体外受精/卵胞质内单精子注射单胚胎移植活产周期的性别相关生长差异研究  

Study on sex-related growth difference in the live birth cycle of single embryo transfer by IVF/ICSI

作　　者：张爱玉 王冬梅[1] 蒋帅 张晟宁 Zhang Aiyu;Wang Dongmei;Jiang Shuai;Zhang Shengning(Reproductive Medicine Center,Yantaishan Hospital,Yantai 264001,China)

机构地区：[1]烟台市烟台山医院生殖医学中心,烟台264001

出　　处：《中华生殖与避孕杂志》2024年第11期1138-1145,共8页Chinese Journal of Reproduction and Contraception

基　　金：山东省医药卫生科技发展计划(202005030403);烟台市科技创新发展计划(2022YD064)。

摘　　要：目的研究单胚胎移植(single embryo transfer,SET)单胎活产周期胚胎形态学参数及早期血清β-人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)水平的性别相关生长差异(sex-related growth difference,SRGD)。方法采用回顾性队列研究,分析烟台市烟台山医院生殖医学中心2020年1月至2022年12月新鲜和冷冻的非供体、SET、单胎活产周期患者的临床资料(n=311),以新生儿性别分组,男婴组为154例,女婴组为157例,并根据移植胚胎期(卵裂期93例、囊胚218例)及胚胎质量(优质胚胎组250例、非优质胚胎组61例)行亚组分层分析,采用单因素和二元logistic/逐步回归分析是否在胚胎发育阶段和妊娠早期存在胚胎形态学参数及早期β-hCG水平的SRGD。结果单因素分析显示,父母年龄、母亲体质量指数、移植胚胎期、胚胎质量、授精方式、周期类型等一般资料匹配均具有可比性(均P>0.05)。性别相关的形态学参数单因素分析显示,男婴组的第2天(day 2,D2)胚胎细胞数[(4.25±0.94)枚]大于女婴组[(3.98±0.84)枚,P=0.007],二元logistic回归分析显示D2胚胎细胞数与活产男婴呈正相关(OR=1.428,95%CI:1.052~1.938,P=0.022);囊胚亚组分析显示,D2细胞数(OR=1.522,P=0.021)、囊胚扩张度(OR=2.969,P=0.029)与活产男婴呈正相关。逐步回归分析显示,早期β-hCG水平男婴组[776.40(521.95,1127.25)U/L]高于女婴组[634.60(425.80,973.05)U/L,P=0.003],并与移植胚胎期(β=0.139,P=0.012)、胚胎质量(β=0.136,P=0.014)相关;不同胚胎期、胚胎质量亚组分层分析中,卵裂期、囊胚期和优质胚胎中男婴组的β-hCG水平[677.20(462.63,1028.50)U/L、838.30(557.50,1191.00)U/L、816.00(563.95,1199.75)U/L]均高于女婴组[538.40(344.80,804.80)U/L、724.95(446.83,1016.75)U/L、651.40(431.30,985.73)U/L],差异均有统计学意义(P=0.041、P=0.044、P=0.001)。囊胚亚组回归分析显示,β-hCG水平与较高的囊胚扩张度(β=0.162,P=0.010)、高滋养外胚层等级(β=0.344,Objective:To study the sex-related growth difference(SRGD)of embryo morphological parameters and early serumβ-human chorionic gonadotropin(β-hCG)level in single embryo transfer(SET)singleton live birth cycles.Methods:A retrospective cohort study analyzed the clinical data of patients with fresh and frozen non-donor,SET,and singleton live birth cycles from January 2020 to December 2022 in the Reproductive Medicine Center of Yantaishan Hospital(n=311),and the neonatal sex group was grouped by gender,with 154 cases in the male infant group and 157 cases in the female infant group.The embryo transfer stage(93 cases in cleavage stage,218 cases in blastocysts)and embryo quality(250 cases in the good-quality embryo group and 61 cases in the non-good-quality embryo group)were analyzed by subgroup stratification.Univariate and binary logistic/stepwise regression analysis were used to analyze whether there were embryonic morphological parameters and earlyβ-hCG levels in the embryonic development stage and early pregnancy.Results:Univariate analysis showed that the general data matching of patients,such as parents'age,body mass index,embryo transfer stage,embryo quality,insemination method,and cycle type were comparable(all P>0.05).Univariate analysis of sex-related morphological parameters showed that the number of cells on the day 2(D2)embryo in the male infant group(4.25±0.94)was larger than that in the female infant group(3.98±0.84,P=0.007).Binary logistic regression analysis showed that the number of cells on D2 embryo was positively correlated with the number of live-born males(OR=1.428,95%CI:1.052-1.938,P=0.022).Subgroup analysis of blastocysts showed that the number of cells on D2 embryo(OR=1.522,P=0.021)and blastocyst expansion(OR=2.969,P=0.029)were positively correlated with live-born males.The earlyβ-hCG level in the male infant group[776.40(521.95,1127.25)U/L]was higher than that in the female infant group[634.60(425.80,973.05)U/L,P=0.003],and it was related to the embryo transfer period(β=0.139,P=0.012)a

关 键 词：单胚胎移植 胚胎发育 人绒毛膜促性腺激素 性别因素 单胎活产 性别相关生长差异 

分 类 号：R714.8[医药卫生—妇产科学]