本文選題：精液分析 + 精子形態(tài)學　； 參考：《新鄉(xiāng)醫(yī)學院》2014年碩士論文

【摘要】：背景復發(fā)性流產(chǎn)(recurrent spontaneous abortion, RSA)大多數(shù)為早期流產(chǎn),發(fā)病因素復雜,總體上包括胚胎因素、母親因素、父親因素,環(huán)境及心理因素等。最近有研究表明男性的遺傳因素、精液因素或其它因素(如年齡及行為特點)對早期流產(chǎn)有很大影響。精液常規(guī)分析及精子形態(tài)學分析近年來都作為評估精液質(zhì)量的重要指標,在復發(fā)性流產(chǎn)患者的病因排查的臨床工作中我們發(fā)現(xiàn)仍有一部分復發(fā)性流產(chǎn)患者在排除了女方因素后,僅根據(jù)精液常規(guī)及精子形態(tài)學分析未得到確切的病因解釋,因此僅以精子形態(tài)學分析解釋男性精液因素對復發(fā)性流產(chǎn)發(fā)生的影響還存在爭議,而對精子染色質(zhì)結構的分析從遺傳物質(zhì)的角度,補充了對男性精子質(zhì)量的評判方法。本研究以早期RSA患者配偶為研究對象,通過精液常規(guī)分析,改良巴氏染色法行精子形態(tài)學分析及精子染色質(zhì)擴散實驗,進一步證實男性精液質(zhì)量、形態(tài)學及染色質(zhì)完整性與早期復發(fā)性自然流產(chǎn)相關性。目的通過比較在排除女方影響因素后男性精液的常規(guī)指標、形態(tài)學分析、染色質(zhì)損傷程度在復發(fā)性流產(chǎn)和T正常妊娠患者配偶之間的差異,初步探討男性精液質(zhì)量、形態(tài)學及染色質(zhì)損傷與早期復發(fā)性自然流產(chǎn)相關性,期望為早期RSA的預防和治療提供參考和新的臨床指導。方法選取于新鄉(xiāng)醫(yī)學院第三附屬醫(yī)院生殖醫(yī)學中心就診的90例復發(fā)性流產(chǎn)患者配偶的精液標本與80例有正常生育史配偶的精液標本進行分析。患者禁欲3-7天后采用手淫法取精液,射入塑料取精杯。1.將精液樣本放置于37℃恒溫水浴箱里等待液化。60分鐘內(nèi)評估精液物理性狀(pH值、精液體積)。準備顯微鏡下WLJY9000型偉力彩色精子質(zhì)量檢測系統(tǒng)對精子進行計數(shù),評估精液密度、精子活動率。每份精液計數(shù)2次,取平均值。2.改良巴氏染色法行精子形態(tài)學分析,用100倍油鏡觀察涂片,系統(tǒng)選擇精液涂片的觀察視野,并評估視野中的每一條精子(形態(tài)不完整的不計入內(nèi))。每份標本應至少重復觀察評估至少200個精子,統(tǒng)計正常精子數(shù)目、畸形精子數(shù)目、頭部畸形、頸部及中段畸形和尾部畸形的數(shù)目。3.精子染色質(zhì)擴散實驗,計數(shù)200個精子,觀察精子光暈,根據(jù)光暈和精子頭部橫徑的比例,分為大、中、小和無光暈4個等級,大光暈和中光暈表示精子DNA完整無碎片,小和無光暈表示精子DNA斷裂為碎片。結果1.研究組及對照組的雙方年齡差異無統(tǒng)計學意義(P0.05)。2.研究組和對照組精液量、精子密度、總活動率差異無統(tǒng)計學意義(P0.05),研究組運動活躍型精子比例比對照組低,差異有統(tǒng)計學意義(t=4.665,P=0.000)。3.研究組和對照組『正常形態(tài)率、頸部及中段畸形率和尾部畸形率差異無統(tǒng)計學意義(P0.05),而研究組精子頭部畸形率較對照組高,差異有統(tǒng)計學意義(t=-7.401,P=0.000)。4.研究組及對照組精子染色質(zhì)擴散實驗情況比較：大、中、小光暈精子、無光暈精子比率及精子DNA碎片率差異均具有統(tǒng)計學意義(P0.05)。結論1.早期復發(fā)性流產(chǎn)患者男性運動活躍型精子比率降低,頭部畸形精子百分率增高,DNA碎片率增高可能參與了早期復發(fā)性流產(chǎn)的發(fā)生2.精液常規(guī)、精子形態(tài)學分析不能完全解釋男性精液質(zhì)量與復發(fā)性流產(chǎn)的關系,應進一步結合精子DNA損傷檢測,以指導臨床診斷。
[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.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.21
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本文編號：2118454