Page 40 - 2023-02-中国全科医学

2023年1月 第26卷 第2期 http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn ·161·

transfer of a normal embryo screened by preimplantation genetic testing（PGT）. Objective To analyze the influencing factors
affecting implantation failure and miscarriage after PGT assisted reproduction. Methods Three hundred and twenty-nine women
who received PGT assisted reproduction in Reproductive Center，the First Affiliated Hospital of Anhui Medical University from
December 2018 to February 2021 were enrolled，including 218 with clinical pregnancy〔175 of whom had a live birth（live
birth subgroup），and 43 had an abortion（abortion subgroup）〕，and 111 with implantation failure. Clinical data，results
of accessory examinations，ovulation induction and in vitro embryonic development were compared between women with clinical
pregnancy and implantation failure，and between live birth and abortion subgroups. The influencing factors of implantation failure
and abortion after PGT assisted reproduction were screened by multivariate logistic regression analysis，and predictive values of
the determined factors for implantation failure and abortion were estimated using the receiver operating characteristic （ROC）
analysis. Results Multivariate logistic regression analysis showed that，two or more previous abortions〔OR=4.032 0，95%CI
（2.423 0，6.710 0）〕 and low level of high-density lipoprotein cholesterol（HDL-C）〔OR=3.890 0，95%CI （1.455 0，
10.403 0）〕were risk factors for implantation failure after PGT assisted reproduction （P<0.05），while the low gonadotropin
（Gn） dosage〔OR=0.999 5，95%CI（0.999 2，0.999 9）〕 was associated with decreased risk of implantation failure after
PGT assisted reproduction （P<0.05）. Two or more abortions〔OR=2.203 0，95%CI（1.099 0，4.417 0）〕 and low normal
rate of embryo biopsy〔OR=5.655 0，95%CI（1.286 0，24.865 0）〕 were associated with increased risk of abortion after PGT
assisted reproduction（P<0.05），while low fasting insulin（FINS） level〔OR=0.912 0，95%CI（0.835 0，0.996 0）〕
was associated with decreased risk of abortion after PGT assisted reproduction （P<0.05）. ROC analysis indicated that for
predicting implantation failure after PGT assisted reproduction，the AUC of two or more previous abortions was 0.650 with 70.3%
sensitivity，59.6% specificity and Youden index of 0.299，the AUC of HDL-C level was 0.579 with 33.3% sensitivity，80.3%
specificity and Youden index of 0.136，and the AUC of the dosage of Gn was 0.561 with 60.4% sensitivity，56.9% specificity and
Youden index of 0.173. The AUC of two or more previous abortions for predicting the abortion after PGT assisted reproduction was
0.648 with 66.2% sensitivity，63.4% specificity and Youden index of 0.296，and the AUC of fasting insulin level was 0.629 with
72.1% sensitivity，52.6% specificity and Youden index of 0.247，and that of normal embryo biopsy rate was 0.641 with 65.1%
sensitivity，60.6% specificity and Youden index of 0.257. Conclusion Two or more previous abortions，dosage of Gn and serum
HDL-C were influencing factors and partial predictors of implantation failure after PGT assisted reproduction. And two or more
previous abortions，fasting insulin level，and normal embryo biopsy rate were influencing factors and partial predictors of abortion
after PGT assisted reproduction.
【Key words】 Preimplantation diagnosis；Preimplantation genetic testing；Pregnancy outcome；Live birth；
Miscarriage；Reproductive techniques，assisted；Root cause analysis

植入前遗传学检测（preimplantation genetic testing， 1 资料与方法
PGT）是以体外受精 - 胚胎移植（in vitro fertilization- 1.1 研究对象 回顾性分析 2018 年 12 月至 2021 年 2
embryo transfer，IVF-ET）为基础，在胚胎植入前从获 月在安徽医科大学第一附属医院生殖中心行 PGT 助孕
得的囊胚中取出 3~8 个细胞，对其进行活检和遗传学诊 的 329 例患者的临床资料。根据患者是否临床妊娠分为
断，筛选正常胚胎植入子宫，从而提高胎儿健康概率的 临床妊娠组（218 例）和种植失败组（111 例），临床
一种孕前诊断技术。1990 年 HANDYSIDE 等 ［1］ 报道了 妊娠率 66.26%（218/329）。其中临床妊娠组再根据妊
人类第 1 例 PGT 婴儿的出生。随后，在临床辅助生殖 娠结局分为活产亚组（175 例）和流产亚组（43 例），
领域 PGT 扮演了重要的角色。随着 PGT 技术在人类辅 流产率 19.72%（43/218）。
助生殖技术（assisted reproductive technology，ART）中 纳入标准：有 PGT 临床指征并行 PGT 助孕的患者，
的应用越来越多，全球范围内应用该技术治疗不孕不育 患者均采用第 1 次移植周期数据。PGT 技术包含以下 3
的患者逐渐增多。胚胎异常（基因或染色体结构异常） 种：（1）胚胎植入前单基因遗传病检测（preimplantation
是导致种植失败及流产比较公认的原因之一 ［2］ 。然而 genetic testing for monogenic，PGT-M）， 临 床 指 征 为
经 PGT 筛选后的正常胚胎仍有可能出现种植失败，其 有遗传性单基因疾病的患者；（2）胚胎植入前染
原因目前并没有形成统一的结论。因此本研究回顾性分 色 体 非 整 倍 体 检 测（preimplantation genetic testing for
析了行 PGT 治疗患者的一般资料及辅助检查结果、促 aneuploidy，PGT-A）， 临 床 指 征 为 有 不 良 妊 娠 史 的
排卵及体外胚胎发育情况，以探讨影响 PGT 患者种植 患者、严重男性因素不孕症患者（男方严重的少、
失败及流产的危险因素，为降低 PGT 患者种植失败率 弱、畸形精子的患者）；（3）胚胎植入前染色体结
及流产率提供参考依据。 构 异 常 检 测（preimplantation genetic testing for structure