重庆地区1020对不良孕产史夫妇的细胞遗传学分析

作者为了研究不良孕产史与染色体异常的关系，采用外周血淋巴细胞常规培养法制备染色体标本，对1020对有不良孕产史的夫妇双方进行了染色体检查，共检出异常核型128例，异常检出率为6．28％，明显高于普通人群。异常核型所涉及的染色体有1、2、3、4、5、6、7、8、9、10、11、12、13、14、15、16、17、18、20、21、X、Y等65种核型。其中4种核型经专家鉴定属世界首报。在异常染色体核型中，平衡易位98例(相互易位68例，罗伯氏易位30例)，占76．56％，染色体臂间倒位16例，占12．50％，其它染色体异常核型12例，占9．38％，嵌合体2例。占1．56％，男性47例。占36．72％；女性81例；占63．28％。并就不良孕产史异常染色体的检出率；染色体平衡易住与不良孕产史；染色体臂间倒位与不良孕产史；大Y染色体与不良孕产史；异常染色体的男女比例等进行了分析和讨论。认为不良孕产史不但与染色体畸变有关，而且与染色体多态性也有一定关系。对于不良孕产史的夫妇进行染色体检查十分必要。这不仅有助于病因的诊断与分析，而且也有助于临床的处理扣指导。     

增加染色体分析量诊断45，X／46，XX／47，XX，＋91例报告

在染色体核型分析时，一般文献认为分析30个中期分裂相即可以作出核型诊断。在临床实践中，我们发现按一般的分析量，有一部分患者核型正常，但临床其它检查又往往无异常发现，给最后病因诊断带来了极大困难。最近作者发现一例有不良孕产史患者，在染色体分析时，当逐渐增加分析量500个分裂相，患者的核型为三种嵌合体，现报告如下。     

716对不良孕产史夫妇的细胞遗传学分析

本文对 716对有不良孕产史的夫妇进行了细胞遗传学检查 ,发现染色体异常核型 74例 ,异常率为 5 .17%。其中平衡易位 5 5例 ,嵌合体 4例 ,其它染色体异常 15例。异常核型中男性 2 6例 ,女性 48例。并就染色体异常与不良孕产史的关系进行了讨论     

人类种植前胚胎的染色体分析

核型分析是诊断人类胚胎染色体异常的常规方法 ,但是通过细胞遗传学方法对人类种植前胚胎进行染色体检测并不容易。因此分裂间期细胞核的荧光原位杂交 (FISH)就成为首选方法之一。体外受精 (IVF)种植前胚胎的 FISH和核型分析均表明 :胚胎的染色体异常率可高达 2 5 %～ 5 1%。FISH分析显示染色体异常最常见的情况是染色体嵌合 (2 2 %～ 2 4 % )和胚胎分裂紊乱 (7%～ 2 6 % )。虽然目前还不能应用以上方法对自然受精的胚胎进行检测 ,但是染色体嵌合以及胚胎分裂紊乱较高的发生率可以为我们合理的解释人类的月经周期自然妊娠率为什么如此之低 (2 5 % ) ,提供理论依据     

湖州地区137对不良孕产史夫妇细胞遗传学分析

目的探讨不良孕产史与细胞遗传学的关系。方法对137对有不良孕产史的夫妇进行外周血淋巴细胞染色体核型分析。结果发现20例异常核型,异常检出率为7.30%。其中结构异常7例,数目异常5例,Y染色体长度变异7例,另有1例性分化异常。结论不良孕产史夫妇染色体核型异常发生率明显偏高,对其行细胞遗传学分析很有必要,可为临床病因诊断提供依据。     

台州地区461对不良孕产史夫妇的细胞遗传学分析

目的对有不良孕产史夫妇进行细胞遗传学检查,探讨染色体异常与不良孕产史的关系。方法采用外周血淋巴细胞培养进行染色体核型分析。结果922例患者中共检出异常核型30例,异常率为3.25%(30/922);另检出染色体多态性变异27例,检出率为2.93%(27/922),其中大Y 4例,小Y 1例,qh 9例,D/G组p 或s 13例。异常核型中染色体相互易位15例,罗伯逊易位4例,臂间倒位5例,其它6例。结论染色体畸变是不良孕产史的一个重要原因,对有不良孕产史夫妇进行染色体检查具有临床意义,同时,染色体多态性与不良孕产史密切相关,其遗传效应及机制尚需进一步探讨。     

854例不良孕产史夫妇的染色体核型分析

目的 探讨不良孕产史夫妇与染色体核型异常的关系.方法 对854例不良孕产史夫妇进行外周血淋巴细胞培养及染色体核型分析.结果 染色体异常核型41例,染色体异常率为4.80%,其中相互易位16例,倒位3例,缺失9例,大Y5例,其它9例,分别占染色体异常核型的36.6%、7.32%、21.9%、12.2%和21.9%.染色体异常在男女发生的比例相当.结论 染色体核型异常是导致不良孕产史的重要原因之一,对不良孕产史夫妇双方进行细胞遗传学检查十分必要.     

邢台地区1145例不良孕产史夫妇的细胞遗传学研究

目的 探讨不良孕产史病因。方法 采用外周血进行淋巴细胞培养，制备染色体标本、G显带核型分析。结果 对1145例就诊患者进行检测，发现染色体异常核型47例，异常率为4．10％；另检出染色体多态性变异89例，检出率为7．77％，其中大Y87例，小Y1例，9qhl＋2例。结论 染色体畸变是不良孕产史的一个重要因素。     

河北地区2373例遗传咨询患者遗传检测结果回顾性分析

目的分析2373例遗传咨询者的遗传检测结果与临床效应的关系。方法采用外周血淋巴细胞培养方法常规制备染色体标本,G显带进行核型分析。通过提取外周血DNA,定性检测AZF微缺失。结果 2373例遗传咨询者中检测出染色体异常154例,核型异常率为(6.49%),其中男性染色体异常126例,占异常染色体的81.82%,女性染色体异常28例,占异常染色体的18.18%。染色体数目异常101例,占异常染色体的65.58%,染色体结构异常30例,占异常染色体的19.48%,嵌合体5例,占异常染色体的3.25%,两性畸形4例,占异常染色体的2.60%,染色体多态性14例,占异常染色体的9.09%。2373例咨询者中,有573对夫妻具有不良孕产史(包括人流,胚胎停育,生化妊娠,自然流产史,生育有出生缺陷儿等),其中共检出21例染色体核型异常,异常率为7.33%。982例男性中同时检查了AZF微缺失的为411例,其中AZF异常为52例,异常率为12.65%,AZF C区缺失为主,约占总缺失的50.0%。在男性中检测出34例大Y核型和90例小Y核型,大Y染色体中,异常精子(无精子,少弱精子,死精子等)占61.76%,小Y中异常精子率为61.11%。大Y染色体中配偶有不良妊娠史的(包括自然流产史、胚胎停育、多发流产、畸形儿生育史、死胎死产史等)的占32.35%,小Y染色体中配偶有不良妊娠史的占21.11%。小Y染色体组中配偶有不良妊娠史的发生率和大Y染色体组相比无显著性差异(χ2=1.7,P0.05);结论染色体异常是导致性发育异常、不孕不育、智力低下、胎儿畸形、不良孕产史等疾病的重要原因之一,我们发现一些常染色体间易位/常染色体性染色体间的易位可以导致男性精液的改变甚至导致无精,对男性不育的遗传因素研究补充临床数据。因此,对高危人群进行染色体检查,对临床指导优生及提高人口素质具有重要意义。     

2315对不孕不育、不良孕产史夫妇细胞遗传学分析

目的探讨不孕不育、不良孕产史与染色体异常的关系。方法采用细胞遗传学方法进行分析。结果①2315对不孕不育、不良孕产史夫妇检出染色体异常核型127例,异常检出率为2．74％。其中,性染色体数目异常29例,占染色体异常的22．84％（29／127）;性染色体结构异常7例,占染色体异常的5．51％（7／127）;常染色体结构异常91例,占染色体异常的71．65％（91／127）,其中女性异常核型53例,男性异常核型38例。异常染色体包括1—18号、20-22号、X、Y共23条染色体。结论夫妇任何一方染色体核型异常是不孕不育及不良孕产史的重要原因之-。     

Preimplantation genetic diagnosis and sperm analysis by fluorescence in-situ hybridization for the most common reciprocal translocation t(11;22).

In this study we describe the pre-clinical development and clinical application of preimplantation genetic diagnosis (PGD) by fluorescence in-situ hybridization (FISH) for two non-related carriers (one male and one female) of the most common balanced reciprocal translocation: t(11;22)(q25;q12). For the couple with the female carrier, enumeration of the sex chromosomes in the embryos was also indicated (husband: 47,XXY karyotype). Four-colour FISH analysis was performed on six blastomeres from three embryos. No embryo transfer was possible because all the embryos were unbalanced. Three PGD cycles, with two-colour FISH, were carried out for the couple with the male translocation carrier. A total of 35 embryos were biopsied and diagnosed by FISH; nine out of the 35 embryos (25. 7%) were normal and seven of them were transferred (two embryos from the first and four from the third cycle), six out of 35 embryos (17%) were unbalanced, three out of 35 embryos (5.7%) were triploid or polyploid, 10 out of 35 embryos (28.6%) were mosaic and seven out of 35 embryos (20%) were chaotic. Diagnosis failed in 2.9% of the embryos. The spermatozoa of the male carrier were also analysed using three-colour FISH. Only 29.1% of the sperm cells seemed to be balanced or normal. By choosing probes lying on both sides of the breakpoints and by using a combination of sub-telomeric or locus-specific probes and centromeric probes, the use of three-colour FISH enabled detection of all the imbalances in sperm and/or cleavage-stage embryos in the patients. This may improve risk assessment and genetic counselling in the future for translocation carriers.     

Clinical experience of sex determination by fluorescent in-situ hybridization for preimplantation genetic diagnosis.

In our centre we started using fluorescent in-situ hybridization (FISH) technique for sexing in couples with sex-linked diseases in May 1995. Probes specific for chromosomes X, Y and 18 were applied, allowing us to detect simultaneously both gender and ploidy status. The efficiency of the FISH procedure is 90.4% per biopsied blastomere or 95.2% per biopsied blastomere with a distinct nucleus visible at spreading. Up to December 1997, we treated 15 couples (20 treatment cycles) at risk for X-linked recessive disease and two couples with Yq deletion (two treatment cycles) with the aim of transferring only female embryos. In one cycle, no embryos suitable for biopsy were obtained and in five cycles no normal female embryos were available at diagnosis. In the remaining 16 cycles, transfer was possible and six pregnancies ensued: one miscarriage has occurred and six children have been born from the other five pregnancies. The implantation rate (fetal sacs) per transferred embryo was 20.8%. In 98 (61%) of the 161 diagnosed embryos, a diploid status was observed in one or in both biopsied blastomeres. In 10 out of the 161 (6.2%) embryos a heterogeneity among the two biopsied blastomeres was found: a diploid nucleus in one blastomere and a non-diploid pattern or binuclear status in the other. In the remaining 53 (32.9%) out of 161 diagnosed embryos, the biopsied blastomeres were abnormal. The embryos that were not transferred or frozen were further analysed. When two sex chromosomes and two autosomes were present in the biopsied blastomere, the sex determination of the biopsied blastomere was never in conflict with the sex determination in the rest of the embryo. Furthermore, if the biopsied cell was diagnosed as abnormal (triploid, aneuploid, chaotic) the embryo was indeed completely abnormal or at least mosaic. A FISH error could not be excluded in two embryos (1.2%); however, a wrong gender determination did not result from this.     

Preimplantation genetic diagnosis of a reciprocal translocation t(3;11)(q27.3;q24.3) in siblings

Preimplantation genetic diagnosis (PGD) was performed in two couples to avoid chromosomally unbalanced progeny in a family in which a brother and a sister carry an identical maternally inherited balanced translocation t(3;11)(q27.3;q24.3). Embryos were biopsied 3 days after fertilization and blastomeres were analysed by fluorescent in-situ hybridization (FISH). Embryos were classified as unbalanced or normal/balanced. In the first case, the male carrier and his wife underwent one IVF/PGD treatment cycle. In all, 18 embryos were analysed. Of those, 15 revealed an unbalanced karyotype. For one embryo, results were not conclusive, from one embryo results were contradictory and one embryo was classified as normal/balanced and subsequently transferred. A singleton pregnancy was achieved. The PGD analysis was confirmed at 16 weeks gestation by amniocentesis. At term, a healthy girl with a balanced karyotype was born. Pregnancy and delivery were without complications. In the second case, the female carrier and her husband underwent two IVF/PGD treatment cycles. During the first cycle, three embryos were analysed. One embryo revealed an unbalanced karyotype and two embryos were designated a normal/balanced karyotype and transferred but no pregnancy was achieved. During the second PGD cycle three embryos were analysed. Of those, none appeared suitable for transfer. The couple decided not to undergo further treatment. Our results indicate that for individuals carrying a reciprocal translocation PGD is a feasible approach to obtain embryos with a normal chromosome balance and to avoid both spontaneous and induced abortion.     

全染色体涂抹探针在女性罗伯逊易位携带者植入前遗传学诊断中的临床应用

目的应用全染色体涂抹探针（whole chromosome painting probe，WCP）对女性罗伯逊易位携带者进行卵母细胞第一极体的植入前遗传学诊断（preimplantation genetic diagnosis，PGD）。方法应用全染色体涂抹探针进行第一极体荧光原位杂交，对4例女方罗伯逊易位携带者进行了4个周期的PGD。患者染色体核型均为45，XX，der（13；14），（q10；q10）。所有周期取卵后6h内通过活检取出第一极体，采用WCP探针进行荧光原位杂交，受精后第3天选择染色体组成正常或平衡的胚胎进行宫腔内移植。结果4个周期共获卵61个，其中54个成熟可进行活检，活检成功率92．6％（50／54），固定成功率90．O％（45／50）。40个获得明确诊断，总体诊断率为74．1％（40／54）。卵胞浆内单精子注射后受精率64．8％（35／54），优质胚胎率为65．7％（23／35）。获得2例临床妊娠。其中1例于孕9周胚胎停止发育，绒毛染色体分析核型为45，X；另1例产前诊断证实核型为46，XX。2006年6月足月分娩一正常活女婴。结论全染色体涂抹探针可准确区分正常、平衡以及异常卵子，从而可有效应用于女性染色体易位携带者的PGD。     

Analysis of the evolution of chromosome abnormalities in human embryos from Day 3 to 5 using CGH and FISH

The use of interphase fluorescent in situ hybridization (FISH) has shown that a large number of human embryos exhibit chromosomal abnormalities in vitro. The most common abnormality is mosaicism which is seen in up to 50% of preimplantation embryos at all stages of development. In this study, comparative genomic hybridization (CGH) was used to analyse 1-2 cells biopsied on Day 3 of development while the rest of the embryo was cultured until Day 5. Embryos were spread on Day 5 and analysed by FISH using probe combinations that varied depending on the CGH result, to investigate the progress of any abnormalities detected on Day 3. A total of 37 frozen-thawed embryos were analysed in this study. One gave no CGH or FISH results and was excluded from analysis. Six embryos failed to give any FISH result as they were degenerating on Day 5. Thirty embryos provided results from both techniques. According to the CGH results, the embryos were divided into two groups; Group 1 had a normal CGH result (13 embryos) and Group 2 an abnormal CGH result (17 embryos). For Group 1, three embryos showed normal CGH and FISH results, while 10 embryos were mosaic after FISH analysis, with various levels of abnormalities. For Group 2, FISH showed that all embryos were mosaic or completely chaotic. The combination of CGH and FISH enabled the thorough investigation of the evolution of mosaicism and of the mechanisms by which it is generated. The main two mechanisms identified were whole or partial chromosome loss and gain. These were observed in embryos examined on both Day 3 and 5.     

应用两轮荧光原位杂交进行人类植入前胚胎染色体嵌合型的研究

目的应用2轮荧光原位杂交技术(fluorescence in situ hybridization,FISH)对人类植入前胚胎染色体嵌合型的发生机制和影响因素进行初步研究。方法选择体外受精与胚胎移植(in vitro fertilization-embryo transplantation,IVF-ET)治疗周期中不适于胚胎移植和冷冻的正常受精胚胎为研究对象,固定后进行2轮FISH,分析13、16、18、21、22、X、Y等7条染色体组成。结果51个胚胎中正常胚胎14个(27.5%),嵌合型16个(31.4%),无规律分裂12个(23.5%),异常非嵌合型9个(17.6%)。5～8细胞期胚胎中嵌合型胚胎的比例显著高于≤4细胞期胚胎(40.0%比12.5%)。非整倍体胚胎的比率在≥35岁组为57.1%,显著高于<35岁组(23.3%)。结论胚胎染色体嵌合型是植入前胚胎的常见现象,可能是影响IVF成功率的重要因素,而应用2轮FISH技术可有效地进行常见染色体异常的筛查。     

一例嵌合型18三体少精子症患者精染色体分析及植入前遗传学诊断

目的 分析1例嵌合型18三体少精子患者精子18、X、Y染色体数目畸变并进行植入前遗传学诊断(preimplantation genetic djagnosis,PGD).方法 采用G带及荧光原位杂交(fluorescence in situ hybridjzation,FISH)对中期分裂相进行分析,应用三色探针CEP18、CEPY、Tel Xq/Yq对患者精子进行FISH分析,同时以1名染色体正常男性的正常精液作为对照,并对嵌合型18三体患者进行PGD.结果 患者精子18二体率、性染色体二体率和二倍体率分别为0.63%、0.94%和0.87%,与对照组相比(0.16%、0.35%、0.31%)差异有统计学意义.患者进行1个PGD周期的治疗、活检4个胚胎,移植正常的XY1818、XX1818各1胚胎后获得临床妊娠.结论 精子FISH分析可为其提供更准确的遗传咨询及指导植入前遗传学诊断,FISH-PGD可有效地应用于嵌合型18三体的植入前遗传学诊断.     

Preimplantation genetic diagnosis for ornithine transcarbamylase deficiency by simultaneous analysis of duplex-nested PCR and fluorescence in situ hybridization: a case report

Ornithine transcarbamylase (OTC) deficiency is an X-linked co-dominant disorder. A couple, with a previous history of a neonatal death and a therapeutical termination due to OTC deficiency, was referred to our center for preimplantation genetic diagnosis (PGD). The female partner has a nonsense mutation in the exon 9 of the OTC gene (R320X). We carried out nested polymerase chain reaction (PCR) for R320X mutation and fluorescence in situ hybridization (FISH) for aneuploidy screening. Among a total of 11 embryos, two blastomeres per embryo from 9 embryos were biopsied and analyzed by duplex-nested PCR and FISH, and one blastomere per embryo from 2 embryos by only duplex-nested PCR. As a result of PCR and restriction fragment length polymorphism analysis, four embryos were diagnosed as unaffected embryos having the normal OTC gene. Among these embryos, only one embryo was confirmed as euploidy for chromosome X, Y and 18 by FISH analysis. A single normal embryo was transferred to the mother, yielding an unaffected pregnancy and birth of a healthy boy. Based on our results, PCR for mutation loci and FISH for aneuploidy screening with two blastomeres from an embryo could provide higher accuracy for the selection of genetically and chromosomally normal embryos in the PGD for single gene defects.     

Fluorescence in-situ hybridization of sex chromosomes in spermatozoa and spare preimplantation embryos of a Klinefelter 46,XY/47,XXY male

It has been suggested recently that 47,XXY germ cells are able to progress through meiosis to produce hyperhaploid spermatozoa. We report on a 46,XY/47,XXY Klinefelter patient whose spermatozoa were recovered from the ejaculate and used for intracytoplasmic sperm injection (ICSI). Fluorescence in-situ hybridization (FISH) analysis of the patient's spermatozoa and of spare preimplantation embryos with DNA probes specific for chromosomes X, Y and 18 revealed sex chromosome hyperploidy in 3.9% of the sperm nuclei analysed (2.23% XY18, 1.12% XX18, 0.56% YY18), while only three out of 10 spare embryos analysed were normal for chromosomes tested. The abnormalities included two diploid mosaic embryos with the majority of the blastomeres normal for the chromosomes tested, and five embryos with mostly abnormal blastomeres and chaotic chromosome X, Y and 18 patterns. None of the embryos analysed showed a XXY1818 or XXX1818 chromosome complement. The frequency of sex chromosome hyperploidy in the spermatozoa of the mosaic Klinefelter patient was higher than the mean reported for karyotypically normal males, supporting the hypothesis that 47,XXY germ cells are able to complete meiosis and produce aneuploid spermatozoa. However, most of the spermatozoa analysed were normal for sex chromosomes, and ICSI of the patient's spermatozoa did not result in a spare embryo with a uniform 47,XXY or 47,XXX chromosome complement. Instead, fertilization produced a high percentage of mosaic embryos with chaotic chromosome arrangements.     

Intrachromosomal insertion translocation resulting in duplication of chromosome band Yq11.2 in two fertile brothers

Chromosome analysis in a couple referred because of two spontaneous abortions showed a normal 46,XX karyotype in the 28-year-old female and an aberrant Y chromosome with an enlarged short arm in the 30-year-old male. Subsequent chromosome analysis showed that his 33-year-old brother was carrier of the same Y chromosome aberration. Further characterization of the aberrant Y chromosome with FISH using probes specific for chromosome bands Yp11.32, Yq11.2, the centromere and the subtelomeric region of the p-arm of the Y chromosome showed that chromosome band Yq11.2 was duplicated and inserted in the p-arm of the Y chromosome. Combining the results of the analysis of GTG-banded chromosomes and of the FISH analysis we conclude that both patients have a 46,X,ins dup(Y)(pter --> p11.23::q12 --> q11.1::p11.23 -->) karyotype. The clinical and cytogenetical findings are reported and discussed.