反复移植失败相关因素回顾性分析

Retrospective analysis of factors related to repeated transplantation failure

目的探讨反复移植失败的影响因素。方法回顾性研究2018年3月至2018年12月期间在山西省妇幼保健医院行常规体外受精/卵胞质内单精子显微注射(IVF/ICSI)治疗并进行营养咨询的女性患者3263例,按照移植后结局分为移植成功组(对照组,n=620)和反复移植失败组(n=368)。通过观察比较寻找反复移植失败的相关因素。结果①基本指标:对照组年龄、不孕年限、继发不孕的比例、膳食结构不均衡的比例、选择ICSI助孕的比例均比反复移植失败组小,差异有统计学意义(P=0.0001,P=0.021,P=0.0001,P=0.0001,P=0.0001)。②实验室指标:对照组获卵数、MⅡ卵数、双原核(2PN)数、卵裂数、可移植胚胎数、剩余冷冻胚胎数比反复移植失败组多,差异有统计学意义(P均=0.0001)。③代谢指标:对照组胆固醇≥5.2 mmol/L的比例、甘油三酯≥1.7 mmol/L的比例、高密度脂蛋白(HDL)<1.29 mmol/L的比例、白蛋白<40 g/L的比例较反复移植失败组低,差异有统计学意义(P=0.044,P=0.027,P<0.001,P<0.001)。④logistic回归分析:不孕年限、2PN数、可移植胚胎数、HDL<1.29 mmol/L、白蛋白<40 g/L等与反复移植失败密切相关。结论膳食失衡导致白蛋白、HDL降低,增加代谢综合征的发生,影响2PN数、可移植胚胎数,最终影响血液循环,导致反复移植失败。

Objective To investigate the factors of repeated transplant failure,and the correlation between repeated transplantation failure with general characteristics,embryonic laboratory conditions and metabolic indicators etc.Methods From March 2018 to December 2018,3263 female patients who received routine in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)treatment and nutrition consultation in Shanxi Maternal and Child Health Care Hospital were selected to analyze the related factors which affected the failure of repeated transplantation.The patients were divided into successful transplantation group(control group,620 cases)and repeated transplantation failure group(failure group,368 cases)depend on the result of transplantation.Those patients were observed and compared between the two groups about those factors.Results 1)Basic indicators:the age of control group was younger than that of the failure group(P=0.0001).The duration of infertility in control group was shorter than that in the failure group(P=0.021).The rate of secondary infertility,the rate of unbalanced dietary,the rate of ICSI pregnancy in control group were lower than those in the failure group(all P=0.0001).2)Laboratory indicators:the number of eggs obtained,the number of MII eggs,the number of two pronuclear(2PN),the number of cleavage eggs,the number of embryos,the number of remaining frozen embryos in control group were more than those in the failure group(all P=0.0001).3)Metabolic index:the ratio of cholesterol(TC)≥5.2 mmol/L,the ratio of triglycerides(TG)≥1.7 mmol/L,the ratio of high density lipoprotein(HDL)<1.29 mmol/L,the ratio of albumin(<40 g/L)in control group were lower than those in the failure group(P=0.044,P=0.027,P<0.001,P<0.001).4)Logistic regression analysis:infertility duration,2PN number,number of embryos prepared,HDL<1.29 mmol/L and albumin<40 g/L were closely related to repeated transplantation failure.Conclusion Dietary imbalance leads lower albumin and HDL,which increases the occurrence of metabolic syndrome,impairs the number of 2PN and the number of embryos,and finally affects the blood circulation,leading to the failure of repeated transplantation.