【摘要】：目的探討不育男性精子DNA完整性與抗精子抗體(AsAb)及精液常規(guī)參數(shù)之間的相關(guān)關(guān)系,其中男性年齡、精子活力、活動率、精子運動參數(shù)是主要的常規(guī)參數(shù)；利用Meta分析探討精子DNA完整性與輔助生殖結(jié)果的關(guān)系。 方法 1.精子DNA完整性與相關(guān)參數(shù)的檢測 通過計算機輔助精液分析系統(tǒng)(CASA)對男性精液進行常規(guī)檢測分析,進而獲取精子的活力、活動率、運動參數(shù)等信息。采用精子染色質(zhì)擴散實驗(SCD)來檢測精子DNA碎片化程度,并計算精子DNA的碎片指數(shù)(DFI)。采用混合抗球蛋白凝集實驗(MAR)來檢測抗精子抗體,計算陽性率。整理實驗結(jié)果,應(yīng)用SPSS16.0統(tǒng)計軟件進行數(shù)據(jù)分析。 2. Meta分析 通過電子檢索及人工檢索的方式搜索篩選文獻,檢索PubMed, EMBASE, Biosis Previws, Cochrane Database, Springer Link數(shù)據(jù)庫等外文數(shù)據(jù)庫。中文數(shù)據(jù)庫包括讀秀、知網(wǎng)、維普信息資源系統(tǒng)、萬方數(shù)據(jù)庫以及中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫(CBM)等。手工檢索《中華男科學(xué)雜志》等雜志。納入以受精率、臨床妊娠率、流產(chǎn)率為主要結(jié)果,關(guān)于輔助生殖結(jié)局與精子DNA完整性研究的文獻,由兩名研究員同時獨立進行文獻納入和排除。使用Stata分析軟件進行數(shù)據(jù)處理分析。 結(jié)果 1.男性年齡與精子DNA完整性、抗精子抗體以及精液各參數(shù)之間均無相關(guān)關(guān)系(P0.05)；精子DNA完整性與精子密度、精子活力及活動率之間均呈負相關(guān)關(guān)系(P0.01)；精子DNA完整性與抗精子抗體之間無相關(guān)關(guān)系(P0.05)；AsAb僅與精子擺動性和前向性呈弱相關(guān)關(guān)系(P0.05),AsAb的產(chǎn)生影響精子的運動參數(shù)。精液的液化狀態(tài)影響精子的直線速率(VSL)、曲線速率(VCL)以及平均路徑速率(VAP),從而影響精子與卵子的結(jié)合。 2. Meta分析共納入15篇有效文獻,發(fā)表性偏倚、異質(zhì)性分析以及敏感性分析結(jié)果表明,本次Meta分析的結(jié)果穩(wěn)定良好。精子DNA完整性與輔助生殖結(jié)局有一定的相關(guān)性,在體外受精(IVF)組中,DFI值的高低與IVF受精率沒有相關(guān)性(P0.05),DFI值升高可導(dǎo)致臨床妊娠率下降,RR=0.81,95%CI(0.69,0.95),P=0.009,高DFI還能增加流產(chǎn)的風(fēng)險,RR=1.74,95%CI(1.09,2.76), P=0.020。 3.在卵胞漿內(nèi)單精子注射技術(shù)(ICSI)組,DFI值的高低與ICSI受精率沒有相關(guān)性(P0.05),對ICSI臨床妊娠率的影響也沒有統(tǒng)計學(xué)意義(P0.05),但DFI值升高,會導(dǎo)致ICSI流產(chǎn)率升高,RR=2.05,95%CI (1.21,3.47)。漏斗圖,Begg's檢驗提示納入文獻無發(fā)表偏倚。 結(jié)論精子DNA檢測作為常規(guī)檢測的補充指標,具有一定的重要性。精子DNA完整性與輔助生殖結(jié)局具有一定的相關(guān)性,因此,在進行輔助生育時,篩選DNA完整性高的精子極其重要,可提高臨床妊娠率,降低流產(chǎn)率,減少輔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 鹵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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.8

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