本文關(guān)鍵詞： 輔助生殖技術(shù) 自然妊娠 圍生期結(jié)局 胎盤　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：1978年,世界上第一例試管嬰兒的誕生,標(biāo)志著生殖醫(yī)學(xué)發(fā)展史的里程碑。目前人類輔助生殖技術(shù)(Assisted reproductive technology,ART)出生新生兒占其總數(shù)1%~4%,數(shù)量已超過500萬[1]。多項(xiàng)研究證實(shí),ART助孕與自然妊娠對比,ART助孕技術(shù)增加患者母嬰圍生期不良妊娠結(jié)局,但部分研究顯示ART的不良母嬰圍生期結(jié)局與母體不孕因素相關(guān),目前仍存在爭議。胎盤作為胎兒和母體進(jìn)行物質(zhì)交換的重要場所,其微血管網(wǎng)絡(luò)的生成及循環(huán)建立是母、兒物質(zhì)交換的保障,對于正常妊娠的維持有重要意義。最新研究表明,ART技術(shù)顯著影響人與動(dòng)物的宮內(nèi)生長軌跡,胎盤功能對胎兒宮內(nèi)生長發(fā)育及其出生后健康狀態(tài)密切相關(guān),而ART技術(shù)對胎盤功能的影響備受關(guān)注。目的評價(jià)ART助孕患者的母嬰圍生期結(jié)局,探討ART技術(shù)對不同年齡階段助孕患者母嬰圍生期結(jié)局和胎盤功能中的影響。資料與方法1.研究對象:選取我院2012年1月~2016年1月在鄭州大學(xué)第三附屬醫(yī)院產(chǎn)科分娩的ART助孕患者925例;按1:3配對及時(shí)間匹配方式隨機(jī)抽取我院自然妊娠(Spontaneous conception pregnancy,SC)分娩患者2935例作為對照組。2.研究方法:回顧性隊(duì)列分析。比較兩組間母體年齡,初潮年齡、孕產(chǎn)次、孕期體質(zhì)量增加、分娩孕周等基線數(shù)據(jù);比較兩組間母嬰圍生期結(jié)局及胎盤效率間的差異。進(jìn)一步,根據(jù)年齡進(jìn)行分層,將兩組分為年齡35歲組和年齡≥35歲組,比較不同年齡組上述母基線數(shù)據(jù)及嬰圍生期結(jié)局間的差異,進(jìn)一步探討ART技術(shù)對不同年齡階段助孕患者母嬰圍生期結(jié)局的影響。3.統(tǒng)計(jì)學(xué)方法:采用SPSS 21.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)量資料采用(?)±s表示,計(jì)數(shù)資料采用百分率描述;計(jì)量資料兩組比較采用兩獨(dú)立樣本t檢驗(yàn),計(jì)數(shù)資料兩組比較實(shí)用χ2檢驗(yàn)或連續(xù)性校正,相關(guān)因素分析采用二分類Logistic分析。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.母體基線數(shù)據(jù)比較:兩組患者年齡、高齡初產(chǎn)比率、瘢痕子宮發(fā)生率、孕產(chǎn)次、分娩方式及分娩孕周等差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組初潮年齡、孕期體質(zhì)量增加等方面無統(tǒng)計(jì)學(xué)差異(P≥0.05),將瘢痕子宮發(fā)生率納入孕產(chǎn)次行二分類Logstic分析后[aOR:1.122,95%CI(0.839-1.499)],兩組間差異無統(tǒng)計(jì)學(xué)意義(P≥0.05)。2.母體圍生期結(jié)局比較:將年齡和孕產(chǎn)次納入二分類Logstic分析顯示,兩組間在前置胎盤發(fā)生率中ART組(5.0%)高于自然妊娠組(3.9%)[P=0.023,aOR:0.646,95%CI(0.443-0.942)];余兩組間妊娠期并發(fā)癥及合并癥如:妊娠期高血壓疾病、妊娠期糖尿病(GDM)、妊娠期膽汁淤積癥(ICP)、產(chǎn)后出血,妊娠合并甲狀腺功能異常、妊娠合并貧血、妊娠合并B組鏈球菌感染;兩組間羊水及胎膜疾病等差異均無統(tǒng)計(jì)學(xué)意義(P≥0.05)。3.胎兒發(fā)育、新生兒情況及胎盤效率比較:ART組新生兒重度窒息發(fā)生率(6.7%vs 2.3%)和新生兒出生缺陷率(1.7%vs 0.5%)較自然妊娠組高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);ART組胎盤重量(590.44±96.77 g)高于自然妊娠組(577.17±90.81 g),而胎盤效率低于自然妊娠組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。余ART組與自然妊娠組在胎兒宮內(nèi)生長受限(FGR)、新生兒性別比、新生兒體質(zhì)量、新生兒身長及新生兒死亡率等方面均無統(tǒng)計(jì)學(xué)差異(P≥0.05)。4.按年齡分層后,各年齡組母體基線數(shù)據(jù)及圍生期結(jié)局比較:(1)年齡35歲組:ART組年齡高于自然妊娠組,分娩孕周小于自然妊娠組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);經(jīng)年齡,孕產(chǎn)次校正后,兩組間各種母嬰圍生期結(jié)局,兩組間差異均無統(tǒng)計(jì)學(xué)意義(P≥0.05);ART組新生兒平均出生體質(zhì)量較低,新生兒重度窒息率及新生兒出生缺陷等發(fā)生率高于自然妊娠組,而胎盤效率低于自然妊娠組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);(2)年齡≥35歲組:兩組在年齡、分娩孕周及孕期體質(zhì)量增加等發(fā)面差異無統(tǒng)計(jì)學(xué)意義(P≥0.05);ART組在羊水過少和前置胎盤發(fā)生率,及新生兒體質(zhì)量和胎盤重量均較自然妊娠組高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),余兩組間母體年齡和母嬰圍生期結(jié)局,差異均無統(tǒng)計(jì)學(xué)意義(P≥0.05)。結(jié)論1.ART助孕技術(shù)對母嬰圍生期結(jié)局相對安全。2.ART助孕技術(shù)影響胎盤效率。3.隨著年齡增加,母體年齡對母嬰圍生期結(jié)局的影響顯著。
[Abstract]:In 1978, the birth of the world's first test tube baby, marking the history of milepost in reproductive medicine. At present, human assisted reproductive technology (Assisted reproductive technology, ART) of newborn, accounting for the total number of 1%~4%, the number has more than 5 million [1]. a number of studies have confirmed that ART help pregnant and spontaneous pregnancy comparison, ART assisted reproductive technology patients increase maternal Wai period of adverse pregnancy outcomes, but some studies have shown that ART of maternal adverse perinatal outcomes and maternal factors related to infertility, it is still controversial. As an important place of placenta fetal and maternal material exchange, generation and circulation microvascular network establishment is the mother, son of material exchange security is important in maintaining normal pregnancy. The latest research shows that ART technology significantly affect human and animal intrauterine growth trajectory, health function of placenta on fetal growth and postnatal development States are closely related, and the effects of ART technology on placental function concern. Objective to evaluate the ART help pregnant patients with maternal and perinatal outcomes, discusses the ART technology in different age stages of pregnancy with maternal effect of perinatal outcome and placental function. Materials and methods: 1. subjects were selected in our hospital during January 2012 ~2016 in January 925 cases of ART patients with progesterone Third Affiliated Hospital of Zhengzhou University Department of Obstetrics; according to 1:3 matching and matching time in our hospital were randomly selected (Spontaneous conception pregnancy, the natural pregnancy childbirth SC) patients 2935 cases as control group.2. methods: retrospective cohort analysis. Comparison between the two groups of maternal age, menarche age, gravidity during pregnancy, increased body weight, gestational age and baseline data; perinatal differences between maternal outcome and placental efficiency were compared between the two groups. Further, stratified according to age, the two group was divided into 35 years of age Group and 35 years of age or older were compared in different age groups the mother and infant baseline data of perinatal period outcome differences, to further explore the effect of ART technology on.3. statistical methods in different age stages of pregnancy with maternal perinatal outcome: statistical analysis was performed using SPSS 21 statistical software, measurement data using (?). S said the count data were described by percentage; the measurement data between the two groups using two independent samples t test, count data between the two groups of practical 2 test or continuity correction, correlation analysis using two classification Logistic analysis.P0.05 the difference was statistically significant. Results 1. maternal baseline data comparison: two groups of patients with age, elderly primipara the ratio of incidence of uterine scar pregnancy, mode of delivery and the statistically significant differences in gestational age (P0.05). The two groups had no significant difference on age at menarche, pregnancy weight gain (P = 0.05), the incidence of uterine scar pregnancy into the two category Logstic analysis [aOR:1.122,95%CI (0.839-1.499)], there was no significant difference between the two groups (P = 0.05).2. maternal perinatal outcome comparison: age and parity into the two category Logstic analysis showed that among the two groups in the incidence of placenta previa. The ART group (5%) was higher than that of natural pregnancy group (3.9% [P=0.023), aOR:0.646,95%CI (0.443-0.942)]; two groups of pregnancy complications such as gestational hypertension, gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), postpartum hemorrhage, thyroid dysfunction during pregnancy, pregnant women with anemia group B streptococcal infection in pregnancy, amniotic fluid and fetal membranes; differences in disease between the two groups were not statistically significant (P = 0.05).3. fetal development, comparison and placental efficiency: the incidence of neonatal severe neonatal asphyxia ART group (6.7%vs 2.3%) and new Birth defect rate (1.7%vs 0.5%) were higher than that of natural pregnancy group, the difference was statistically significant (P0.05); group ART, placental weight (590.44 + 96.77 g) is higher than that of natural pregnancy group (577.17 + 90.81 g), and the placental efficiency is lower than the natural pregnancy group, the differences were statistically significant (P0.05). More than ART group the natural pregnancy group in intrauterine growth restriction (FGR), the sex ratio at birth, neonatal body mass, there was no significant difference on neonatal length and neonatal mortality (P = 0.05).4. stratified by age, baseline data among different age groups of maternal and perinatal outcomes: (1) 35 years old age group: ART the age group is higher than the natural pregnancy group, gestational age less than natural pregnancy group, the difference was statistically significant (P0.05); the age, parity between the two groups after the correction, a variety of maternal and perinatal outcomes, differences between the two groups had no statistical significance (P = 0.05); group ART newborn physique The amount is low, the incidence is higher than the natural rate of pregnancy group and birth defects of severe neonatal asphyxia, and placental efficiency is lower than the natural pregnancy group, the differences were statistically significant (P0.05); (2) 35 years of age or older group: the two groups in age, gestational age and maternal body weight increased from the aspects of no statistical difference significance (P = 0.05); group ART in oligohydramnios and incidence of placenta previa, body weight and placenta weight and neonatal were natural pregnancy group, the difference was statistically significant between the two groups (P0.05), maternal age and maternal and perinatal outcomes, there were no significant differences (P = 0.05). 1.ART assisted reproductive technology on maternal and perinatal outcomes relative to affect the safety of assisted reproductive technology.2.ART placental efficiency of.3. increased with age, the maternal age effect on maternal and perinatal outcome significantly.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.8

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