-
不孕症的临床定义是女性未采取避孕措施,正常性生活状态下≥12个月未孕。我国流行病学调查[1]显示,不孕症的总发病率达5.7%,已成为严重的公共卫生问题,其中20%不孕症夫妇解决生殖问题的唯一途径为辅助生殖技术[2]。近年来随着辅助生殖技术的成熟,病人的需求量与日剧增,临床常见的辅助生殖技术包括促排卵技术、人工授精、试管婴儿等。试管婴儿是指是通过人工方法使卵细胞和精子在体外受精和早期胚胎发育,然后移植到母体子宫内发育而诞生的婴儿,包括常规体外受精-胚胎移植(IVF-ET)和卵细胞质内单精子注射(ICSI),而胚胎移植技术又分为新鲜胚胎移植和冻融胚胎移植。目前对试管婴儿的安全性有诸多争议,试管婴儿可能会对母体健康造成损害,如妊娠期高血压疾病等。妊娠期高血压疾病以高血压、蛋白尿、水肿为主要症状,是孕产妇死亡的第二大原因,占10%~16%,早期病人无自觉症状,容易治疗不及时而出现重度子痫,亦间接影响子体健康。既往已有研究[3]报道试管婴儿与妊娠期高血压疾病的相关性,但对于何种试管婴儿技术种类、步骤引起的报道较为少见,本研究选取546例接受试管婴儿技术受孕的不孕症妇女,分析妊娠期高血压疾病的发病情况,探讨其与不同试管婴儿技术的相关性及妊娠结局。现作报道。
-
年龄、不孕病程、孕周、分娩胎数及新生儿体质量等基本资料在A组与B组、C组与D组之间差异均无统计学意义(P>0.05)(见表 1)。
分组 n 年龄/岁 BMI/(kg/m2) 子宫内膜厚度/mm 不孕病程/年 孕周/周 分娩胎数 新生儿体质量/g 单胎 双胎 A组 313 32.3±3.7 21.37±2.88 11.26±2.10 4.2±2.9 33.4±3.1 216 97 2 789±702 B组 233 32.8±3.9 21.56±2.68 10.97±2.21 4.6±3.3 33.8±3.6 165 68 2 831±689 t — 1.26 0.34 0.71 1.50 1.39 0.21* 0.70 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 C组 370 32.5±3.7 22.41±1.88 10.97±2.11 4.4±3.0 33.6±3.5 254 116 2 818±675 D组 176 32.2±3.5 22.12±1.95 10.62±1.92 4.6±3.1 33.7±2.9 126 50 2 749±714 t — 0.90 0.23 0.71 0.72 0.33 0.49* 1.10 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 *示χ2值 表 1 各组病人的一般资料比较(x ±s)
-
546例病人中,妊娠期高血压24例(4.40%),子痫前期28例(5.13%),子痫0例。A组与B组比较,A组的妊娠期高血压发病率明显低于B组(P < 0.05),但2组的子痫前期发病率差异无统计学意义(P>0.05)。C组与D组的妊娠期高血压及子痫前期的发病率差异均无统计学意义(P>0.05)(见表 2)。
分组 n 妊娠期高血压 子痫前期 A组 313 8(2.66) 16(5.12) B组 233 16(6.87) 12(5.15) χ2 — 5.95 0.00 P — < 0.05 >0.05 C组 370 15(4.05) 19(5.14) D组 176 7(3.98) 11(6.25) χ2 — 0.00 0.29 P — >0.05 >0.05 表 2 各组妊娠期高血压发病情况比较[n; 百分率(%)]
-
A组与B组、C组与D组的不良妊娠结局总发生率差异均无统计学意义(P>0.05)(见表 3)。
分组 n 早期流产 晚期流产 早产 低体质量儿 畸形 合计[n; 百分率(%)] χ2 P A组 313 5 3 9 7 1 25(7.99) 0.88 >0.05 B组 233 4 3 11 5 1 24(10.30) 合计 546 9 6 20 12 2 49(8.97) C组 370 6 3 10 5 2 26(7.03) 2.24 >0.05 D组 176 3 2 9 5 0 19(10.80) 合计 546 9 5 19 10 2 45(8.24) 表 3 各组不良妊娠结局比较
妊娠期高血压疾病与不同试管婴儿技术的相关性研究及妊娠结局
Study on the correlation between hypertensive disorder complicating pregnancy and different in vitro fertilization techniques, and pregnancy outcomes
-
摘要:
目的 分析妊娠期高血压疾病与不同试管婴儿技术的相关性及妊娠结局。 方法 回顾性分析接受试管婴儿技术受孕的546例不孕症病人的研究资料,依据受精方式将入选病人分为A组313例(常规体外受精-胚胎移植)和B组233例(卵细胞质内单精子注射);依据胚胎转移周期分为C组370例(新鲜周期胚胎移植)和D组176例(冷冻周期胚胎移植);比较各组之间妊娠期高血压疾病的发生情况。 结果 546例中,妊娠期高血压24例,子痫前期28例,子痫0例。A组的妊娠期高血压发病率为2.66%,低于B组的6.87%(P < 0.05),2组子痫前期发病率差异无统计学意义(P>0.05)。C组与D组的妊娠期高血压及子痫前期的发病率差异均无统计学意义(P>0.05)。不良妊娠结局总发生率在A组与B组间、C组与D组间差异均无统计学意义(P>0.05)。 结论 在不孕症病人中,卵细胞质内单精子注射技术会增加产妇发生妊娠期高血压的风险,与常规体外受精-胚胎移植及移植胚胎是否新鲜无关。 -
关键词:
- 妊娠期高血压疾病 /
- 体外受精-胚胎移植 /
- 卵细胞质内单精子注射
Abstract:Objective To analyze the correlation between hypertensive disorder complicating pregnancy and different in vitro fertilization techniques, and its pregnancy outcomes. Methods The data of 546 infertility patients with in vitro fertilization were analyzed retrospectively. According to the method of fertilization, the patients were divided into the group A(313 cases with conventional in vitro fertilization-embryo transfer) and group B(233 cases with intracytoplasmic sperm injection). According to the embryo transfer cycle, the patients were divided into the group C(370 cases with embryo transfer in fresh cycle) and group D(176 cases with embryo transfer in frozen cycle). The incidence rates of hypertensive diseases during pregnancy were compared among four groups. Results Among 546 cases, 24 cases with gestational hypertension, 28 cases with preeclampsia and no eclampsia case were identified.The incidence rate of gestational hypertension in group A(2.66%) was lower than that in B group(6.87%)(P < 0.05), and there was no statistical significance in the incidence of preeclampsia between two groups(P>0.05). There was no statistical significance in the incidence rates of gestational hypertension and preeclampsia between group C and group D(P>0.05). The differences of the total incidence rates of adverse pregnancy outcomes between group A and group B, and between group C and group D were not statistically significant(P>0.05). Conclusions In infertile women, the intracytoplasmic sperm injection increases the risk of gestational hypertension, regardless of conventional in vitro fertilization-embryo transfer or freshness of embryo transfer. -
表 1 各组病人的一般资料比较(x ±s)
分组 n 年龄/岁 BMI/(kg/m2) 子宫内膜厚度/mm 不孕病程/年 孕周/周 分娩胎数 新生儿体质量/g 单胎 双胎 A组 313 32.3±3.7 21.37±2.88 11.26±2.10 4.2±2.9 33.4±3.1 216 97 2 789±702 B组 233 32.8±3.9 21.56±2.68 10.97±2.21 4.6±3.3 33.8±3.6 165 68 2 831±689 t — 1.26 0.34 0.71 1.50 1.39 0.21* 0.70 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 C组 370 32.5±3.7 22.41±1.88 10.97±2.11 4.4±3.0 33.6±3.5 254 116 2 818±675 D组 176 32.2±3.5 22.12±1.95 10.62±1.92 4.6±3.1 33.7±2.9 126 50 2 749±714 t — 0.90 0.23 0.71 0.72 0.33 0.49* 1.10 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 *示χ2值 表 2 各组妊娠期高血压发病情况比较[n; 百分率(%)]
分组 n 妊娠期高血压 子痫前期 A组 313 8(2.66) 16(5.12) B组 233 16(6.87) 12(5.15) χ2 — 5.95 0.00 P — < 0.05 >0.05 C组 370 15(4.05) 19(5.14) D组 176 7(3.98) 11(6.25) χ2 — 0.00 0.29 P — >0.05 >0.05 表 3 各组不良妊娠结局比较
分组 n 早期流产 晚期流产 早产 低体质量儿 畸形 合计[n; 百分率(%)] χ2 P A组 313 5 3 9 7 1 25(7.99) 0.88 >0.05 B组 233 4 3 11 5 1 24(10.30) 合计 546 9 6 20 12 2 49(8.97) C组 370 6 3 10 5 2 26(7.03) 2.24 >0.05 D组 176 3 2 9 5 0 19(10.80) 合计 546 9 5 19 10 2 45(8.24) -
[1] 雷倩, 高雪婷, 屈鹏飞, 等. 试管婴儿与自然受孕双胎婴儿6月龄时体格发育分析[J]. 中国妇幼健康研究, 2020, 31(5): 617. doi: 10.3969/j.issn.1673-5293.2020.05.013 [2] FANG X, LINGQING H, YUN Z, et al. Correlation of hypertensive disorders in pregnancy with procedures of in vitro fertilization and pregnancy outcomes[J]. Exp Ther Med, 2017, 14(6): 5405. [3] LU L, HONGMEI W, ZHONGYUAN L, et al. Obstetric and perinatal outcomes of intracytoplasmic sperm injection versus conventional in vitro fertilization in couples with nonsevere male infertility[J]. Fertil Steril, 2020, 114(4): 792. doi: 10.1016/j.fertnstert.2020.04.058 [4] 闫喜秋. 体外受精-胚胎移植受孕的试管婴儿与自然分娩新生儿围生结局比较[J]. 中国现代医生, 2020, 58(7): 66. [5] SARA YVONNE B, THOMAS S, FLORIN-ANDREI T, et al. Living-donor uterus transplantation: pre-, intra-, and postoperative parameters relevant to surgical success, pregnancy, and obstetrics with live births[J]. J Clin Med, 2020, 9(8): 2485. doi: 10.3390/jcm9082485 [6] 安萍, 韩宝生, 金晔, 等. 试管婴儿备孕期夫妇营养干预对精子、卵子质量的影响[J]. 中国煤炭工业医学杂志, 2020, 23(2): 174. [7] LARUE L, KEROMNES G, MASSARI A, et al. Transvaginal ultrasound-guided embryo transfer in IVF[J]. J Gynecol Obstet Hum Reprod, 2017, 46(5): 411. doi: 10.1016/j.jogoh.2017.02.015 [8] TIITINEN A. Single embryo transfer: Why and how to identify the embryo with the best developmental potential[J]. Best Pract Res Clin Endocrinol Metab, 2019, 33(1): 77. doi: 10.1016/j.beem.2019.04.001 [9] LI RS, HWU YM, LEE RK, et al. Day 4 good morula embryo transfer provided compatible live birth rate with day 5 blastocyst embryo in fresh IVF/ET cycles[J]. Taiwan J Obstet Gynecol, 2018, 57(1): 52. doi: 10.1016/j.tjog.2017.12.008 [10] 谢素嫣, 黄晓丹, 黄小芮. 试管婴儿双胎与自然受孕双胎的临床对比分析[J/CD]. 实用临床护理学电子杂志, 2020, 5(12): 115. [11] RIENZI L, GRACIA C, MAGGIULLI R, et al. Oocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance[J]. Hum Reprod Update, 2017, 23(2): 139. [12] SIGALOS GΑ, TRIANTAFYLLIDOU O, VLAHOS NF. Novel embryo selection techniques to increase embryo implantation in IVF attempts[J]. Arch Gynecol Obstet, 2016, 294(6): 1117. doi: 10.1007/s00404-016-4196-5 [13] MAGDI Y, SAMY A, ABBAS AM, et al. Effect of embryo selection based morphokinetics on IVF/ICSI outcomes: evidence from a systematic review and meta-analysis of randomized controlled trials[J]. Arch Gynecol Obstet, 2019, 300(6): 1479. doi: 10.1007/s00404-019-05335-1 [14] 牛静. 不同年龄段血清抗苗勒管激素水平(AMH)与试管婴儿临床妊娠率的相关性及临床预测价值[J]. 黑龙江医药, 2020, 33(5): 1130. [15] GRIESINGER G, TREVISAN S, COMETTI B. Endometrial thickness on the day of embryo transfer is a poor predictor of IVF treatment outcome[J]. Hum Reprod Open, 2018, 2018(1): hox031.