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目的:探讨辅助生殖和自然妊娠中女性年龄与早期自然流产绒毛染色体数目异常的关系。方法:通过多重连接依赖探针扩增技术(MLPA)对55例自然妊娠(NC)、147例体外受精(IVF)妊娠和85例卵胞质内单精子注射(ICSI)妊娠孕早期自然流产的绒毛组织进行染色体数目检测,比较不同妊娠方式、不同染色体、不同异常染色体个数间女性年龄和非整倍体的关系。结果:NC组和IVF组中非整倍体的孕妇年龄显著高于绒毛染色体正常的孕妇年龄(NC组:35.0±5.0岁vs 31.6±4.1岁,P=0.014;IVF组:35.2±4.5岁vs 32.1±4.6岁,P=0.000),而ICSI组中无统计学差异(34.4±5.1岁vs33.5±4.1岁,P=0.391);NC组和IVF组随孕妇年龄的增长流产儿非整倍体率递增,IVF组有统计学差异(P=0.002),但ICSI组未观察到该现象。15、20、21和22号染色体异常率随孕妇年龄的增长递增,其中20、21号染色体有统计学差异(P<0.05);13号染色体异常率在40~47岁亚组中显著增高(P=0.027);16号染色体在各孕母年龄段的异常率相近;性染色体异常率在40~47岁亚组中降低。多重非整倍体组的孕妇年龄显著高于单一非整倍体组(37.4±5.3岁vs 34.9±4.6岁,P=0.039),40~47岁亚组中多重非整倍体发生率显著增高(P<0.05)。结论:女性高龄是NC和IVF妊娠非整倍体胎儿的高危因素,而ICSI可能还存在其他机制导致胎儿染色体异常。多重非整倍体及大部分小染色体非整倍体的流产儿多见于高龄孕妇,而性染色体单体流产儿则多见于较年轻孕妇,16-三体不存在母亲年龄效应。
OBJECTIVE: To investigate the relationship between female age and abnormal chromosome number of spontaneous abortion in assisted reproductive and natural pregnancy. Methods: Fifty-five spontaneous pregnancies (NC), 147 in vitro fertilization (IVF) pregnancies and 85 in-sperm intracytoplasmic sperm injection (ICSI) were performed by MLPA. Tissue chromosome number detection, comparison of different gestational patterns, different chromosomes, different number of abnormal chromosomes between female age and aneuploidy. Results: Aneuploidy pregnant women in NC group and IVF group were significantly older than those in normal chorionic villus (NC group: 35.0 ± 5.0 years vs 31.6 ± 4.1 years, P = 0.014; IVF group: 35.2 ± 4.5 years vs 32.1 ± 4.6 years old, P = 0.000), but there was no significant difference in ICSI group (34.4 ± 5.1 years vs33.5 ± 4.1 years, P = 0.391); NC group and IVF group increased with age of pregnant women There was a significant difference in IVF group (P = 0.002), but this phenomenon was not observed in the ICSI group. The abnormalities of chromosomes 15, 20, 21 and 22 increased with the increase of pregnant women ’s age, among which chromosomes 20 and 21 were significantly different (P <0.05). The abnormality rate of chromosome 13 was significantly increased in 40 - 47 years old subgroup P = 0.027). The abnormality rate of chromosome 16 in each pregnant mother’s age group was similar. The rate of sex chromosome abnormality was decreased in the subgroup of 40-47 years old. The multiple aneuploidy group had significantly higher maternal age than single aneuploidy group (37.4 ± 5.3 vs 34.9 ± 4.6 years, P = 0.039), and the incidence of multiple aneuploidies in the 40- to 47-year-old subgroup was significantly higher (P <0.05). CONCLUSION: Female seniority is a risk factor for fetal aneuploidy in NC and IVF pregnancies, and other mechanisms may contribute to fetal chromosomal abnormalities in ICSI. Multiple aneuploidies and most of the small aneuploidy of abortion more common in older pregnant women, and sexually transmitted single-genital mothers are more common in younger pregnant women, 16-trisomy there is no mother’s age effect.