【摘要】 目的 比较两种评分方法下囊胚形态学参数对选择性单囊胚移植(eSBT)新生儿结局的独立影响。方法 选取2018年7月至2023年4月于运城市中心医院生殖医学科行eSBT后单胎活产的304例患者为研究对象(新鲜周期66例，解冻周期238例),分别运用Gardner评分(Gardner法)和更标准化的囊胚形态学评价中国专家共识(简称共识法)两种方法对移植的囊胚进行评级。比较两种评分方法下囊胚扩张分期、内细胞团(ICM)、滋养外胚层(TE)评分对新生儿早产(PTB)、低出生体重(LBW)、巨大儿(FW)、大于胎龄儿(LGA)、小于胎龄儿(SGA)、出生时性别比(SSR)的影响。结果 (1)Gardner法3个囊胚形态学参数不同评分(囊胚扩张分期、ICM、TE)对应的新鲜或解冻SBT周期新生儿结局均无统计学差异(P>0.05);共识法囊胚扩张分期5期者的解冻SBT周期的FW和LGA比例显著高于4期者(P<0.05),解冻周期ICM分级为B级者LBW比例显著高于A、C级者(P<0.05),而不同TE分级对应的新鲜或解冻周期新生儿结局均无统计学差异(P>0.05)。(2)调整混杂因素后对新生儿结局进行Logistic回归分析或者精确Logistic回归分析，结果显示：囊胚形态学参数与新生儿结局之间，Gardner法囊胚扩张分期均未发现显著影响(P>0.05),共识法解冻周期5期囊胚对应的LGA比例是4期囊胚的5.197倍(P<0.05);Gardner法新鲜周期ICM分级为C级者SSR是A级者的10.051倍(P<0.05),共识法不同ICM分级均未发现对于新生儿结局的显著影响(P>0.05);Gardner法与共识法的不同TE分级均未发现对于新生儿结局的显著影响(P>0.05)。(3)对两种方法进行Cohen’s Kappa一致性检验，囊胚扩张分期、ICM分级、TE分级的加权Kappa系数分别为0.792、0.564、0.371,扩张分期一致性较强，ICM分级一致性中等，TE分级一致性一般。结论 两种囊胚形态学评分方法下，囊胚形态学参数对新生儿结局的影响有所不同；两种方法一致性有所不同。更多还原

【Abstract】 Objective:To explore the independent effects of morphological parameters of blastocysts on neonatal outcomes in selective single blastocyst transfer(SBT) using two scoring methods.Methods:A retrospective analysis of data of 304 patients with singleton live birth after selective SBT treatment(66 fresh embryo transfer cycles and 238 frozen-thawed embryo transfer cycles) at Reproductive Medicine Department of Yuncheng Central Hospital from July 2018 to April 2023 was conducted. The transplanted blastocysts were rated using two methods as the Gardner score(Gardner method) and the more standardized blastocyst morphology evaluation Chinese expert consensus(referred to as consensus method). The effects of blastocyst expansion stage, scores of inner cell mass(ICM),trophectoderm(TE) on preterm birth(PTB),low birth weight(LBW),fetal macrosomia(FM),large for gestational age(LGA),small for gestational age(SGA) and gender ratio at birth were evaluated when using two methods mentioned above.Results:There were no statistically significant differences in outcomes of neonates from fresh or frozen-thawed SBT cycle corresponding to different scores of three blastocyst morphological parameters(blastocyst expansion stage, ICM,TE) using the Gardner method(P>0.05). When using consensus method, the proportion of FM and LGA in the frozen-thawed SBT cycle of patients with stage 5 blastocyst expansion was significantly higher than that of patients with stage 4(P<0.05). The proportion of LBW in patients with ICM grade B during the thawing cycle was significantly higher than that of patients with grade A and C(P<0.05),while there were no statistical differences in outcomes of neonates from the fresh or frozen-thawed cycles corresponding to different TE grades(P>0.05). After adjusted for confounding factors, Logistic regression analysis or precise Logistic regression analysis was performed on neonatal outcomes. As for the correlation between morphological parameters of blastocysts and neonatal outcomes, there was no effect of blastocyst expansion staging using the Gardner method on neonatal outcomes(P>0.05),while the proportion of LGA corresponding to stage 5 blastocysts classified by the consensus method in the frozen-thawed cycle was 5.197 times that of stage 4 blastocysts(P<0.05). The SSR of fresh cycle with ICM graded C by Gardner’s method was 10.051 times higher than that of grade A(P<0.05),and no significant effects on neonatal outcomes were found in different ICM grades by consensus method(P>0.05). The different TE grades of Gardner’s method and consensus method did not show a significant impact on neonatal outcomes(P>0.05). Cohen’s kappa consistency test was conducted on two methods, and the weighted kappa coefficients for blastocyst expansion stage, ICM grading and TE grading were 0.792,0.564,and 0.371,respectively. The consistency of expansion stage was strong, ICM grading was moderate, and TE grading was average.Conclusions:The impact of blastocyst morphological parameters on neonatal outcomes varies between the two blastocyst morphological scoring methods. The consistency of the two methods is different.更多还原