辅助生殖技术子代4岁龄运动发育结局分析

Assessment the motor developmental outcome at 4 years old of children conceived by intracytoplasmic sperm injection

目的探讨辅助生殖技术（assisted reproductive technology,ART）对子代远期运动发育结局的影响。方法选取2009年1-12月在南京市妇幼保健院生殖医学中心进行卵胞浆内单精子注射（intracytoplasmic sperm injection,ICSI）的单胎活产子代18例为研究对象（ICSI）,以年龄、性别、胎数为匹配条件,选取在南京市妇幼保健院出生的活产婴儿36例为对照组（NC）,排除孕周〈32周,体重〈1 500g,有宫内窘迫,出生窒息史者进行研究。利用儿童运动评估系列（Movement Assessment Battery for Children,M-ABC）量表和儿童感觉统合发展检核表（3-6岁）分别比较两组儿童4岁龄的运动及感觉统合能力发育结局。结果体格发育：ICSI子代出生身长[ICSI：（48.72±2.52）cm,NC：（50.33±1.24）cm]、出生体重[ICSI：（3.04±0.68）kg,NC：（3.50±0.42）kg]均低于对照组,差异有统计学意义（P〈0.05）;4岁龄,两组的身高、体重及头围均无统计学差异;运动发育：两组在手灵巧度、目标/抓握运动及总分方面无统计学差异（P均〉0.05）;在平衡能力（ICSI：8.44±1.72,NC：10.92±3.18）方面,ICSI组能力低于对照组,差异有统计学意义（P〈0.05）。感觉统合能力：两组在前庭平衡和大脑双分化情况、触觉防御、发育期运用障碍、视觉空间和形状感觉、重心、整体评估差异均无统计学意义（P均〉0.05）。结论通过细化评估内涵、扩大样本量和延长随访时间可以为辅助生殖子代远期发育结局的判断提供更有力的证据。

Objective To assess the motor developmental outcome at 4 years old children conceived by intracytoplasmic sperm injection （ICSI） and to compare with children conceived naturally. Methods Children enrolled were conceived by ICSI from Jan.2009,through to the end of Dec.2009 in the State key Laboratory of Reproductive Medicine Department of Nanjing Maternity and Child Health Care Hospital.18 ICSI alive single born underwent movement assessments and 36 control subjects as normal control （NC） were matched with respect to age,gender,and birth number.The children were excluded if their gestational weeks less than 32 weeks,birth weight less than 1 500 g,with fetal distress or birth asphyxia history.Children＇s motor development was assessed with the Movement Assessment Battery of Children （M-ABC） and children sensory integration scale,respectively. Results Physical development：the birth length [ICSI：（48.72±2.52）cm,NC：（50.33±1.24）cm],and birth weight [ICSI：（3.04±0.68）kg,NC：（3.50±0.42）kg] of ICSI group were significantly lower than the control group （P〈0.05）;at 4 years old,no significant differences were found in the height,weight or head circumference of the two groups（all P〉0.05）.Motor development：there were no differences in terms of flexibility,hand-eye coordination or total score; However,ICSI group was significantly lower than the control group in balance （ICSI：8.44±1.72,NC：10.92±3.18,P〈0.05）.Sensory integration capabilities：There were no differences in balance and vestibular double differentiation of the brain,tactile defensiveness,developmental dyspraxia,visual-spatial and shape sensory,the center of gravity or overall evaluation. Conclusion By refining assessment content,expanding the sample size and extending follow-up time,we can provide more powerful evidence for judgment of the long-term developmental outcomes of assisted reproductive offspring.