IVF/ICSI助孕后患者流产组织染色体异常相关因素分析  

Analysis of factors related to chromosomal abnormalities in abortion tissue of patients after IVF/ICSI assisted conception

作　　者：石铭 张晨 康鑫 杨惠云 石杨 刘小雪 张静[4] Shi Ming;Zhang Chen;Kang Xin;Yang Huiyun;Shi Yang;Liu Xiaoxue;Zhang Jing(Department of Clinical Laboratory Sports New Town District,Dalian Women and Children's Medical Center(Group),Dalian 116037,China;Dalian Medical University College of Laboratory Medicine,Dalian 116044,China;Reproductive and Genetic Laboratory Sports New Town District,Dalian Women and Children's Medical Center(Group),Dalian 116037,China;Department of Laboratory,Dalian Municipal Center Hospital,Dalian 116033,China)

机构地区：[1]大连市妇女儿童医疗中心(集团)体育新城院区检验科,大连116037 [2]大连医科大学检验医学院,大连116044 [3]大连市妇女儿童医疗中心(集团)体育新城院区生殖与遗传实验室,大连116037 [4]大连市中心医院检验科,大连116033

出　　处：《中华生殖与避孕杂志》2024年第11期1170-1174,共5页Chinese Journal of Reproduction and Contraception

基　　金：大连市妇女儿童医疗中心(集团)博士启动基金([2022]156)。

摘　　要：目的探究体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)助孕后患者流产组织染色体异常相关影响因素,并建立染色体异常预测模型,为临床提供更多的治疗依据。方法收集2022年6月至2023年8月就诊于大连市妇女儿童医疗中心(集团)生殖与遗传实验室的113例IVF/ICSI助孕后患者(106例IVF、7例ICSI)流产组织,采用拷贝数变异测序(copy number variation sequencing,CNV-seq)技术对样本进行检测,将结果按照孕妇年龄分为年轻孕妇(<35岁,45例)和高龄孕妇(≥35岁,68例)两组。采用回顾性病例对照研究,分析不同孕妇年龄、男方年龄、不孕年限、既往流产次数、移植胚胎数、胎龄与染色体异常发生的相关性。结果①113例IVF/ICSI助孕后患者流产组织中共检出异常染色体72例[63.72%(72/113)],其中数目异常61例[84.72%(61/72)],以三体型居多(53例),结构异常8例[11.11%(8/72)],其他复杂异常类型3例[4.17%(3/72)]。②年轻孕妇组流产组织染色体异常率[51.11%(23/45)]小于高龄孕妇组[72.06%(49/68)],差异有统计学意义(P=0.023)。③高龄孕妇流产组织中,单因素分析结果显示男方年龄及既往流产次数与染色体异常的发生有关(P=0.004,P=0.008)。④多因素logistic回归分析结果表明,男方年龄、既往流产次数是导致高龄孕妇(≥35岁)染色体异常的独立危险因素(OR=1.248,95%CI:1.064~1.464,P=0.006;OR=0.493,95%CI:0.287~0.848,P=0.011),最终确定回归方程为logit(P)=0.222×男方年龄-0.707×既往流产次数-6.042,受试者工作特征曲线下面积为0.789,95%CI:0.673~0.905。约登指数最大值为0.489。结论孕妇年龄与流产组织染色体异常有关,同时在年龄≥35岁孕妇中,以女方因素引起的流产率为固定值条件下的男方年龄增加和既往流产次数较少,均会导致染色体异常发生率的上升。本研究建立的模型对染色体异常的预Objective:To explore the related factors of chromosome abnormality in abortion tissue of patients after in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)and to establish a predictive model of chromosome abnormality,so as to provide more clinical treatment basis.Methods:This was a retrospective case-control study.The abortion tissues of 113 cases of IVF/ICSI assisted pregnancy(106 cases of IVF and 7 cases of ICSI)were collected from the Reproduction and Genetics Laboratory of Dalian Women and Children Medical Center(Group)from June 2022 to August 2023.The samples were detected by copy number variation sequencing(CNV-seq).According to the maternal age,the samples were divided into young pregnant women(<35 years old,n=45)group and elderly pregnant women(≥35 years old,n=68)group.The correlations between different maternal age,male age,duration of infertility,times of previous abortion,number of embryos transferred,gestational age and chromosome abnormalities were analyzed.Results:1)A total of 72 cases[63.72%(72/113)]of abnormal chromosomes were detected in the abortion tissues of patients with IVF/ICSI-assisted pregnancy,of which 61 cases[84.72%(61/72)]were numerically abnormal,most of them were trisomy(53 cases),structural abnormalities were found in 8 cases[11.11%(8/72)],and other complex abnormalities were found in 3 cases[4.17%(3/72)].2)The chromosome abnormality rate of abortion tissue in the young pregnant women[51.11%(23/45)]was lower than that in the elderly pregnant women[72.06%(49/68)],and the difference was statistically significant(P=0.023).3)In the abortion tissue of elderly pregnant women,univariate analysis showed that the age of the man and times of previous abortion were related to the occurrence of chromosome abnormalities(P=0.004,P=0.008).4)Multivariate logistic regression analysis showed that the age of the man and times of previous abortion were the independent risk factors for chromosomal abnormalities in elderly pregnant women(OR=1.248,95%CI:1.064-1.464,

关 键 词：染色体异常 自然流产 生殖技术 辅助 

分 类 号：R714.8[医药卫生—妇产科学]