辅助生殖技术中低出生体质量儿相关风险因素及CFTR/HLA-G相关性分析

Risk factors associated with low birth weight infants in assisted reproduction

关键词:  辅助生殖技术  低出生体质量  危险因素  产科结局  鲜胚移植

Key words:  assisted reproductive technology  low birth weight  risk factor  obstetric outcome  fresh embryo transfer

摘要:

目的 探讨辅助生殖技术中低出生体质量（low birth weight, LBW）儿的相关风险因素及其影响机制。方法 回顾性分析2014年3月—2016年12月在同济大学附属同济医院生殖医学科接受辅助生殖技术助孕分娩的患者，用EXCEL软件建立数据库，计算机录入资料并整理数据后，采用χ2检验及多因素Logistic回归分析等方法，探讨影响辅助生殖技术子代中LBW儿发生的危险因素及其影响机制。结果 女方免疫性不孕（OR=0.31）、男方少弱精（OR=2.843）、轻度子痫前期（OR=2.438）、妊娠期肝内胆汁淤积症（OR=0.478）、双胎（OR=1.728）、胎膜早破（OR=0.351）、短方案（OR=0.608）、分娩孕周（<37周，OR=5.018），均与LBW相关(P<0.05)。HCG日低雌激素组（E2<3000pg/mL）的新生儿出生体质量高于高雌激素组（E2>3000pg/mL）；鲜胚组新生儿体质量低于冻胚组；自然妊娠组新生儿体质量高于鲜胚和冻胚组；差异均有统计学意义（P<0.05）。新鲜周期妊娠组卵泡液中囊性纤维化跨膜转导调节因子（cystic fibrosis transmebrane conductance regulator, CFTR）浓度和新生儿体质量呈负相关，可溶性人白细胞抗原-G（sduble human lecucocyte antigen G, sHLA-G）浓度和新生儿体质量呈正相关。结论 女方免疫性不孕、男方少弱精症、轻度子痫前期、妊娠期胆汁淤积症、双胎、胎膜早破、短方案、分娩孕周（<37周）均与辅助生殖子代LBW密切相关。HCG日雌激素水平低于3000pg/mL的新生儿体质量较高。卵泡液中适宜的CFTR和sHLA-G水平是影响ART新生儿体质量的重要因素。

Abstract:

Objective To investigate the risk factors of low birth weight infants in assisted reproduction (ART). Methods Clinical data of 54 patients who received assisted reproduction and had successful childbirth in Tongji Hospital affiliated Tongji University from March 2014 to December 2016 were retrospectively analyzed. multi-factor Logistic were used. The risk factors associated low birth weight infants were analyzed with multivariate Logistic regression. Results Female immune infertility (OR=0.31), male oligospermia and asthenospermia (OR=2.843), mild preeclampsia (OR=2.438), intrahepatic cholestasis of pregnancy (OR=0.478), twins (OR=1.728), premature rupture of membranes (OR=0.351), short regimen (OR=0.608), gestational weeks of delivery (<37 weeks, OR=5.018) were associated with low birth weight of infants (P<0.05). The neonatal birth weight of the low estrogen on HCG day group (E2<3000pg/mL) was higher than that of the high estrogen group (E2>3000pg/mL); the fresh embryo group had lower body weight than the frozen embryo group; the body weight of neonates in the natural pregnancy group was higher than that in the fresh embryo and frozen embryo group (All P<0.05). The CFTR concentration in the follicular fluid of the fresh cycle pregnancy group was negatively correlated with the body weight of the newborns, and the concentration of sHLA-G was positively correlated with the body weight of the newborns. Conclusion Female immune infertility, male oligozoospermia, mild preeclampsia, intrahepatic cholestasis of pregnancy, twins pregnancy, premature rupture of membranes，gestational age less than 37 weeks and short-term protocol are closely related to low birth weight of assisted reproductive offspring. The body weight of newborns in mother with E2 level below 3000pg/mL on HCG day trends to be larger. The appropriate levels of CFTR and sHLA-G in follicular fluid are affecting the body weight of ART newborns.