抗核抗体对体外受精-胚胎移植结局的影响研究

The impact of antinuclear antibody levels on pregnancy outcomes of in vitro fertilization-embryo transfer

目的探讨抗核抗体(ANA)对体外受精(IVF)-胚胎移植(ET)结局的影响,并探讨免疫抗凝治疗的效果。方法回顾性分析2018年1月至2022年11月在浙江省人民医院生殖内分泌科接受IVF-ET治疗的不孕症患者资料,其中818个IVF周期和673个ET周期。根据ANA滴度分为ANA阴性组、ANA弱阳性组(滴度为1∶32)和ANA阳性组(滴度≥1∶100),ANA阳性组进一步分为低滴度阳性组(滴度≥1∶100~<1∶320)和高滴度阳性组(滴度≥1∶320),比较各组获卵、受精和胚胎质量,分析不同ANA分型对上述指标的影响以及免疫抗凝治疗对ANA弱阳性和阳性患者ET结局的影响。结果ANA阳性组获卵率低于ANA阴性组(72.79%比75.90%,P<0.05)。ANA阴性组、ANA弱阳性组和ANA阳性组卵裂率、受精卵在体外发育到第3天(D3)优质胚胎(简称优胚)率比较差异均无统计学意义(均P>0.05)。高滴度阳性组获卵率、D3优胚数、D3优胚率均低于低滴度阳性组[分别为67.18%比75.37%、2.00(1.00,4.00)个比3.00(2.00,5.00)个、42.39%比58.62%,均P<0.05]。抗着丝点抗体(ACA)阳性组IVF受精率低于抗干燥综合征相关抗原A阳性组(48.41%比76.54%,P<0.01)。ANA阴性组、ANA弱阳性组和ANA阳性组ET后人绒毛膜促性膜激素(hCG)阳性率、临床妊娠率、胚胎种植率、临床妊娠流产率和活产率比较差异均无统计学意义(均P>0.05)。ANA阴性未用药组和ANA阳性用药组患者hCG阳性率、临床妊娠率、临床妊娠流产率和活产率比较差异均无统计学意义(均P>0.05)。ANA弱阳性治疗组和ANA弱阳性未治疗组患者hCG阳性率、临床妊娠率、临床妊娠流产率和活产率比较差异均无统计学意义(均P>0.05)。结论ANA高滴度阳性对获卵、受精和胚胎发育有不利影响,其中ACA阳性对受精影响显著。免疫抗凝药物治疗未能显著改善ANA弱阳性患者的IVF-ET结局。

Objective To investigate the impact of antinuclear antibody(ANA)levels on the pregnancy outcomes of in vitro fertilization(IVF)-embryo transfer(ET)and to explore the efficacy of immunological anticoagulant therapy.Methods The data of infertility patients undergoing IVF-ET in the Reproductive Endocrinology Department of Zhejiang Provincial People's Hospital from January 2018 to November 2022 were retrospectively analyzed,including 818 IVF cycles and 673 ET cycles.Based on ANA titers,patients were categorized into ANA negative group,ANA weak-positive group(titer 1∶32),and ANA positive group(titer≥1∶100),the ANA positive group further divided into low titer positive group(titer≥1∶100 and<1∶320)and high titer positive group(titer≥1∶320).The ovum retrieval rate,fertilization,and embryo quality were compared among the groups,the impact of ANA levels on the IVF-ET outcomes was analyzed,and the efficacy of immunological anticoagulant therapy for patients with weakly-positive and positive ANA titers was assessed.Results The ovum retrieval rate in the ANA positive group was lower than that in the ANA negative group(72.79%vs.75.90%,P<0.05).There were no statistically significant differences in the rates of cleavage and D3 superior embryo rate among the ANA negative group, ANA weakly-positive group, and ANA positive group (all P>0.05). The ovum retrieval rate, D3 superior embryo numbers, and D3 superior embryo rate were lower in the high titer positive group compared to the low titer positive group [67.18% vs. 75.37%, 2.00 (1.00, 4.00) vs. 3.00 (2.00, 5.00), and 42.39% vs. 58.62%;all P<0.05]. The IVF fertilization rate was lower in the anti centromere antibody (ACA) positive group compared to the SSA antibody positive group (48.41% vs. 76.54% , P<0.01). There were no significant differences in the hCG positivity rate, clinical pregnancy rate, embryo implantation rate, clinical pregnancy miscarriage rate, and live birth rate among the ANA negative group, ANA weakly- positive group, and ANA positive group after ET (all P>0.05). There were no significant differences in above indicators between the ANA negative untreated group and the ANA positive treated group (all P>0.05);and between the ANA weakly- positive treatment group and the untreated group (all P>0.05). Conclusion High titer positive ANA has an adverse effect on ovum retrieval, fertilization, and embryo development in infertile patients receiving IVF-ET, and there is a significant impact on fertilization in ACA-positive cases. Immunological anticoagulant therapy may not significantly improve the outcomes of IVF-ET in patients with weakly-positive ANA.