囊胚滋养层细胞评分与移植后第7日血β-HCG和妊娠结局的关系

Relationship between trophectoderm morphological scoring and serumβ-HCG levels and pregnancy outcome

目的分析囊胚滋养层细胞的分级与移植后第7日血β-HCG值和妊娠结局的关系,为将来的单囊胚移植提供理论依据。方法回顾性分析2005年1月至2014年12月在北京协和医院生殖中心进行复苏囊胚移植的患者资料,按照滋养层细胞的级别(A、B、C)分为三组,分析滋养层细胞级别与移植后第7日血β-HCG值的关系,并比较三组的极早期妊娠(生化妊娠而非临床妊娠)丢失率、流产率和继续妊娠率。结果三组患者复苏时年龄、胚胎冻存时间、内膜准备方案和移植日内膜厚度均无显著性统计学差异。移植后第7日的血清HCG值随滋养层细胞级别的降低呈明显的递减趋势,三组分别为(288.0±433.1)、(90.8±172.1)和(60.0±102.9)U/L。C组的极早期妊娠丢失率为30.2%,明显高于A组和B组(分别为11.4%和9.6%)(P<0.05)。三组的流产率无显著的统计学差异,但是A组和B组的继续妊娠率显著高于C组(P均<0.05),而A和B组之间无统计学差异(P>0.05)。进行Logistic回归分析时,发现滋养层细胞质量对极早期妊娠丢失率和继续妊娠率有最好的预测价值。结论囊胚的Gardner评分系统中滋养层细胞质量与移植后第7日血β-HCG值呈正相关,挑选高质量滋养层细胞的囊胚能够避免极早期妊娠丢失,能够提高继续妊娠率。

Objective： To analyze the relationship between trophectoderm morphological scoring and serum β-HCG levels on day 7 after embryo transfer and pregnancy outcome,in order to provide theoretical basis for single blastocysts transfer. Methods： The data of the single frozen-thawed blastocysts transfer cycles in our productive center from January 2005 to December 2014 were retrospectively analyzed. The patients were grouped according to the trophectoderm morphological scoring （group A, B and C） . The relationship between the trophectoderm scoring and the serum β-HCG levels on day 7 after embryo transfer and pregnancy outcome was analyzed. And the rates of early pregnancy loss, miscarriage and ongoing pregnancy were compared among the three groups. Results： There was no significant difference in patients characteristics including age, frozen time of embryos,endometrial preparation program and endometrial thickness on the transplantation day among the three groups. The serum HCG levels on day 7 after embryo transfer [（288±433.1）,（90.8±172.1）,（60±102.9）U/L in group A,B ＆C respectively~ were changed along with the degree of trophectoderm. The rate of early pregnancy loss in group C（30.2%）was significantly higher than the other two groups（11. 4% and 9.6%）（P〈0.05）. No significance difference was found in the miscarriage rate among the three groups. The ongoing pregnancy rate in group A ＆ B was significantly higher than that in group C（P〈 0.05）,but there was no significant difference between the group A and B（P〉0.05）.The results of Logistic regression analysis showed that trophectoderm quality had good predictive value for pregnancy outcome. Conclusions： The trophectoderm quality evaluated by Gardner scoring system was significantly correlated with the serum HCG levels on day 7 after embryo transfer. Choosing a blastocyst with good trophectoderm morphology can avoid early pregnancy loss and increase the ongoing pregnancy rate.