目的 分析卵胞浆内单精子注射(ICSI)子代4岁龄智能发育情况。方法 选取2009年1月-2009年12月在南京市妇幼保健院进行卵胞浆内单精子注射的单胎活产子代作为研究对象(ICSI，n=18例)，以年龄、性别为匹配条件，选取该院出生的自然受孕单胎活产婴儿为作对照组(SC，n=36例);排除标准:孕周<32周，体重<1 500g，有宫内窘迫，出生窒息史者。利用中国韦氏学前儿童智力量表(C-WPPSI)分别比较两组儿童4岁龄的智力发育水平。结果 比较两组儿童4岁龄智能发育水平后发现，韦氏智力测验中ICSI子代总智商、言语智商及操作智商均值在正常范围，但得分均低于SC组(总智商:ICSI 100.67±11.45，SC 115.33±10.82;言语智商:97.72±14.21，111.72±12.40;操作智商:104.83±7.87，116.50±10.68)，两者差异具有统计学意义(P<0.05)。进一步分析两组智力异常的发生率，发现ICSI子代图画填充项目量表分<7的人数明显高于SC组(ICSI 4/18，SC 0/36，χ2=8.64，P<0.05)。结论 有限的样本量结果提示，ICSI子代4岁龄智能发育在正常范围，但韦氏智力测验IQ值低于SC组。ICSI子代远期智能情况需要通过更广泛、长期、系统的随访跟踪才能得出更为详实的结论。
Abstract
Objective To analyse the cognitive development of 4 year old children conceived by intracytoplasmic sperm injection (ICSI). Methods Children enrolled into our study were conceived by ICSI from January 2009,through to the end of December 2009 in the State key Laboratory of Reproductive Medicine Department of Nanjing Maternal and Child Health Care Hospital.18 ICSI alive single born underwent cognitive assessments and 36 spontaneously conceived (SC) singletons as control subjects were matched with respect to age,gender,and birth number.The children were excluded if their gestational weeks less than 32 weeks,birth weight less than 1 500 g,with fetal distress or birth asphyxia history.Children's cognitive development was assessed with the Chinese-Wechsler preschool and primary scale of intelligence (C-WPPSI). Results Singletons conceived by ICSI achieved lower IQ scores than SC singletons (full-scale IQ:ICSI 100.67±11.45,SC 115.33±10.82; verbal IQ:97.72±14.21,111.72±12.40;performance IQ:104.83±7.87,SC 116.50±10.68,P<0.05).However,ICSI children obtained lower scores on the "picture completion" subtests (ICSI 4/18,SC 0/36,χ2=8.64,P<0.05). Conclusion In the relatively limited sample investigated,cognitive development among ICSI singletons is lower than SC singletons.By refining assessment content,expanding the sample size and extending follow-up time,we can provide more powerful evidence for judgment of the long-term developmental outcomes of assisted reproductive offspring.
关键词
:辅助生殖技术 /
卵胞浆内单精子注射 /
子代 /
智能
Key words
assisted reproductive technology /
intracytoplasmic sperm injection /
offspring /
cognitive
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参考文献
[1] 孙莹璞,王芳.辅助生殖技术方式的选择[J].中国实用妇科与产科杂志,2010,10,26(10):735-737.
[2] Pandey S,Shetty A,Hamilton M,et al.Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI:a systematic review and meta-analysis[J].Human Reproduction Update,2012,18(5):485-503.
[3] 沈秀珍,朱依敏.辅助生殖技术对子代心理健康的影响[J].国际生殖健康/计划生育杂志,2011,7,30(4):3305-3308.
[4] Winte C,Van Acker F,Bonduelle M,et al.Cognitive and psychomotor development of 5- to 6-year-old singletons born after PGD:a prospective case- controlled matched study[J].Human Reproduction,2014,29(9):1968-1977.
[5] 章瑜,黄荷凤.辅助生殖技术安全性研究进展[J].中国实用妇科与产科杂志,2010,26(10):796-800.
[6] Kallen B,Finnstrom O,Lindam A,et al.Trends in delivery and neonatal outcome after in vitro fertilization in Sweden:datafor25years[J].Hum Reprod,2010,25(4):1026-1034.
[7] Knoester M,Helmerhorst FM,Vandenbroucke JP,et al.Perinatal outcome,health,growth,and medical care utilization of 5- to 8-year-old intra cytoplasmic sperm injection singletons[J].Fertil Steril,2008,89(5):1133-1146.
[8] Bay B.Fertility treatment:long-term growth and mental development of the children[J].Dan Med J,2014,61(10):B4947.
[9] Ludwiq AK,Katalinic A,Thyen U,et al.Physical health at 5.5 years of age of term-born singletons after intracytoplasmic sperm injection:results of a prospective,controlled,single blinded study[J].Fertil Steril,2009,91(1):115-124.
[10] Bowen JR,Gibson FL,Leslie GI,et al.Medical and developmental outcome at 1 year for children conceived by intracytoplasmic sperm injection[J].Lancet,1998,351(23):1529-1534.
[11] Leslie GI,Gibson FL,McMahon C,et al.Children conceived using ICSI do not have an increased risk of delayed mental development at 5 years of age[J].Hum Reprod,2003,18(10):2067-2072.
[12] Leunens L,Celestin-Westreich S,Bonduelle M,et al.Follow-up of cognitive and motor development of 10-year-old singleton children born after ICSI compared with spontaneously conceived children[J].Hum Reprod,2008,23(1):105-111.
[13] Goldbeck L,Gagsteiger F,Mindermann I,et al.Cognitive development of singletons conceived by intracytoplasmic sperm injection or in vitro fertilization at age 5 and 10 years[J].J Pediatr Psychol,2009,34(7):774-781.
[14] Knoester M,Helmerhorst FM,Vandenbroucke JP,et al.Cognitive development of singletons born after intracytoplasmic sperm injection compared with in vitro fertilization and natural conception[J].Fertil Steril,2008,90(2):289-296.
[15] 陈小琴,张清学,李予,等.266例辅助生殖技术出生1~3岁儿童体格和精神运动发育状况分析[J].国际生殖健康/计划生育杂志,2014,33(2):113-116.
[16] 赵倩,潘琼,邹小英,等.325例辅助受孕儿24月龄时精神运动发育水平研究[J].中国儿童保健杂志,2012,20 (10):878-880.
基金
国家自然科学基金(81250008);中国疾病预防控制中心妇幼保健中心“2015年度合生元母婴营养与健康研究项目”(2015FYH011);江苏省医学重点人才项目(RC2011022);南京市医学科技发展项目(201108007)
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