精子DNA完整性与精液相关参数的研究及其与辅助生殖结局关系的Meta分析

发布时间：2018-07-20 19:58

【摘要】：目的探讨不育男性精子DNA完整性与抗精子抗体(AsAb)及精液常规参数之间的相关关系,其中男性年龄、精子活力、活动率、精子运动参数是主要的常规参数；利用Meta分析探讨精子DNA完整性与辅助生殖结果的关系。方法 1.精子DNA完整性与相关参数的检测通过计算机辅助精液分析系统(CASA)对男性精液进行常规检测分析,进而获取精子的活力、活动率、运动参数等信息。采用精子染色质扩散实验(SCD)来检测精子DNA碎片化程度,并计算精子DNA的碎片指数(DFI)。采用混合抗球蛋白凝集实验(MAR)来检测抗精子抗体,计算阳性率。整理实验结果,应用SPSS16.0统计软件进行数据分析。 2. Meta分析通过电子检索及人工检索的方式搜索筛选文献,检索PubMed, EMBASE, Biosis Previws, Cochrane Database, Springer Link数据库等外文数据库。中文数据库包括读秀、知网、维普信息资源系统、万方数据库以及中国生物医学文献数据库(CBM)等。手工检索《中华男科学杂志》等杂志。纳入以受精率、临床妊娠率、流产率为主要结果,关于辅助生殖结局与精子DNA完整性研究的文献,由两名研究员同时独立进行文献纳入和排除。使用Stata分析软件进行数据处理分析。结果 1.男性年龄与精子DNA完整性、抗精子抗体以及精液各参数之间均无相关关系(P0.05)；精子DNA完整性与精子密度、精子活力及活动率之间均呈负相关关系(P0.01)；精子DNA完整性与抗精子抗体之间无相关关系(P0.05)；AsAb仅与精子摆动性和前向性呈弱相关关系(P0.05),AsAb的产生影响精子的运动参数。精液的液化状态影响精子的直线速率(VSL)、曲线速率(VCL)以及平均路径速率(VAP),从而影响精子与卵子的结合。 2. Meta分析共纳入15篇有效文献,发表性偏倚、异质性分析以及敏感性分析结果表明,本次Meta分析的结果稳定良好。精子DNA完整性与辅助生殖结局有一定的相关性,在体外受精(IVF)组中,DFI值的高低与IVF受精率没有相关性(P0.05),DFI值升高可导致临床妊娠率下降,RR=0.81,95%CI(0.69,0.95),P=0.009,高DFI还能增加流产的风险,RR=1.74,95%CI(1.09,2.76), P=0.020。 3.在卵胞浆内单精子注射技术(ICSI)组,DFI值的高低与ICSI受精率没有相关性(P0.05),对ICSI临床妊娠率的影响也没有统计学意义(P0.05),但DFI值升高,会导致ICSI流产率升高,RR=2.05,95%CI (1.21,3.47)。漏斗图,Begg's检验提示纳入文献无发表偏倚。结论精子DNA检测作为常规检测的补充指标,具有一定的重要性。精子DNA完整性与辅助生殖结局具有一定的相关性,因此,在进行辅助生育时,筛选DNA完整性高的精子极其重要,可提高临床妊娠率,降低流产率,减少辅助生育子代的出生缺陷率。
[Abstract]:Objective to investigate the relationship between sperm integrity and anti-sperm antibody (AsAb) and sperm routine parameters in infertile men, in which age, sperm motility, motility and sperm motility are the main routine parameters. Meta analysis was used to investigate the relationship between sperm DNA integrity and assisted reproductive outcome. Method 1. The sperm DNA integrity and related parameters were detected by computer aided semen analysis system (CASA), and then the sperm motility, motility and motility parameters were obtained. Sperm DNA fragmentation was measured by sperm chromatin diffusion assay (SCD) and the fragment index (DFI) of sperm DNA was calculated. Mixed antiglobulin agglutination assay (Mar) was used to detect anti-sperm antibody and calculate the positive rate. The experimental results were analyzed by SPSS 16.0 statistical software. 2. 2. Meta-analysis searched and screened the literature by electronic and manual search, and searched the foreign language databases such as PubMed, EMBASE, Biosis PreviwsCochrane Database, Springer Link database and so on. Chinese database includes read show, knowledge net, Weip information resource system, Wanfang database and Chinese biomedical literature database (CBM). Manual retrieval of the Chinese Journal of andrology, and other magazines. The main results were fertilization rate, clinical pregnancy rate and abortion rate. The literature on the study of accessory reproductive outcome and sperm DNA integrity was included and excluded by two researchers independently at the same time. Use Stata analysis software for data processing and analysis. Result 1. There was no correlation between age and sperm DNA integrity, anti-sperm antibody and semen parameters (P0.05), but there was a negative correlation between sperm DNA integrity and sperm density, sperm motility and motility (P0.01). There was no correlation between sperm DNA integrity and anti-sperm antibody (P0.05) Asab was only weakly correlated with sperm swing and anteversion (P0.05) the production of Asab affected sperm motility parameters. The liquefaction of semen affects the linear rate (VSL), the curve rate (VCL) and the average path rate (VAP) of sperm, thus affecting the combination of sperm and egg. 2. The results of published bias, heterogeneity analysis and sensitivity analysis showed that the results of meta-analysis were stable and good. In IVF group, there was no correlation between the level of DFI and IVF fertilization rate (P0.05). The increase of DFI value could lead to the decrease of clinical pregnancy rate (P 0.009). High DFI also increased the risk of abortion (1.74% 95 CI (1.09 卤2.76), P0.020.3%). In ICSI group, there was no correlation between DFI value and ICSI fertilization rate (P0.05), and the effect on ICSI pregnancy rate was not statistically significant (P0.05). However, the increase of DFI value would lead to the increase of ICSI abortion rate and CI (1.213.47). Funnel diagram and Beggs test showed that there was no publication bias in the literature. Conclusion it is important to detect sperm DNA as a supplementary index for routine detection. The sperm DNA integrity has a certain correlation with the assisted reproductive outcome. Therefore, it is very important to screen sperm with high DNA integrity during assisted reproduction, which can increase the clinical pregnancy rate and reduce the abortion rate. Reduce the rate of birth defects in assisted offspring.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8

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