染色体镶嵌成为植入前基因检测(PGT)中的常见现象。进行此荟萃分析以研究哪些染色体镶嵌性特征与胚胎移植相容。
搜索PubMed数据库后,Embase,CCTR和相关审查,直到2021年5月。两名评审员提取了相关信息,并通过纽卡斯尔-渥太华量表独立评估了研究质量。使用固定或随机效应模型计算临床结果的概要奇数无线电(OR)。网络荟萃分析比较了不同染色体的临床结果。
总共包括6项研究,其中1,106个周期的单镶嵌胚胎转移。显著结果的植入率(IR),流产率(MR),当比较镶嵌水平<50%和≥50%的胚胎时,观察到持续妊娠/活产率(OP/LBR)[OR1.42,95%CI(1.06,1.89);OR0.45,95%CI(0.27,0.75);OR1.74,95%CI(1.28,2.37)],和镶嵌性胚胎,仅影响节段染色体,仅涉及整个染色体[OR1.31,95%CI(1.01,1.71);OR0.57,95%CI(0.36,0.93);OR1.51,95%CI(1.15,2.00)]。只有镶嵌收益或损失的胚胎具有比复杂镶嵌显著更高的IR和OP/LBR[增益与复杂:OR1.75,95%CI(1.20,2.54);OR1.73,95%CI(1.16,2.58)。损失与复杂:OR1.90,95%CI(1.34,2.71);OR2.10,95%CI(1.44,3.07)]。与涉及三个或更多个染色体的花叶胚相比,仅涉及一个染色体的花叶胚具有IR和OP/LBR的显着有利结果[OR1.76,95%CI(1.23,2.52);OR1.86,95%CI(1.25,2.78)]。Chr.7,Chr。2,Chr。1,Chr。18,Chr。11,Chr。X,Chr.13,Chr。14,Chr.12和Chr。9被认为是用于转移的镶嵌胚胎的优先染色体。
该分析支持镶嵌水平≥50%的胚胎,涉及整个染色体,多个马赛克异常与更差的妊娠结局相关.50%的镶嵌水平可以用作评估镶嵌胚的阈值。
Chromosomal mosaicism becomes a common phenomenon in Preimplantaion genetic testing (PGT). This meta-analysis was conducted to study which feature of chromosomal mosaicism was compatible for embryo transfer.
After searching the database PubMed, Embase, CCTR and related reviews up until May 2021. Two reviewers extracted relevant information and assessed study quality by the Newcastle-Ottawa scale independently. Summary Odd Radios (OR) were calculated using fixed- or random-effects models for clinical outcomes. A network meta-analysis compared the clinical outcomes of different chromosomes.
A total of six studies with 1,106 cycles of single mosaic embryo transferred were included. Significant results of implantation rate (IR), miscarriage rate (MR), and ongoing pregnancy/live birth rate (OP/LBR) were observed when comparing embryos with mosaicism level < 50% and ≥ 50% [OR 1.42, 95% CI (1.06, 1.89); OR 0.45, 95% CI (0.27, 0.75); OR 1.74, 95% CI (1.28, 2.37)], and embryos with mosaicism with only affecting segmental chromosome(s) and only involving whole chromosome(s) [OR 1.31, 95% CI (1.01, 1.71); OR 0.57, 95% CI (0.36, 0.93); OR 1.51, 95% CI (1.15, 2.00)]. Embryos with only mosaic gains or losses had significant higher IR and OP/LBR than complex mosaicism [Gains vs complex: OR 1.75, 95% CI (1.20, 2.54); OR 1.73, 95% CI (1.16, 2.58). Losses vs complex: OR 1.90, 95% CI (1.34, 2.71); OR 2.10, 95% CI (1.44, 3.07)]. Mosaic embryos with only one chromosome involved had significant favorable outcomes of IR and OP/LBR than with three or more chromosomes involved [OR 1.76, 95% CI (1.23, 2.52); OR 1.86, 95% CI (1.25,2.78)]. Chr. 7, Chr. 2, Chr. 1, Chr. 18, Chr. 11, Chr. X, Chr. 13, Chr. 14, Chr. 12, and Chr. 9 were considered as prioritized chromosomes of mosaic embryos for transfer.
This analysis support the embryos with mosaicism level ≥ 50%, whole chromosome(s) involved, multiple mosaic abnormalities were associated with worse pregnancy outcomes. Mosaicism level of 50% could be used as a threshold to assess the mosaic embryos.