IVF/ICSI助孕患者单卵双胎妊娠风险因素分析及其对围产期结局的影响  

Risk factor analysis of monozygotic twin pregnancy in IVF/ICSI and its impact on perinatal outcomes

作　　者：张明媚 张建瑞[1] 耿爱华[1] 姚卓林 吴珊珊 任炳楠 曹源 王一萍 王昕 管一春[1] 李真[1] Zhang Mingmei;Zhang Jianrui;Geng Aihua;Yao Zhuolin;Wu Shanshan;Ren Bingnan;Cao Yuan;Wang Yiping;Wang Xin;Guan Yichun;Li Zhen(Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Reproductive Medicine of Zhumadian Central Hospital,Zhumadian 463000,China)

机构地区：[1]郑州大学第三附属医院生殖健康医院,郑州450052 [2]驻马店市中心医院生殖医学科,驻马店463000

出　　处：《中华生殖与避孕杂志》2025年第3期234-239,共6页Chinese Journal of Reproduction and Contraception

摘　　要：目的分析体外受精/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)患者发生单卵双胎(monozygotic twins,MZT)妊娠的影响因素及围产期结局。方法本研究为回顾性队列研究,收集2015年1月至2023年9月期间于郑州大学第三附属医院生殖健康医院行IVF/ICSI选择性单胚胎移植(elective single embryo transfer,eSET)后实现妊娠的12079例患者的临床资料,根据患者移植后30 d超声胎心数分为单胎妊娠组和MZT妊娠组。最终纳入MZT妊娠300例,根据辅助生殖技术助孕时间按照1∶5进行随机抽样匹配单胎妊娠1500例。比较两组患者一般资料、胚胎相关指标及围产期结局,采用多因素logistic回归模型分析MZT的危险因素。结果单胚胎移植后双胎妊娠发生率为2.48%(300/12079),高于自然受孕MZT妊娠。两组患者一般资料比较差异均无统计学意义(均P>0.05);MZT妊娠组的囊胚移植率[93.3%(280/300)]比单胎妊娠组更高[88.8%(1332/1500),P=0.022]。多因素logistic回归分析结果也表明囊胚移植会增加MZT发生风险(OR=0.552,P=0.016,95%CI:0.341~0.894);对囊胚周期进行分析,结果显示移植优质囊胚时发生MZT风险较高[MZT妊娠组为79.6%(223/280),单胎妊娠组为67.8%(903/1332),P<0.001],而滋养层细胞(trophectoderm,TE)分级为C时,MZT发生风险较低[MZT妊娠组为20.4%(57/280),单胎妊娠组为32.2%(429/1332),P<0.001]。多因素logistic回归校正相关混杂因素后显示移植内细胞团(inner cell mass,ICM)分级为B(OR=0.601,P=0.001,95%CI:0.442~0.819)、TE分级为A/B(A级:OR=2.951,P<0.001,95%CI:1.980~4.399;B级:OR=1.840,P<0.001,95%CI:1.315~2.576)囊胚,MZT发生风险增加。MZT妊娠组的妊娠期并发症[47.7%(143/300)]、早产[55.1%(140/254)]、死胎发生风险[3.7%(11/300)]比单胎妊娠组[19.3%(289/1500),P<0.001;7.4%(101/1368),P<0.001;1.5%(22/1500),P=0.016]均显著增高。结论辅助生殖技术增加了MZT发生风险。移植Objective To investigate the influencing factors and perinatal outcomes associated with monozygotic twins(MZT)following elective single embryo transfer(eSET)via in vitro fertilization or intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET).Methods A retrospective cohort study was conducted on 12079 patients who achieved pregnancy after undergoing IVF/ICSI-eSET at Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between January 2015 and September 2023.Patients were stratified into two groups based on ultrasound findings 30 d post-transfer:singleton pregnancy group and MZT pregnancy group.Finally,300 MZT and 1500 single pregnancies,which were randomly matched according to 1∶5 were included by study period.General patients'characteristics,embryo-related factors,and perinatal outcomes were compared between the two groups.A multivariate logistic regression model was employed to identify risk factors for MZT after single embryo transfer,adjusting for potential confounding variables.Results The incidence of twin pregnancy following single embryo transfer was 2.48%(300/12079),which was higher than that of naturally conceived monozygotic twin pregnancy.No significant difference was found in baseline characteristics between the two groups(all P>0.05).The blastocyst transfer rate was higher in the MZT pregnancy group[93.3%(280/300)]than in the singleton pregnancy group[88.8%(1332/1500),P=0.022].Multivariate logistic regression analysis also showed that blastocyst transfer was associated with an increased risk of MZT(OR=0.552,P=0.016,95%CI:0.341-0.894).Analysis of blastocyst cycles showed that the risk of MZT was higher when transferring high-quality blastocysts[79.6%(223/280)vs.67.8%(903/1332),P<0.001],where as a trophectoderm(TE)grading of C[20.4%(57/280)vs.32.2%(429/1332),P<0.001]had a lower risk of MZT.After adjusting for confounding factors,the risk of MZT was found to increase with the transfer of blastocysts with a B-grade inner cell mass(ICM)(OR=0.601,P=0.001,95%CI:

关 键 词：体外受精 胚胎移植 单卵双胎妊娠 囊胚分级 内细胞团 滋养层细胞 

分 类 号：R71[医药卫生—妇产科学]