PGT-SR后囊胚形态学评分与冻融单囊胚移植活产的相关性分析  

Analysis of the correlation between the morphological score of blastocyst and the live birth of frozen-thawed single blastocyst transfer after PGT-SR

作　　者：王宁宁[1] 王世铭 苏迎春[1] Wang Ningning;Wang Shiming;Su Yingchun(Center for Reproductive Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院生殖医学中心,郑州450052

出　　处：《中华生殖与避孕杂志》2024年第3期256-262,共7页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨胚胎植入前染色体结构重排检测(preimplantation genetic testing for chromosome structural rearrangements,PGT-SR)后囊胚形态学评分对冻融单囊胚移植活产的影响。方法回顾性病例对照研究分析2015年3月至2021年1月期间于郑州大学第一附属医院生殖医学中心行PGT-SR助孕后冻融单囊胚移植患者的临床资料,共1412个移植周期。依据是否获得活产分为活产组(n=634)和未活产组(n=778),根据囊胚扩张度、内细胞团和滋养层细胞形态对囊胚进行评分,比较各形态学参数的活产率差异。通过二元logistic回归评估每个形态学参数对单囊胚移植活产的预测价值。再依据囊胚发育天数分为第5天囊胚(n=977)和第6天囊胚(n=435),进一步探究第5天和第6天囊胚的不同扩张度分期的活产。结果活产组的不孕年限[(2.88±2.41)年]比未活产组[(3.18±2.67)年,P=0.028]短。活产组的移植日内膜厚度[(10.12±2.03)mm]和第5天囊胚移植周期比例[75.6%(479/634)]比未活产组[(9.78±1.76)mm,P=0.003;64.0%(498/778),P<0.001]高;两组间内膜准备方案、囊胚扩张度和滋养层细胞等级构成比比较差异均有统计学意义(P=0.008、P=0.002、P=0.015)。两组间内细胞团等级构成比差异无统计学意义(P=0.236)。调整相关混杂因素后,二元logistic回归分析结果显示,与1~2期相比,3期、4期的活产率显著升高(aOR=1.894,95%CI:1.056~3.394,P=0.032;aOR=1.970,95%CI:1.046~3.709,P=0.036),内细胞团和滋养层细胞等级并不是活产的独立影响因素(aOR=1.480,95%CI:0.790~2.772,P=0.221;aOR=1.242,95%CI:0.952~1.621,P=0.111)。内膜准备方案、囊胚发育天数和内膜厚度同样是活产的独立影响因素,与激素替代方案相比,自然周期方案的活产率显著升高(aOR=1.425,95%CI:1.028~1.975,P=0.033);与第6天囊胚相比,第5天囊胚的活产率显著升高(aOR=1.448,95%CI:1.068~1.963,P=0.017)。进一步分析相同囊胚发育天数的不同扩张度分期的活产,结果显示Objective To explore the effect of morphological score of blastocyst on the live birth of frozen-thawed single blastocyst transfer after preimplantation genetic testing for chromosome structural rearrangements(PGT-SR).Methods In this retrospective case-control study,the clinical data of 1412 patients who underwent frozen-thawed single blastocyst transfer after PGT-SR assisted pregnancy in Center for Reproductive Medicine,the First Affiliated Hospital of Zhengzhou University from March 2015 to January 2021 were analyzed.According to whether the live birth was obtained,it was divided into two groups:live birth group(n=634)and non-live birth group(n=778).Blastocysts were graded according to degree of blastocyst expansion,inner cell mass and trophectoderm morphology,and the differences of live birth rate of each morphological parameter were compared.The predictive value of each morphologic parameter to live birth after single blastocyst transfer was evaluated by binary logistic regression.Then it was divided into day 5(D5)blastocyst(n=977)and day 6(D6)blastocyst(n=435)according to the blastocyst development days,and the live birth rate among different blastocyst expansions in D5 and D6 blastocysts was further explored.Results The live birth group had shorter infertility duration[(2.88±2.41)years],higher endometrial thickness[(10.12±2.03)mm]and higher proportion of D5 blastocyst transfer cycle[75.6%(479/634)]compared with the non-live birth group[(3.18±2.67)years,P=0.028;(9.78±1.76)mm,P=0.003;64.0%(498/778),P<0.001].There were significant differences in endometrial preparation protocols,blastocyst expansion and trophoblast cell grade between the two groups(P=0.008,P=0.002,P=0.015).There was no significant difference in the grade of inner cell mass between the two groups(P=0.236).After adjusting the related confounding factors,the results of binary logistic regression showed that the live birth rate in expansion 3 and expansion 4 was significantly higher than that in expansion 1-2(aOR=1.894,95%CI:1.056-3.394,P=0.03

关 键 词：冻融胚胎移植 单囊胚移植 形态学评分 活产率 胚胎植入前结构重排遗传学检测 

分 类 号：R714.8[医药卫生—妇产科学]