男性精液质量及形态与早期复发性自然流产相关性分析

发布时间：2018-07-12 21:02

  本文选题：精液分析 + 精子形态学　； 参考：《新乡医学院》2014年硕士论文

【摘要】：背景复发性流产(recurrent spontaneous abortion, RSA)大多数为早期流产,发病因素复杂,总体上包括胚胎因素、母亲因素、父亲因素,环境及心理因素等。最近有研究表明男性的遗传因素、精液因素或其它因素(如年龄及行为特点)对早期流产有很大影响。精液常规分析及精子形态学分析近年来都作为评估精液质量的重要指标,在复发性流产患者的病因排查的临床工作中我们发现仍有一部分复发性流产患者在排除了女方因素后,仅根据精液常规及精子形态学分析未得到确切的病因解释,因此仅以精子形态学分析解释男性精液因素对复发性流产发生的影响还存在争议,而对精子染色质结构的分析从遗传物质的角度,补充了对男性精子质量的评判方法。本研究以早期RSA患者配偶为研究对象,通过精液常规分析,改良巴氏染色法行精子形态学分析及精子染色质扩散实验,进一步证实男性精液质量、形态学及染色质完整性与早期复发性自然流产相关性。目的通过比较在排除女方影响因素后男性精液的常规指标、形态学分析、染色质损伤程度在复发性流产和T正常妊娠患者配偶之间的差异,初步探讨男性精液质量、形态学及染色质损伤与早期复发性自然流产相关性,期望为早期RSA的预防和治疗提供参考和新的临床指导。方法选取于新乡医学院第三附属医院生殖医学中心就诊的90例复发性流产患者配偶的精液标本与80例有正常生育史配偶的精液标本进行分析。患者禁欲3-7天后采用手淫法取精液,射入塑料取精杯。1.将精液样本放置于37℃恒温水浴箱里等待液化。60分钟内评估精液物理性状(pH值、精液体积)。准备显微镜下WLJY9000型伟力彩色精子质量检测系统对精子进行计数,评估精液密度、精子活动率。每份精液计数2次,取平均值。2.改良巴氏染色法行精子形态学分析,用100倍油镜观察涂片,系统选择精液涂片的观察视野,并评估视野中的每一条精子(形态不完整的不计入内)。每份标本应至少重复观察评估至少200个精子,统计正常精子数目、畸形精子数目、头部畸形、颈部及中段畸形和尾部畸形的数目。3.精子染色质扩散实验,计数200个精子,观察精子光晕,根据光晕和精子头部横径的比例,分为大、中、小和无光晕4个等级,大光晕和中光晕表示精子DNA完整无碎片,小和无光晕表示精子DNA断裂为碎片。结果1.研究组及对照组的双方年龄差异无统计学意义(P0.05)。2.研究组和对照组精液量、精子密度、总活动率差异无统计学意义(P0.05),研究组运动活跃型精子比例比对照组低,差异有统计学意义(t=4.665,P=0.000)。3.研究组和对照组『正常形态率、颈部及中段畸形率和尾部畸形率差异无统计学意义(P0.05),而研究组精子头部畸形率较对照组高,差异有统计学意义(t=-7.401,P=0.000)。4.研究组及对照组精子染色质扩散实验情况比较：大、中、小光晕精子、无光晕精子比率及精子DNA碎片率差异均具有统计学意义(P0.05)。结论1.早期复发性流产患者男性运动活跃型精子比率降低,头部畸形精子百分率增高,DNA碎片率增高可能参与了早期复发性流产的发生2.精液常规、精子形态学分析不能完全解释男性精液质量与复发性流产的关系,应进一步结合精子DNA损伤检测,以指导临床诊断。
[Abstract]:Background recurrent miscarriages (recurrent spontaneous abortion, RSA) are mostly early abortion with complex factors, including embryo, mother, father, environmental, and psychological factors. Recent studies have shown that genetic factors, semen factors, or other factors, such as age and behavioral characteristics, are very important for early abortion. General analysis of semen and morphological analysis of spermatozoa have been used as an important index to evaluate the quality of semen in recent years. In the clinical work of the cause of recurrent abortion, we found that some of the patients with recurrent miscarriages were still excluded from the women's factors and were only based on the sperm routine and the sperm morphology analysis. It is controversial to explain the effect of male seminal factors on the occurrence of recurrent miscarriage only with sperm morphology analysis, and the analysis of sperm chromatin structure from the angle of genetic material supplemented the method of judging the quality of male sperm. This study took the spouses of the early RSA patients as the research object and through the semen routine score. Analysis of the modified PAP staining method for sperm morphology analysis and sperm chromatin diffusion test, further confirmed the relationship between male seminal fluid quality, morphology and chromatin integrity and early recurrent spontaneous abortion. Objective to compare the routine index, morphological analysis and the degree of chromatin damage after removing the influence factors of women. The difference between the spouses of recurrent spontaneous abortion and T normal pregnancy is a preliminary study of the relationship between male seminal fluid quality, morphological and chromatin damage and early recurrent spontaneous abortion. It is expected to provide reference and new clinical guidance for the prevention and treatment of early RSA. The methods are selected in the center of reproductive medicine in Third Affiliated Hospital of Xinxiang Medical College The semen specimens of the spouses of 90 patients with recurrent spontaneous abortion were analyzed with 80 semen specimens with normal birth history spouses. The semen was taken by masturbation after 3-7 days of ascetic abstinence, and the semen samples were placed in the plastic sperm cup.1. to wait for the liquefied.60 minutes to assess the physical properties of the semen (pH value, semen volume) in the liquefied.60 minutes. The sperm counts, the sperm density and the rate of sperm motility were counted, the sperm density and the rate of sperm activity were evaluated under the microscope. 2 times of semen were counted, the average value of semen was 2 times, the average value of.2. was improved by PAP staining, the sperm morphology was analyzed, the smear was observed with 100 times of the oil mirror, the visual field of the semen smear was selected, and each of the visual field was evaluated in the field of vision. A sperm (incompletely morphologically incomplete). Each specimen should be repeated at least 200 sperm to assess the number of normal sperm, the number of malformed sperm, the head deformity, the number of cervical and middle deformities and the tail malformation in the.3. sperm chromatin diffusion test, with a total of 200 sperm, observed the halo of the sperm, according to the halo and head of the sperm. The proportion of transverse diameter was divided into 4 grades of large, medium, small and no halo. The large halo and medium halo indicated that the sperm DNA was intact, and the small and no halo indicated that the sperm DNA broke into fragments. Results the age difference between the 1. study group and the control group was not statistically significant (P0.05), the sperm volume, the sperm density, and the total activity rate of the control group and the control group There was no statistical significance (P0.05). The proportion of active sperm in the study group was lower than that of the control group. The difference was statistically significant (t=4.665, P=0.000) in the.3. study group and the control group. There was no significant difference in the normal rate, the rate of deformity of the neck and middle segments and the rate of tail malformation (P0.05), but the rate of sperm head deformity in the study group was higher than that in the control group, and there was a difference between the study group and the control group. The comparison of sperm chromatin diffusion between the t=-7.401 (P=0.000).4. research group and the control group: large, medium, small halo sperm, non halo sperm ratio and sperm DNA fragmentation rate were statistically significant (P0.05). Conclusion the rate of male sexual activity spermatozoa in the early 1. recurrent abortion patients decreased and the head deformity sperm percentage was 100%. The increase of the rate, the increase of DNA fragmentation rate may be involved in the 2. semen routine of the early recurrent abortion. The sperm morphology analysis can not fully explain the relationship between the quality of the semen and the recurrent abortion. It should be further combined with the detection of sperm DNA damage to guide the clinical diagnosis.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.21
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本文编号：2118454