原核形态、卵裂胚发育与染色体异常关系的研究

Relationship among pronuclear morphology,cleaved-embryo development and chromosomal abnormality

目的探讨原核形态评分(原核评分)、卵裂胚发育与染色体异常的关系。方法2005年9月至2006年3月在广州医学院第三附属医院对需要行胚胎植入前诊断(PGD)的7例患者,于受精后第3天,应用荧光原位杂交(FISH)方法,选用13、18、21、X、Y5种染色体探针筛查这些病人种植前胚胎的非整倍体,同时分析原核评分、胚胎发育与染色体异常的关系。结果7例患者各行PGD1个周期,共获得73个胚胎;根据原核评分将所有胚胎分成A、B两组,原核评分≥14分的胚胎为A组,共49个;<14分者为B组,24个;在A组中,优质胚胎比例为46·9%(23/49),显著高于B组的20·8%(5/24),P<0·05;对52个胚胎进行活检,51个胚胎有FISH诊断结果;在有FISH诊断结果、原核评分≥14分的胚胎中,正常胚胎的比例为51·4%(19/37),显著高于评分<14分胚胎的21·4%(3/14),P<0·05;优质胚胎中,正常胚胎的比例为55·6%(15/27),显著高于非优质胚胎的29·2%(7/24),P<0·05。原核评分≥14分的优质胚胎中,染色体正常胚胎的比例为70·0%(14/20),高于优质胚胎的55·6%,但差异无统计学意义(P>0·05)。结论评分高的原核有更大的机会发育成优质胚胎和染色体正常的胚胎,优质胚胎中染色体正常胚胎的比例高于非优质胚胎。

Objective To analyze the relationship among pronuclear morphology, embryo development and chromosomal abnormality. Methods Seven couples were presented for PGD from September 2005 to March 2006 in the Third Affiliated Hospital of Guangzhou Medical College. On day 3 after insemination, chromosomal constitutions were detected in the embryos from these patients using 13,18,21, X and Y chromosome probes and the relationship among pronuclear score, embryo development and chromosomal abnormality was analyzed. Results Every couple received one PGD cycle; 73 embryos were obtained. These embryos were classified into two groups based on the score of pronuclear morphology. There were 49 embryos in group A（ score≥ 14） and 24 embryos in group B （score 〈 14）. There were 46.9% （23/49） morphologically good quality embryos in group A. It was significantly higher than that in group B[ 20.8% （5/24） ] ,P 〈 0.05. Fifty-two embryos were biopsied; 51 embryos were successfully analyzed. After FISH analysis, there were 51.4% （19/37） normal embryos in the 37 embryos with score 〉t14, which was significantly higher than 21.4% （3/21） in the embryos with score 〈 14, P 〈0.05. The rate of chromosomal normality in good quality embryos was significantly higher than that in non-good quality ones. （ 55.6% vs. 29.2 %, P 〈 0.05 ）. Adding an extra selection criteria of pronuclear score ≥14 to the group of good quality embryos increased the rate of chromosomally normal embryos from 55.6% to 70% （14/20）. But there was no statistical significance （P 〉 0.05 ）. Conclusion The embryos with high pronuclear score develop potentially. Embryos of good quality have a significantly higher rate of chromosomal normality than those of nongood quality.