梗阻性无精子症患者附睾精子DNA损伤与卵胞浆内单精子注射治疗结局的相关性研究

目的检测梗阻性无精子症(OA)患者附睾精子DNA损伤情况,并与后续卵胞浆内单精子注射(ICSI)治疗结局进行对照分析。方法选取OA患者121例(OA组),均拟行ICSI治疗;另选取配偶于1年内自然受孕,且精液参数正常范围的38份精液标本作对照组。OA组患者进行经皮附睾精子抽吸术后镜检分析,对照组进行常规精液分析,同时进行穿刺液/精液吖啶橙试验。以精子DNA损伤指数(DFI)<30%为正常,两组进一步分为高DFI亚组(DFI>30%)和低DFI亚组(DFI<30%)。对OA组患者后续ICSI治疗的受精率、临床妊娠率等指标进行统计分析。结果 OA组整体精子密度、前向运动精子比例显著低于对照组整体(均P<0.01);OA组两个DFI亚组间精子密度差异无统计学意义(P>0.05),但高DFI亚组前向运动精子比例显著低于低DFI亚组(P<0.01);OA组与对照组整体相比,吖啶橙(AO)试验阴性率较低(P<0.01);OA组患者的ICSI治疗结局,高DFI亚组与低DFI亚组受精率差异无统计学意义(P>0.05),而高DFI亚组临床妊娠率显著低于低DFI亚组(P<0.01)。结论 ICSI前对精子DNA进行评估十分必要。OA患者通过对诊断性经皮附睾精子抽吸术获取的附睾精子进行DNA损伤分析,是预测ICSI结局的有效方法。

Correlation analysis between epididymal sperm DNA damage and outcome of intracytoplasmic sperm injection in patients with obstructive azoospermia

Objective To investigate the epididymal sperm DNA damage in patients with obstructive azoospermia(OA),and explore its correlationship with the outcome of subsequent intracytoplasmic sperm injection(ICSI).Methods One hundred and twenty-one patients with OA suject to ICSI were selected as OA group,and 38 semen samples with normal range of parameters were served as control group.Patients in OA group underwent percutaneous epididymal sperm aspiration and microscopic analysis,while computer assisted semen analysis was conducted in control group.Acridine orange fluorescence staining tests of aspiration fluid/semen were carried out in both groups.The normal parameter of DNA fragmentation index(DFI) was below 30%,and both groups were subdivided into high DFI subgroups(DFI>30%) and low DFI subgroups(DFI<30%).The fertilization rate and clinical pregnancy rate of the subsequent ICSI in patients with OA were statistically analysed.Results The sperm density and the proportion of forward moving sperm of OA group were significantly lower than those of control group as a whole(P<0.01).There was no significant difference in the sperm density between high DFI subgroup and low DFI subgroup of OA group(P>0.05),while the proportion of forward moving sperm in high DFI subgroup of OA group was significantly lower than that in low DFI subgroup of OA group(P<0.01).The negative rate of acridine orange test in OA group was significantly lower than that in control group as a whole(P<0.01).As to the outcome of ICSI in OA group,there was no significant difference in the fertilization rate between high DFI subgroup and low DFI subgroup(P>0.05),while the clinical pregnancy rate in high DFI subgroup was significantly lower than that in low DFI subgroup(P<0.01).Conclusion It is essential to evaluate the sperm DNA for patients with OA before ICSI.Sperm DNA damage analysis for the epididymal sperm from diagnostic percutaneous epididymal sperm aspiration is an effective method for predicting ICSI outcome for patients with OA.