亚组、D5B亚组)。在两个年龄组中,分别比较各亚组的妊娠及新生儿结局。结果Ⅰ组中,D5A、D5B亚组的临床妊娠率和活产率高于D3A及D3B亚组(P<0.001)。Ⅱ组中,D5A亚组的临床妊娠率[63.2%(48/76)]及活产率[56.6%(43/76)]最高;而D5B亚组与D3A亚组的临床妊娠率和活产率比较,差异无统计学意义(P>0.05)。两个年龄组中,D3B亚组的临床妊娠率及活产率最低。各亚组的新生儿结局,包括出生孕龄、早产率、新生儿体重、低体重儿率及巨大儿率比较,差异无统计学意义(P>0.05)。多因素logistic回归分析显示:Ⅰ组中各亚组与D3A亚组比较,D3B亚组的临床妊娠率降低(P=0.003),而D5A亚组和D5B亚组的临床妊娠率升高(P<0.001,P=0.018);Ⅱ组中,与D3A亚组比较,仅D3B、D5A亚组临床妊娠率的差异有统计学意义(P<0.001,P=0.004)。结论瘢痕子宫患者在新鲜周期行eSET时,D5囊胚的妊娠结局优于D3卵裂期胚胎,而不同级别胚胎的新生儿结局无明显差异。Objective To explore the effect of embryo grade on pregnancy and neonatal outcomes in patients with scar uterus who undergo elective single embryo transfer(eSET).Methods A retrospective cohort study was conducted to analyze the data of 883 patients with scar uterus who received in vitro fertilization/intracytoplasmic sperm injectionembryo transfer(IVF/ICSI-ET)and treatment with eSET in fresh cycle in the Reproductive Medicine Center,the First Affiliated Hospital of Zhengzhou University from January 2016 to January 2020.Firstly,they were divided into two groups according to their age(groupⅠ,aged<35 years;groupⅡ,aged 35-38 years).According to the developmental progression(D3,D5)and morphological score of transferred embryo,they were further divided into four subgroups:D3 good-quality and poor-quality cleavage-stage embryos subgroup(D3A subgroup and D3B subgroup)and D5 goodquality and poor-quality blastocyst subgroup(D5A subgroup and D5B subgroup).In two age groups,pregnancy and neonatal outcomes were compared for each subgroup.Results In groupⅠ,the clinical pregnancy rate and live birth rate in D5A and D5B subgroups were higher than those in D3A and D3B subgroups(P<0.001).In groupⅡ,D5A subgroup had the highest clinical pregnancy rate(63.2%[48/76])and live birth rate(56.6%[43/76]).There were no significant differences in clinical pregnancy rate and live birth rate between D5B subgroup and D3A subgroup(P>0.05).In the two age groups,the clinical pregnancy rate and live birth rate of D3B subgroup were the lowest.There were no significant differences in neonatal outcomes among the four subgroups,including gestational age,premature birth rate,neonatal weight,low birth weight rate and macrosomia rate(P>0.05).The multi-factor logistic regression analysis showed that compared with D3A subgroup in groupⅠ,D3B subgroup had lower clinical pregnancy rate(P=0.003),while D5A and D5B subgroups had higher clinical pregnancy rate(P<0.001,P=0.018).In groupⅡ,compared with D3A subgroup,statistically significant differences i

关 键 词：瘢痕子宫 选择性单胚胎移植 胚胎级别 妊娠结局 新生儿结局 

分 类 号：R711.6[医药卫生—妇产科学]