微刺激方案中成熟卵母细胞纺锤体参数s与卵细胞质内单精子注射结局间的关系

doi:10.16150/j.1671-2870.2020.02.012

摘要/Abstract

摘要：

目的：探讨微刺激方案中行卵细胞质内单精子注射（intra cytoplasmic sperm injection,ICSI）时卵母细胞纺锤体的存在与否以及阻滞值等参数与ICSI后结局间的关系。方法：回顾性分析2017年12月至2019年6月期间在本院生殖中心行ICSI助孕的354例患者的临床资料,按助孕前是否见到卵母细胞纺锤体将其分成可见组（SP⁺组）和不可见组（SP^-组）,并测量纺锤体的阻滞值等参数,比较2组间的正常受精率、异常受精率、卵裂率、优质胚胎（优胚）率、囊胚形成率及临床妊娠率;同时在SP⁺组中,比较正常受精组、卵裂组、优胚组、囊胚形成组以及临床妊娠组与其对立组间的纺锤体阻滞值差异。结果：SP⁺组的正常受精率、卵裂率、优胚率、囊胚形成率及临床妊娠率均显著高于SP^-组（分别为83.72%比72.22%、98.14%比85.16%、73.07%比62.50%、50.67%比36.76%、45.56%比27.27%）,差异均有统计学意义（P<0.05）,SP⁺组的异常受精率低于SP^-组（4.26%比16.11%）（P<0.000 1）;卵母细胞可见纺锤体时,正常受精组、卵裂组、优胚组、囊胚形成组以及临床妊娠组的纺锤体阻滞值分别高于异常受精组、未卵裂组、非优胚组、囊胚未形成组以及临床未妊娠组（2.01 nm比1.81 nm、2.03 nm比1.66 nm、2.03 nm比1.91 nm、2.20 nm比2.02 nm、2.19 nm比2.01 nm）,差异都有统计学意义（P<0.05）,但纺锤体体积、面积、纺锤体与第一极体的角度在上述各组间的差异没有统计学意义。随年龄增高,<35岁组、35~40岁组、≥40岁组的人均获SP⁺卵数逐渐减少（分别为3.30个、2.91个、2.46个）,差异有统计学意义（P=0.025）。结论：纺锤体可见的卵母细胞行ICSI后有更高的正常受精率、卵裂率、囊胚形成率及临床妊娠率,而异常受精率更低;临床上应首选纺锤体阻滞值高的卵子来源的胚胎或者囊胚进行移植,以提高临床妊娠概率。

关键词: 成熟卵母细胞, 纺锤体, 阻滞值, 胚胎发育

Abstract:

Objective: To investigate correlation of human oocyte spindle and its retardant value with the outcome of embryo development after ICSI using mini stimulation protocol. Methods: A total of 354 patients placed on ICSI cycles were enrolled from December 2017 through June 2019, and the relevant clinical and laboratory data were retrieved and retrospectively analyzed. The rates of normal fertilization, cleavage, quality embryo, blastocyst formation and pregnancy were compared between individuals with and without visible spindle (SP⁺, SP^- group). In SP⁺ group, The retardant value was calculated and compared between patients with normal and abnormal fertilization; cleavage and non-cleavage; quality and non-quality embryo; blastocyst formation and non-blastocyst formation; clinical pregnancy and non-clinical pregnancy. Results: The rates of normal fertilization, cleavage, quality embryo, blastocyst formation and clinical pregnancy in patients of SP⁺ group were significantly higher than those in SP^- group （83.72% vs 72.22%, 98.14% vs 85.16%, 73.07% vs 62.50%, 50.67% vs 36.76%, 45.56% vs 27.27%, P<0.05）, while the rate of abnormal fertilization in SP⁺ group was lower（4.26% vs 16.11%, P<0.0001）. The spindle retardant value in patients with normal fertilization, cleavage, quality embryo and pregnancy were significantly higher than those without （2.01 vs 1.81, 2.03 vs 1.66, 2.03 vs 1.91, 2.20 vs 2.02、2.19 vs 2.01, P<0.05), however, there was no significant difference in spindle volume, area and spindle angle with the first polar body. With the increase of age in patients, the number of SP⁺ eggs obtained per patient decreased[<35 years old, 3.30; 35-40 years old, 2.91; ≥40 years old, 2.46] (P=0.025). Conclusion: ICSI using oocytes with visible spindle may enable higher rate of normal fertilization, cleavage, blastocyst formation and lower rate of abnormal fertilization. The embryos developed from oocytes with higher spindle retardant value could improve the clinical pregnancy rate.

Key words: Mature oocytes, Spindle, Retardant value, Embryo development

中图分类号:

R715.9

黄亚, 吴鋆龙, 徐利, 葛凤菊, 陈亚宁, 祁秀娟. 微刺激方案中成熟卵母细胞纺锤体参数s与卵细胞质内单精子注射结局间的关系[J]. 诊断学理论与实践, 2020, 19(02): 162-167.

HUANG Ya, WU Yunlong, XU Li, GE Fengju, CHEN Yaning, QI Xiujuan. Correlation of spindle parameters of human mature oocytes with the outcomes of ICSI performed with mini-stimulation protocol[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(02): 162-167.

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参考文献 14

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胚胎级别	受精第2天			受精第3天
胚胎级别	细胞数	卵裂球大小	碎片	细胞数	卵裂球大小	碎片
Ⅰ	3~5	均匀	<5%	6~10	均匀	<5%
Ⅱ	3~5	均匀	5%~15%	6~10	均匀	5%~15%
	2	均匀	<5%	4~5	均匀	<5%
Ⅲ	3~5	不均匀	15%~25%	6~10	不均匀	15%~25%
	2	均匀	10%~25%	4~6	均匀	10%~25%
Ⅳ	任何细胞数,碎片25%~50%			任何细胞数,碎片25%~50%
Ⅴ	任何细胞数,碎片>50%			任何细胞数,碎片>50%

年龄组（岁）	患者数（%）	平均年龄（$\bar{x}\pm s$）	基础FSH （U/L）	基础LH （U/L）	基础E₂ （pg/L）	AMH （ng/mL）	MⅡ卵数（个）	人均获卵数（个）	SP⁺卵数（个）	人均获SP⁺ 卵数（个）
<35	103（29.10）	31.0±2.6	12.28±8.35	4.03±2.41	28.73±14.14^d）	2.09±2.02	350	3.44±2.53	295	3.30±2.22^d）
35~40	146（41.20）	37.4±1.7^a）	12.22±1.66	4.17±2.75	32.29±15.61	1.34±1.66^a）	440	3.05±2.22	367	2.91±2.10
≥40	105（29.70）	43.5±1.9^a）,b)	14.99±12.21^c)	4.77±4.16	35.77±18.83	0.78±0.87^a）,b)	305	2.85±2.51	253	2.46±1.99
P值	-	<0.001	0.037	0.198	0.011	<0.001	-	0.189	-	0.025

分组	正常受精率（%）	异常受精率（%）	卵裂率（%）	优胚率（%）	囊胚形成率（%）	临床妊娠率（%）
SP⁺	766/915（83.72）	39/915（4.26）	790/805（98.14）	551/754（73.07）	152/300（50.67）	41/90（45.56）
SP^-	130/180（72.22）	29/180（16.11）	132/155（85.16）	80/128（62.50）	25/68（36.76）	6/22（27.27）
P	0.000 3	<0.000 1	<0.000 1	0.014 2	0.038 3	0.013 8

组别	体积(μm³)	面积(μm²)	角度(°)^a)	阻滞值(nm)
正常受精组	241.30±115.99	84.80±26.75	16.18±20.31	2.01±0.56
异常受精组	243.62±127.34	85.16±29.47	18.19±19.76	1.81±0.51
P值	0.904	0.935	0.906	0.027
卵裂组	241.49±115.38	84.56±26.78	16.25±20.31	2.03±0.57
未卵裂组	190.42±83.19	71.95±19.59	5.88±9.32	1.66±0.27
P值	0.127	0.098	0.078	0.028
优胚组	241.65±114.58	85.09±26.53	16.77±21.03	2.03±0.52
非优胚组	241.13±117.56	83.93±26.99	14.98±18.44	1.91±0.52
P值	0.954	0.581	0.260	0.003
囊胚形成组	249.97±120.66	85.15±26.01	13.88±16.74	2.20±0.61
囊胚未形成组	249.07±116.08	86.10±26.40	15.85±18.24	2.02±0.65
P值	0.952	0.773	0.375	0.029
临床妊娠组	247.97±118.66	84.82±24.74	14.98±15.74	2.19±0.53
临床未妊娠组	245.99±115.69	83.92±23.81	13.85±16.24	2.01±0.56
P值	0.932	0.918	0.802	0.028

年龄分组（岁）	SP⁺卵数	阻滞值（nm）	F值	P值
<35	295	2.1±0.6
35~40	367	2.0±0.6	6.796	0.001
≥40	253	1.9±0.5