精子DNA完整性与不明原因复发性流产相关性分析

发布时间：2018-04-18 22:29

本文选题：不明原因复发性流产 + 精子DNA完整性　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：复发性流产（recurrent spontaneous abortion, RSA）是指连续3次或3次以上的自然流产。其中，约40%的复发性流产找不到病因，这类流产被命名为不明原因复发性流产（unexplained recurrent miscarriage,URM）。迄今为止，复发性流产的病因研究主要针对女性因素，如生殖器解剖异常、内分泌失调、免疫紊乱、凝血异常或生殖道感染等，而对男方因素的研究相对较少。但是，精子在生殖中作为父系的遗传载体，它不仅为受精卵提供了一半遗传物质，并且对胚胎的发育也起到了至关重要的作用，随着对复发性流产病因学研究的不断深入，越来越多的目光投注到了精子DNA完整性上来探索不明原因复发性流产的病因。另外，学者们发现氧化应激是精子DNA损伤的主要致病机制，但目前针对不明原因复发性流产的抗氧化治疗仍在探索中。因此，本研究的目的是采用精子染色质扩散（sperm chromatin dispersion，SCD）方法来评估精子DNA损伤程度，分析其与不明原因复发性流产是否具有相关性，并对精子DNA碎片率异常的不明原因复发性流产男性进行尝试性抗氧化治疗。方法：选自2013年1月至12月期间于大连市妇产医院生殖中心门诊就诊的患者，①按纳入标准将研究对象分为不明原因复发性流产男方组（URM组，n=152）、正常生育男方组（对照组，n=52），采集两组男性的精液标本；②对两组进行一般情况如年龄、吸烟、饮酒和精液常规参数—精子密度、活力、畸形率的分析；③应用SCD法检测两组精子DNA断裂指数（DNA Fractionation Index,DFI）；④复发性流产组中DFI异常的男性进行维生素C(100mg,3次/d)+维生素E(100mg,2次/d)抗氧化治疗3个月。应用SPSS17.0统计软件进行数据的处理，计量资料应用t检验，计数资料应用χ2检验，P＜0.05时认为数据有统计学差异。结果：对URM组和对照组进行统计学分析：①比较两组对象的一般情况，如年龄、吸烟、饮酒情况，均无统计学差异（P＞0.05）；②精液常规参数如精子密度（106/ml）、活力（%）、畸形率（%）分别为（138.5±20.7vs145.2±18.5）、（50.0±12.9vs51.2±9.4）、（72.1±19.2vs73.8±17.6），均无统计学差异（P＞0.05）；③两组DFI异常者分别为40、4，DFI异常率分别为26.3%、7.7%，有统计学差异（P＜0.05）。将URM组DFI异常的患者随机分为抗氧化治疗组（n=20）和对照组（n=20），，复查DFI好转率分别为70%、40%，无统计学差异（P＞0.05）。结论：不明原因复发性流产与精子DNA完整性之间有显著的相关性，与精液常规参数如精子密度、活力、畸形率之间没有相关性，通过口服维生素C、维生素E可能会改善不明原因复发性流产的男性患者的精子质量。
[Abstract]:Objective: recurrent spontaneous abortion (RSAs) is a spontaneous abortion that occurs three or more times in a row.Among them, about 40% of recurrent abortion can not find the cause, this kind of abortion is named as unexplained recurrent miscarriage urmella.So far, the etiology of recurrent abortion is mainly focused on female factors, such as abnormal anatomy of genitals, endocrine disorders, immune disorders, abnormal coagulation or genital tract infection, etc.However, sperm, as a paternal genetic carrier in reproduction, not only provides half of the genetic material for fertilized eggs, but also plays a vital role in the development of embryos.More and more eyes have been placed on sperm DNA integrity to explore the etiology of unexplained recurrent abortion.In addition, researchers have found that oxidative stress is the main pathogenesis of sperm DNA damage, but the antioxidant therapy for recurrent abortion for unknown reasons is still under exploration.Therefore, the purpose of this study was to evaluate the degree of sperm DNA damage by sperm chromatin diffusion and spermatic chromatin dispersion, and to analyze the correlation between spermatozoa DNA damage and recurrent abortion of unknown origin.Trial antioxidant therapy was performed on men with unexplained recurrent abortion whose sperm DNA fragment rate was abnormal.Methods: selected patients from January to December 2013 in the outpatient clinic of the Reproductive Center of Dalian Gynecology and Obstetrics Hospital.1 according to the inclusion criteria, the subjects of the study were divided into two groups: the male group with unexplained recurrent abortion, the group with URM, the group with normal fertility, the control group (control group), the semen samples of the two groups were collected, and the two groups were given general information such as age, smoking, smoking.Alcohol and semen routine parameters-sperm density, motility, deformity rate analysis;3 the men with abnormal DFI in the recurrent abortion group were detected by SCD method. The men with abnormal DFI were treated with vitamin C 100 mg / d twice / d 2 times / d for 3 months.SPSS17.0 statistical software was used to process the data. T test was used for measurement data and 蠂 2 test was used for counting data (P < 0. 05).Results: the URM group and the control group were compared with the control group by comparing the general situation of the two groups, such as age, smoking, drinking.There was no significant difference in semen routine parameters (P > 0.05), such as sperm density of 106ml / ml, motility and deformity rate (138.5 卤20.7vs145.2 卤18.5 卤18.5L 卤9.4D), respectively. There was no statistical difference (P > 0.053.The abnormal rate of DFI was 26.37.7in the two groups of abnormal DFI (P < 0.05). The difference was significant (P < 0.05). The difference between the two groups was significant (P < 0.05), and the difference was significant (P < 0.05) between the two groups (P > 0.05), and the difference was significant (P < 0.05). The difference between the two groups was significant (P > 0.05), but there was no significant difference between the two groups (P > 0.05).The patients with abnormal DFI in URM group were randomly divided into antioxidant treatment group and control group. The improvement rates of DFI were 70% and 40%, respectively. There was no statistical difference (P > 0.05).Conclusion: there is a significant correlation between recurrent abortion of unknown cause and sperm DNA integrity, but there is no correlation between sperm routine parameters such as sperm density, motility and abnormal rate.By taking vitamin C orally, vitamin E may improve sperm quality in men with unexplained recurrent abortions.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.21

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