不同试管婴儿技术对妊娠期肝内胆汁淤积症发病率的影响

雷玲玲　梁毓　王树玉

[摘要] 目的 探讨不同试管婴儿技术对妊娠期肝内胆汁淤积症（ICP）发病率的影响。 方法 收集整理2013年1月～2015年12月在首都医科大学附属北京妇产医院住院分娩的辅助生殖技术（ART）治疗后妊娠产妇2256例的临床资料。根据不同的受精方式分为体外受精-胚胎移植（IVF）组（1873例）和胞浆内单精子注射（ICSI）组（383例）；根据不同的胚胎转移周期分为新鲜胚胎移植（Fresh）组（1483例）和冷冻胚胎移植（FET）组（773例）。分析各组患者不孕不育的原因及不同试管婴儿技术ICP发病率。 结果 ICSI组ICP发病率略高于IVF组，但差异无统计学意义（χ2 = 0.01，P = 0.89）。FET组ICP发病率略高于Fresh组，但两组差异无统计学意义（χ2 = 0.28，P = 0.59）。 结论 接受 ICSI技术后ICP患病风险不会升高。ICP的发病风险与胚胎移植前是否进行冻融无关。

[关键词] 试管婴儿；妊娠期肝内胆汁淤积症；卵泡浆内单精子注射；冷冻周期胚胎移植

[中图分类号] R714.8 [文献标识码] A [文章编号] 1673-7210（2018）09（b）-0074-04

[Abstract] Objective To investigate the effect of different test-tube baby technology on the incidence of intrahepatic cholestasis of pregnancy （ICP）. Methods Clinical data of 2256 pregnancy women after the treatment of assisted reproductive technology at Beijing Obstetrics and Gynecology Hospital from January 2013 to December 2015 were collected. According to different fertilization modes， patients were divided into in vitro fertilization group （IVF group， 1873 cases） and intracytoplasmic sperm injection group （ICSI group， 383 cases）. According to different embryo transfer cycle， patients were divided into fresh embryo transfer （Fresh group， 1483 cases） and frozen-thawed embryo transfer group （FET group， 773 cases）. Reasons of infertility and incidence of ICP of patients in each groups were analyzed. Results The incidence of ICP in the ICSI group was slightly higher than that in the IVF group， but the difference between the two groups was no statistically significant （χ2 = 0.01， P = 0.89）. The incidence of ICP in the FET group was slightly higher than that in the Fresh group， but the difference between the two groups was no statistically significant （χ2 = 0.28， P = 0.59）. Conclusion ICSI fertilization does not increase the risk of intrahepatic cholestasis during pregnancy. Whether or not frozen thawed prior to embryo transfer is not associated with intrahepatic cholestasis during pregnancy.

[Key words] Test-tube baby； Intrahepatic cholestasis during pregnancy； Intracytoplasmic sperm injection； Frozen-thawed embryo transfer

自1978年路易斯·布朗出生以來，体外受精（in vitro fertilization，IVF）已经成为治疗不孕症的一种有效方法，并在全球范围内辅助生殖了数百万个婴儿。辅助生殖技术（assisted reproductive technology，ART）允许多个卵子通过性超促排卵同时成熟。受精和早期胚胎发育需要通过体外培养和显微操作来完成。这些技术干扰了生殖细胞的增殖、受精、发育和分化过程，并可能对胚胎产生潜在的不利影响。因此，人类ART的安全性越来越受到世界各国的关注。目前，多项研究表明，ART增加了不良妊娠结局的发生率，包括子痫前期、妊娠高血压疾病、前置胎盘、妊娠期糖尿病（gestational diabetes mellitus，GDM）、早产、低出生体重、出生缺陷等[1-5]。……