魏明明，何玉洁



·综述·

应用形态学及动力学参数筛选优质囊胚的研究进展

魏明明，何玉洁△

囊胚的质量在选择性单囊胚移植（elective single blastocyst transfer，eSBT）中至关重要，移植1个优质的囊胚，可以有效降低多胎率并保持较高的临床妊娠率。目前，囊胚质量的评价方法仍以形态学为主。传统的形态学评分法对各形态学参数进行综合评分，得分高的囊胚质量较优。但当有2个以上综合评分相同的囊胚可供移植时，需要新的指标来选择出最具有发育潜力者。研究显示，囊胚的3个相互独立的形态学参数：内细胞团（inner cellmass，ICM）、滋养层（trophectoderm，TE）和囊胚扩张程度三者对妊娠结局的预测价值不同，可以为囊胚的进一步筛选提供参考。近年来，应用延时（time-lapse）成像技术可以动态观察胚胎发育的全过程，原核期、卵裂期以及囊胚期的动力学参数成为了囊胚质量评价的新指标。综述应用形态学及动力学参数筛选优质囊胚的研究进展。

受精，体外；胚胎移植；囊胚；形态发生；动力学

【Abstract】The blastocyst quality is very important for the elective single blastocyst transfer（eSBT）.The multiple pregnancy rate can be effectively reduced，and the clinical pregnancy rate can be kept at a higher level，by transplanting a high-quality blastocyst.At present，the main method to evaluate the quality of blastocysts is morphology.The morphological parameters were comprehensively scored by the traditionalmorphological scoring method，which means that the blastocystwith higher score is of the better quality.However，when there aremore than two blastocysts with the same score，new indicators are necessary for embryologists to select the blastocyst with the most developmental potential for transplantation.Three independent morphological parameters of blastocyst，inner cell mass（ICM），trophectoderm（TE）and degree of blastocyst expansion with the different predictive value for the pregnancy outcomes，can provide additional references for the further screening of the blastocyst.In recent years，the whole process of embryonic development can be observed dynamically by timelapse imaging technology.The kinetic parameters of pronuclear stage，cleavage stage and blastocyst stage were tried as the new index for evaluating the quality of embryo.In this article，we reviewed the research progress on the screening high quality blastocyst bymorphological and kinetic parameters.

【Keywords】Fertilization in vitro；Embryo transfer；Blastula；Morphogenesis；Kinetics

（JIntReprod Health/Fam Plan，2016，35：308-312）

随着辅助生殖技术（assisted reproductive technology，ART）日渐成熟，体外受精-胚胎移植（in vitro fertilization and embryo transfer，IVF-ET）的胚胎移植率、着床率、妊娠率均有明显的提高。由于囊胚比卵裂期胚胎更加符合妊娠生理，因此有更好的妊娠结局［1］。为避免导致多胎妊娠，临床工作者逐渐认可选择性单囊胚移植（elective single blastocyst transfer，eSBT）［2］。在eSBT中，囊胚质量关系到妊娠结局，所以如何有效评价囊胚质量，选择一个优质囊胚进行移植，变得尤为重要。目前囊胚的评价方法包括形态学、代谢组学、基因组学，目前常用的是Gardner等［3］提出的囊胚标准形态学评分方法。……