冻融周期单囊胚形态学评分对助孕结局的影响  

Effect of blastocyst morphology scores on fertility outcomes in vitrified-thawed single blastocyst transfer cycles

作　　者：张宜瑄[1] 贾楠[1] 郝好英[1] 张少娣[1] 路锦[1] ZHANG Yi-xuan;JIA Nan;HAO Hao-ying;ZHANG Shao-di;LU Jin(Center of Reproductive Medicine,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院生殖医学中心,郑州450003

出　　处：《医药论坛杂志》2023年第19期19-26,32,共9页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建关项目(LHGJ20220049)。

摘　　要：目的探讨在单囊胚冻融移植周期中不同形态学参数评分对临床妊娠及围产期结局的影响。方法回顾性分析2017年1月至2021年6月在河南省人民医院生殖医学中心行冻融周期单囊胚移植的患者共4200周期,分别比较不同扩张期、内细胞团(inner cell mass,ICM)及滋养层细胞(trophectoderm,TE)评级对临床妊娠及围产期结局的影响,采用单因素分析及多元logistic回归分析各个指标相关性及筛选影响因素。结果在不同的扩张期、ICM、TE的分组中,女方年龄、成熟卵母细胞(MII)数、移植次数、临床妊娠率、活产率差异有统计学意义(P<0.05)。ICM和TE分组中抗苗勒氏管激素(Anti-Mullerian hormone,AMH)水平、早产率差异有统计学意义(P<0.05)。不同扩张期和TE分组的原发不孕比例、体外受精比例差异有统计学意义(P<0.05)。TE分组的评级从A级到C级早期流产率升高(P<0.05)。囊胚的扩张期、ICM评级、TE评级对临床妊娠和活产均存在显著性影响(P<0.05),但对于出生体重、大于胎龄儿、小于胎龄儿则无显著性影响(P>0.05)。TE评级A级和B级的囊胚早期流产率较C级囊胚显著性降低(P<0.05),扩张期为3期较4期的囊胚早期流产率显著升高(P<0.05),扩张期分组中以4期为参照,3期的临床妊娠及活产均下降(OR=0.25,95%CI:0.11~0.59;P<0.05;OR=0.22,95%CI:0.08~0.58;P<0.05),5期的临床妊娠下降(OR=0.63,95%CI:0.44~0.91;P<0.05)。ICM和TE分组的评分等级是临床妊娠和活产的独立影响因素(P<0.05)。结论冻融周期单囊胚移植建议优选4期、ICM/TE评分级别高的胚胎,以获得更好的临床妊娠结局;不同的囊胚形态学参数评分对新生儿出生体重、大于胎龄儿、小于胎龄儿等围产期结局无明显提示作用。Objective To investigate the effects of blastocyst morphology on clinical pregnancy and perinatal outcomes in vitrified-thawed single blastocyst transfer cycles.Methods This retrospective cohort study at Henan Provincial People's Hospital included 4200 cycles of single frozen-thawed blastocyst transfer from January 2017 to June 2021.Univariate a⁃nalysis and multiple logistic regression analysis was performed to evaluate clinical and neonatal outcomes for association with expansion stage,inner cell mass(ICM)quality,and trophectoderm(TE)quality and screening influencing factors.Results Among the different expansion stage,ICM and TE groups,there were significant differences in women’age,number of mature oocytes(MII),transplant cycles,clinical pregnancy rate,and live birth rate(P<0.05).There were sig⁃nificant differences in the anti-Mullerian hormone(AMH)and preterm birth rate between ICM and TE groups(P<0.05).The proportion of primary infertility and in vitro fertilization were statistically significant differences in the di⁃lation stages and TE groups(P<0.05).The early miscarriage rate was increased from grade A to grade C in the TE group(P<0.05).There were significant effects of the clinical pregnancy rate and live birth rate among the three groups(P<0.05).However,there was no significant effect on birth weight,large for gestational age infants,and small for ges⁃tational age infants(P>0.05).The early miscarriage rate of blastocysts in grade A and B were significantly lower than grade C in the TE group(P<0.05).The early abortion rate of stage 3 in the expansion group was significantly higher than in stage 4(P<0.05).In the expansion stage group,stage 4 was used as the reference,the clinical pregnancy and live birth in stage 3 were decreased(OR=0.25,95%CI:0.11-0.59;P<0.05;OR=0.22,95%CI:0.08-0.58;P<0.05),and the clinical pregnancy in stage 5 was also decreased(OR=0.63,95%CI:0.44-0.91;P<0.05).ICM and TE scores were independent factors with clinical pregnancy and live birth rate(P<0.05).Conclusion For single b

关 键 词：冻融周期 单囊胚移植 囊胚形态学评分 临床妊娠 活产 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]