体外受精发生单卵双胎的危险因素及其交互作用分析  

Risk Factors and Interation Analysis of Monozygotic Twins Following IVF-ET

作　　者：周超 庾广聿[1] 高磊磊 于春梅 金珍 ZHOU Chao;YU Guangyu;GAO Leilei(Reproductive Center of Nanxishan Hospital in Guangxi Zhuang Autonomous Region,Guilin Guangxi 541000,China;Obstetrics and Gynecology,Zhejiang Provincial People′s Hospital,Hangzhou Zhejiang 310000,China)

机构地区：[1]广西壮族自治区南溪山医院生殖中心,广西桂林541000 [2]浙江省人民医院妇产科,浙江杭州310000 [3]浙江省人民医院生殖中心,浙江杭州310000 [4]常州市妇幼保健院生殖中心,江苏常州213000

出　　处：《实用妇产科杂志》2024年第5期386-391,共6页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金(编号:82001539);广西壮族自治区卫生健康委员会自筹课题(编号:Z20211100);南京医科大学常州医学中心临床研究项目(编号:CMCC202206)。

摘　　要：目的:探讨体外受精-胚胎移植(IVF-ET)中发生单卵双胎(MZT)的危险因素及其交互作用。方法:选择2011年1月至2021年12月在常州市妇幼保健院接受IVF-ET行单胚胎移植活产患者4537例,将其中76例MZT患者纳入MZT组;通过5∶1进行倾向性评分匹配,将380例单卵单胎患者纳入单卵单胎组。采用单因素与Lasso回归分析校正MZT的影响因子,采用多因素Logistic回归筛选出影响MZT发生的独立危险因素并分析影响权重,再对其进行相乘与相加交互作用分析。结果:单因素分析结果显示,两组患者在年龄、受精方式、辅助孵化、移植胚胎类型、移植胚胎方式、胚胎培养时间、绒促性素(HCG)日雌二醇(E_(2))差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,囊胚移植(OR 2.847,95%CI 1.559~5.199)、冻融胚胎移植(OR 2.640,95%CI 1.354~5.145)、HCG日E_(2)(OR 1.783,95%CI 1.033~3.077)为MZT独立危险因素(P<0.05),影响权重依次为囊胚移植(11.60)>冻融胚胎移植(6.54)>HCG日E_(2)(4.32)。胚胎移植类型与HCG日E_(2)间存在显著的正相加交互作用,交互作用指数(S)为4.690(95%CI 1.896~11.598)、超额危险度(RERI)为4.128(95%CI 2.236~6.019)、归因比(AP)为0.661(95%CI 0.536~0.786)。结论:囊胚移植、冻融胚胎移植、HCG日E_(2)为影响MZT发生的危险因素,胚胎移植类型与HCG日E_(2)间存在显著的正相加交互作用。Objective:To explore the risk factors and their interation in the incidence of monozygotic twins during in vitro fertilization-embryo transfer(IVF-ET).Methods:The cohort for this investigation comprised 4537 patients who underwent IVF-ET with single embryo transfer,resulting in live births at Changzhou Maternal and Child Health Care Hospital spanning from January 2011 to December 2021.Among this cohort,76 paitients with monozygotic twins were enrolled in the monozygotic twin group.Employing a 5∶1 propensity score matching strategy,380 patients with monozygotic singletons were enrolled in monozygotic singleton group.Using single factor and Lasso regression analysis to correct for the influencing factors of monozygotic twins,using multiple factor Logistic regression to screen for independent risk factors of monozygotic twins and analyze their impact weights,and then performing multiplication and addition interaction analysis on them.Results:The results of univariate analysis showed that there were statistically significant differences(P<0.05)between the two groups of patients in terms of age,fertilization method,assisted hatching,embryo type for transfer,embryo transfer method,embryo culture duration,and HCG day estradiol(E_(2))level.The results of multivariate Logistic regression showed that blastocyst transfer(OR 2.847,95%CI 1.559-5.199),frozen-thawed embryo transfer(OR 2.640,95%CI 1.354-5.145),and HCG day E_(2)level(OR 1.783,95%CI 1.033-3.077)were independent risk factors for monozygotic twins(P<0.05),demonstrating a hierarchical impact sequence of blastocyst transfer(11.60)>frozen-thawed embryo transfer(6.54)>HCG day E_(2)(4.32)level.Notably,there was a significant positive additive interaction between embryo transfer type and HCG day E_(2)level,with an interaction index(S)of 4.690(95%CI 1.896-11.598),relative excess risk due to interaction(RERI)of 4.128(95%CI 2.236-6.019),and attributable proportion due to interaction(AP)of 0.661(95%CI 0.536-0.786).Conclusions:Blastocyst transfer,frozen-thawed embryo transfe

关 键 词：单卵双胎 危险因素 辅助生殖技术 体外受精-胚胎移植 巢式病例对照 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]