未见原核受精卵衍生胚胎患者的胚胎发育和临床结局  

Embryonic development and clinical outcomes in patients with 0PN zygote derived embryos

作　　者：范咏琪 杨丹丹 张琦琦 严博 章志国[1] FAN Yongqi;YANG Dandan;ZHANG Qiqi;YAN Bo;ZHANG Zhiguo(Reproductive Medicine Center,Department of Obstetrics and Gynecology,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230032,China;不详)

机构地区：[1]安徽医科大学第一附属医院妇产科生殖医学中心,安徽合肥230032 [2]安徽医科大学第二临床学院,安徽合肥230032

出　　处：《中华全科医学》2024年第11期1837-1841,共5页Chinese Journal of General Practice

基　　金：国家重点研发计划项目(2022YFC2703000);国家自然科学基金项目(82071724)。

摘　　要：目的未见原核(0PN)受精卵的受精及胚胎发育异常的病因尚不清楚,其移植的适宜性仍存在争议,本研究旨在探究0PN受精卵是否具有应用价值。方法分析2019年9月—2022年5月行体外受精(IVF)/卵胞浆内单精子注射(ICSI)的9167个周期。(1)比较6915个周期[每个周期中存在≥1个0PN受精卵,以下简称两原核(2PN)+0PN组]与2252个周期(每个周期均由2PN受精卵发育而来,以下简称2PN组)的胚胎发育与临床结局。(2)根据0PN衍生胚胎的比例将IVF周期中患者进一步分类为:L组(0~30%,2579例)、M组(31%~60%,782例)和H组(61%~100%,221例),比较3组的胚胎发育与临床结局。(3)单独比较72个由0PN受精卵发育周期(0PN100%组)与100个由2PN发育周期(2PN100%组)的胚胎发育与临床结局。结果(1)2PN组的囊胚形成率显著高于2PN+0PN组(62.44%vs.55.01%,P<0.001),2PN组的累计活产率(CLR)显著低于2PN+0PN组(54.97%vs.64.99%,P<0.001)。2PN+0PN组与2PN组新生儿体重、Apgar评分比较差异均无统计学意义。(2)L、M和H组的获卵数、受精率、累计临床妊娠率(CCR)、CLR呈递减趋势。M组的卵裂率显著高于其余2组;优质胚胎率、囊胚形成率、优质囊胚率显著高于L组。(3)0PN衍生胚胎(0PN100%组)的活产率显著低于2PN衍生胚胎(2PN100%组,30.56%vs.60.00%,P<0.001),但2组囊胚移植后的临床结局差异均无统计学意义(P>0.05)。结论0PN衍生胚胎临床妊娠后,并未观察到流产可能性明显增加或对新生儿健康产生明显负面影响。因此,当无法获得正常囊胚时,0PN衍生胚胎的移植应被视为可行的选择。Objective The cause of abnormal fertilization and embryo development in non-pronucleus(0PN)zygotes remains unclear,and the viability of transferring 0PN zygotes is still controversial.The study aims to explore the clinical utility of 0PN zygote-derived embryos.Methods A total of 9167 IVF/ICSI cycles conducted between September 2019 and May 2022 were analyzed.(1)Embryo development and clinical outcomes were compared between 6915 cycles with at least one OPN fertilization(2PN/0PN)and 2252 cycles with all embryos from 2PN fertilization(2PN group).(2)Patients were further categorized based on the proportion of 0PN-derived embryos in IVF cycles:L group(0-30%,n=2579),M group(31%-60%,n=782),and H group(61%-100%,n=221),with embryo development and clinical outcomes compared across groups.(3)Embryo development and clinical outcomes were also compared with complete 0PN(0PN 100%group)and complete 2PN(2PN 100%group).Results(1)The blastocyst formation rate of 2PN group was significantly higher than that of the 2PN/0PN group(62.44%vs.55.01%,P<0.001),whereas the cumulative live birth rate(CLR)of 2PN group was significantly lower than the 2PN/0PN group(54.97%vs.64.99%,P<0.001).There was no significant difference in neonatal weight or Apgar score between the two groups.(2)The number of oocytes retrieved,fertilization rate,cumulative clinical pregnancy rate(CCR),and CLR decreased progressively across L,M,and H.The cleavage rate of group M was significantly higher than that in the other two groups.H group had significantly higher rates of high-quality embryos,blastocyst formation,and top-grade cysts compared to the group L.(3)The live birth rate for 0PN-derived embryos(0PN 100%group)was significantly lower than for 2PN-derived embryos(2PN 100%group,30.56%vs.60.00%,P<0.001),though there was no significant difference in clinical outcomes after blastocyst transfer between the two groups(P>0.05).Conclusion Clinical pregnancy outcomes after transferring 0PN-derived embryos did not show increased risk of miscarriage or adverse neonatal.Th

关 键 词：未见原核受精卵 两原核受精卵 胚胎发育 

分 类 号：R321.1[医药卫生—人体解剖和组织胚胎学] R711.6[医药卫生—基础医学]