本文選題：不明原因復(fù)發(fā)性流產(chǎn) + 精子DNA完整性　； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：復(fù)發(fā)性流產(chǎn)（recurrent spontaneous abortion, RSA）是指連續(xù)3次或3次以上的自然流產(chǎn)。其中，約40%的復(fù)發(fā)性流產(chǎn)找不到病因，這類流產(chǎn)被命名為不明原因復(fù)發(fā)性流產(chǎn)（unexplained recurrent miscarriage,URM）。迄今為止，復(fù)發(fā)性流產(chǎn)的病因研究主要針對女性因素，如生殖器解剖異常、內(nèi)分泌失調(diào)、免疫紊亂、凝血異�；蛏车栏腥镜�，而對男方因素的研究相對較少。但是，精子在生殖中作為父系的遺傳載體，它不僅為受精卵提供了一半遺傳物質(zhì)，并且對胚胎的發(fā)育也起到了至關(guān)重要的作用，隨著對復(fù)發(fā)性流產(chǎn)病因?qū)W研究的不斷深入，越來越多的目光投注到了精子DNA完整性上來探索不明原因復(fù)發(fā)性流產(chǎn)的病因。另外，學(xué)者們發(fā)現(xiàn)氧化應(yīng)激是精子DNA損傷的主要致病機制，但目前針對不明原因復(fù)發(fā)性流產(chǎn)的抗氧化治療仍在探索中。因此，本研究的目的是采用精子染色質(zhì)擴散（sperm chromatin dispersion，SCD）方法來評估精子DNA損傷程度，分析其與不明原因復(fù)發(fā)性流產(chǎn)是否具有相關(guān)性，并對精子DNA碎片率異常的不明原因復(fù)發(fā)性流產(chǎn)男性進行嘗試性抗氧化治療。 方法：選自2013年1月至12月期間于大連市婦產(chǎn)醫(yī)院生殖中心門診就診的患者，①按納入標準將研究對象分為不明原因復(fù)發(fā)性流產(chǎn)男方組（URM組，n=152）、正常生育男方組（對照組，n=52），采集兩組男性的精液標本；②對兩組進行一般情況如年齡、吸煙、飲酒和精液常規(guī)參數(shù)—精子密度、活力、畸形率的分析；③應(yīng)用SCD法檢測兩組精子DNA斷裂指數(shù)（DNA Fractionation Index,DFI）；④復(fù)發(fā)性流產(chǎn)組中DFI異常的男性進行維生素C(100mg,3次/d)+維生素E(100mg,2次/d)抗氧化治療3個月。應(yīng)用SPSS17.0統(tǒng)計軟件進行數(shù)據(jù)的處理，計量資料應(yīng)用t檢驗，計數(shù)資料應(yīng)用χ2檢驗，P＜0.05時認為數(shù)據(jù)有統(tǒng)計學(xué)差異。 結(jié)果：對URM組和對照組進行統(tǒng)計學(xué)分析：①比較兩組對象的一般情況，如年齡、吸煙、飲酒情況，均無統(tǒng)計學(xué)差異（P＞0.05）；②精液常規(guī)參數(shù)如精子密度（106/ml）、活力（%）、畸形率（%）分別為（138.5±20.7vs145.2±18.5）、（50.0±12.9vs51.2±9.4）、（72.1±19.2vs73.8±17.6），均無統(tǒng)計學(xué)差異（P＞0.05）；③兩組DFI異常者分別為40、4，DFI異常率分別為26.3%、7.7%，有統(tǒng)計學(xué)差異（P＜0.05）。將URM組DFI異常的患者隨機分為抗氧化治療組（n=20）和對照組（n=20），，復(fù)查DFI好轉(zhuǎn)率分別為70%、40%，無統(tǒng)計學(xué)差異（P＞0.05）。 結(jié)論：不明原因復(fù)發(fā)性流產(chǎn)與精子DNA完整性之間有顯著的相關(guān)性，與精液常規(guī)參數(shù)如精子密度、活力、畸形率之間沒有相關(guān)性，通過口服維生素C、維生素E可能會改善不明原因復(fù)發(fā)性流產(chǎn)的男性患者的精子質(zhì)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 鹵20.7vs145.2 鹵18.5 鹵18.5L 鹵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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.21

【參考文獻】

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1 J.Erenpreiss;M.Spano;J.Erenpreisa;M.Bungum;A.Giwercman;;Sperm chromatin structure and male fertility:biological and clinical aspects[J];Asian Journal of Andrology;2006年01期

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