反复流产胚胎染色体核型分析

Etiology of women with recurrent miscarriage and the analysis of chromosomal abnormalities of embryos after abortion

目的:探讨反复性流产(RM)病因构成及流产胚胎染色体异常。方法:收集2016年5月—2019年5月本院收治的RM患者(自然流产≥2次)180例,分析常规病因构成及胚胎染色体异常;同期180例无流产史且已分娩活胎的健康产妇为对照组。观察两组临床指标,logistic回归分析可能影响RM因素。结果:180例RM患者中,流产胚胎染色体异常117例(60.9%),常规病因57例(31.7%);常规病因中高龄35例(19.4%),肥胖4例(2.2%),夫妻染色体异常12例(6.7%),子宫异常15例(8.3%),内分泌异常23例(12.8%),抗磷脂抗体综合征6例(3.3%);117例染色体核型异常胚胎中,非整倍体91例,多倍体10例,其他16例;以染色体三体型多见,其中16三体(19.7%,23/117),22三体(11.1%,13/117)、15三体(10.3%,12/117);多因素回归分析显示,除常规病因、子代染色体异常外,体力劳动、接触过有毒装修或化工材料、PM2.5污染、TORCH感染是发生RM的独立危险因素(P<0.05)。结论:胚胎染色体异常是反复流产最常见原因,应针对高危人群加强产前诊断,降低妊娠自然流产率。

Objective:To investigate the etiology constitute of women with recurrent miscarriage(RM),to analyze the chromosomal abnormalities of embryos after abortion,and to provide evidence for reducing the subsequent abortion rate.Methods:180 women with RM≥2 times were enrolled in study group,and 180 healthy women with live birth and without abortion history were included in control group from May 2016 to May 2019.And the etiology and embryonic chromosomal abnormalities of women in the study group were analyzed.The clinical indicators of women in the two groups were observed.Logistic regression analysis was used to analyze the influence factors of RM.Results:In the study group,there were 117(60.9%)women with chromosomal abnormalities of aborted fetus,57(31.7%)women had identified etiology,which included 35(19.4%)women with advanced age,4(2.2%)women with obesity,12(6.7%)women with chromosomal abnormalities,15(8.3%)women with uterus abnormalities,23(12.8%)women with endocrine abnormalities,and 6(3.3%)women with antiphospholipid antibody syndrome.And in 117 cases with most common chromosome trisomy,there were 23(19.7%)cases with 16 trisomy,then there were 13(11.1%)cases with 22 trisomy followed,and then there were 12(10.3%)cases with 15 trisomy.Multivariate regression analysis showed that manual workers,toxic decoration or chemical materials exposure,PM2.5 contamination,and TORCH infection were independent risk factors for RM except to the routine etiology and progeny chromosome abnormalities(P<0.05).Conclusion:Embryonic chromosomal abnormalities are the most common cause of RM,so prenatal diagnosis should be strengthened for high-risk pregnant women to reduce the later SM and to promote better rearing children.