不同原核来源囊胚冻融移植对临床妊娠结局及新生儿的影响

Effect of frozen-thawed blastocyst transfer of different pronuclear zygotes origins on clinical pregnancy outcome and neonatal outcome

目的探讨零原核(nonpronuclear,0PN)、单原核(monopronuclear,1PN)、双原核(two pronuclei,2PN)废弃胚胎来源冻融单囊胚的临床应用价值。方法回顾性队列研究分析2014年3月至2020年11月期间于郑州大学第三附属医院生殖医学中心行冻融单囊胚移植的患者资料。根据移植囊胚的不同来源分为4组:A组为2PN可利用胚胎来源(形态学评级为Ⅰ~Ⅲ级的2PN胚胎),B组为0PN胚胎来源,C组为1PN胚胎来源,D组为2PN废弃胚胎来源(形态学评级为Ⅳ级的2PN胚胎),分析4组患者基本资料,并以A组为参照组,分别比较B、C、D组的临床妊娠结局,在单胎活产的周期比较新生儿情况,采用logistic回归校正混杂因素,计算校正后比值比(adjusted odds ratio,aOR)及95%置信区间(confidence interval,CI)。结果经logistic回归校正混杂因素后,与A组相比,B组的活产率明显低于A组(aOR=0.701,95%CI:0.534~0.920,P=0.011);D组的临床妊娠率、活产率均明显低于A组(aOR=0.595,95%CI:0.456~0.777,P<0.001;aOR=0.600,95%CI:0.449~0.800,P=0.001),余流产率、妊娠期并发症、多胎妊娠率与A组相比差异均无统计学意义(均P>0.05),C组上述各项指标与A组相比差异均无统计学意义(均P>0.05);B组、D组巨大儿、大于胎龄儿(large for gestational age,LGA)的发生风险均明显高于A组(巨大儿,B组:aOR=2.367,95%CI:1.299~4.315,P=0.005;D组:aOR=2.711,95%CI:1.463~5.026,P=0.002;LGA,B组:aOR=1.930,95%CI:1.158~3.217,P=0.012;D组:aOR=2.039,95%CI:1.174~3.543,P=0.011),低出生体质量、小于胎龄儿、早产的发生风险B组、D组与A组相比差异均无统计学意义(均P>0.05),C组上述指标发生的风险与A组相比差异均无统计学意义(均P>0.05)。结论在无可利用2PN胚胎时,可将0PN、1PN、2PN废弃胚胎行囊胚培养后进行移植,但要关注0PN、2PN废弃胚胎增加子代巨大儿、LGA发生的风险。

Objective To explore the clinical application value of frozen-thawed single blastocyst derived from nonpronuclear(0PN)zygotes,monopronuclear(1PN)zygotes and two-pronuclei(2PN)discarded embryos.Methods A retrospective cohort analysis of the data of patients who underwent frozen-thawed single blastocyst transfer at the Reproduction Center of the Third Affiliated Hospital of Zhengzhou University from March 2014 to November 2020.According to the different sources of transplanted blastocysts,they were divided into 4 groups including group A derived from 2PN available embryos(2PN embryos with morphological ratingⅠ-Ⅲ),group B derived from 0PN embryos,group C derived from 1PN embryos,group D derived from 2PN discarded embryos(2PN embryos with morphological ratingⅣ).The basic data of the four groups were analyzed,and group A was used as the reference group to compare the clinical pregnancy outcomes of groups B,C and D,respectively.The neonatal situation was compared at the cycle of singleton live birth.Logistic regression was used to correct for confounding factors and calculate the adjusted odds ratio(aOR)and 95%confidence interval(CI).Results After correcting for confounding factors by logistic regression,the live birth rate in group B was significantly lower than that in group A(aOR=0.701,95%CI:0.534-0.920,P=0.011).The clinical pregnancy rate and the live birth rate in group D were significantly lower than those in group A(aOR=0.595,95%CI:0.456-0.777,P<0.001;aOR=0.600,95%CI:0.449-0.800,P=0.001).The differences in miscarriage rate,pregnancy complications and multiple pregnancy rate were not statistically significant compared with group A(all P>0.05).The differences in all the above indicators in group C were not statistically significant compared with group A(P>0.05).The risk of occurrence of macrosomia(group B:aOR=2.367,95%CI:1.299-4.315,P=0.005;group D:aOR=2.711,95%CI:1.463-5.026,P=0.002),large for gestational age(group B:aOR=1.930,95%CI:1.158-3.217,P=0.012;group D:aOR=2.039,95%CI:1.174-3.543,P=0.011)were significantly higher in groups B and D than in group A.The differences in the risk of occurrence of low birth weight,small for gestational age and preterm birth were not statistically significant in groups B and D compared with group A(P>0.05),and the difference in the risk of occurrence of the above indicators was not statistically significant in group C compared with group A(P>0.05).Conclusion When 2PN embryos are not available,abandoned 0PN,1PN,and 2PN embryos can be transferred after blastocyst culture,but attention should be paid to the increased risk of macrosomia and large for gestational age in offspring.