PGT-A患者囊胚整倍体率的临床影响因素分析

The analysis of the clinical influence factor on blastocyst euploidy rate in PGT-A

目的:探讨影响植入前胚胎非整倍体遗传学筛查(PGT-A)患者囊胚整倍体率的临床影响因素。方法:回顾分析2018年4月至2020年12月于湖北省十堰市人民医院生殖中心采用PGT-A技术助孕患者的临床资料,根据患者囊胚整倍体率分为低整倍体率组(≤50%)和高整倍体率组(>50%)。比较2组患者的临床资料,通过二元logistic回归分析筛选影响PGT-A患者囊胚整倍体率的临床独立影响因素。将年龄和维生素B_(12)分层进一步研究这两者对囊胚整倍体率的影响。结果:共有166个周期(150例患者)纳入研究。单因素分析结果显示,两组的男方年龄、女方年龄、血清维生素B_(12)水平、获卵数、促排卵方案比较,差异有统计学意义(P<0.05)。二元logistics回归显示,女方年龄、血清维生素B_(12)水平是囊胚整倍体率的独立影响因素(OR=0.840,95%CI为0.738~0.957,P<0.01;OR=1.001,95%CI为1.000~1.002,P=0.045)。将女方年龄分层,低龄组(≤35岁)中,维生素B_(12)低水平组(≤497.39pmol/L)的整倍体率与维生素B_(12)高水平组(>497.39 pmol/L)比较,差异无统计学意义[58%(116/200)vs 63.16%(84/133),P=0.347];高龄组(>35岁)中,维生素B_(12)低水平组的整倍体率与维生素B_(12)高水平组比较,差异有统计学意义[24.36%(19/78)vs 41.38%(24/58),P=0.035]。结论:女方年龄和血清维生素B_(12)水平均是PGT-A技术助孕患者囊胚整倍体率的独立影响因素。相比于年轻患者,在高龄患者中,维生素B_(12)水平对囊胚整倍体率的影响更大。

Objective:To explore the clinical factors influencing the blastocyst euploidy rate of preimplantation genetic testing for aneuploidy(PGT-A).Methods:A retrospective analysis was performed on the clinical data of patients with PGT-A in Reproductive Center of Shiyan People's Hospital from April 2018 to December 2020.The patients were divided into low euploidy rate group(≤50%)and high euploidy rate group(>50%)according to the euploid rate of blastocyst,and the differences of clinical data between the two groups were compared.The independent clinical factors affecting the blastocyst euploidy rate of PGT-A patients were screened by binary logistics regression analysis.Age and vitamin B_(12)were stratified to further study the influence of these two factors on the euploidy rate of blastocyst.Results:A total of 166 cycles(150 patients)were included in the study.Univariate analysis showed that there were statistically significant differences in the maternal age,the female's age,serum Vitamin B_(12)level,the number of oocytes retrieved and ovarian stimulation protocols between the two groups(P<0.05).Binary logistics regression showed that the maternal age and serum Vitamin B_(12)level were independent factor influencing the euploidy rate of blastocysts(OR=0.840,95%CI 0.738~0.957,P<0.01;OR=1.001,95%CI 1.000~1.002,P=0.045).After stratified by maternal age,in the lower age group(≤35 years old),the euploidy rate was 58%(116/200)in the low Vitamin B_(12)group(≤497.39 pmol/L),while in the higher Vitamin B_(12)group(>497.39pmol/L)that was 63.16%(84/133),there was no significant difference between them(P=0.347).In the elderly group(>35 years old),the euploid rate of low Vitamin B_(12)group was 24.36%(19/78),while that of high Vitamin B_(12)group was 41.38%(24/58),the difference was statistically significant(P=0.035).Conclusion:Female age and serum Vitamin B_(12)level were both independent factors for the euploidy rate of blastocyst in patients with PGT-A.Vitamin B_(12)levels had a greater effect on blastocyst euploidy in older women than in younger women.