精子顶体酶检测对不明原因不孕夫妇助孕治疗方案选择的临床意义  

Value of sperm acrosin activity detection in selecting the method of assisted reproduction for patients with unexplained infertility

作　　者：孙琴[1] 李鸿儒[1] 梁元姣[1] 姚兵[1] 陈莉[1] 

机构地区：[1]南京军区南京总医院生殖医学中心,江苏南京210002

出　　处：《中华男科学杂志》2017年第2期152-156,共5页National Journal of Andrology

摘　　要：目的:探讨精子顶体酶检测对不明原因不孕(UI)夫妇选择助孕治疗方案的临床意义。方法:回顾性分析2013年1月至2015年12月诊断为UI,并经3次宫腔内人工授精(IUI)治疗失败改行体外受精-胚胎移植(IVF-ET)助孕的49对夫妇共49个周期的临床资料,并对比分析同期因输卵管阻塞因素行常规IVF治疗的95对夫妇的131个周期的临床资料,比较两组实验室数据、临床结局和顶体酶活性差异;进一步根据UI夫妇男方精子顶体酶活性将UI组分成2个亚组:<36 IU/106精子组共20个周期,≥36 IU/106精子组共29个周期,比较两亚组之间受精率的差异。结果:1行IVF-ET治疗的UI夫妇,比同期因输卵管阻塞行常规IVF的夫妇受精率显著下降(67.0%vs 76.4%,P<0.05),补救性卵细胞胞质内单精子注射(ICSI)率高于输卵管因素组(20.4%vs 6.1%,P<0.05);成熟卵母细胞比例(MII卵率)、可利用胚胎率、优胚率、种植率、临床妊娠率两组差异无统计学意义(P>0.05)。2UI组中位精子顶体酶活性低于输卵管因素组(36.03 IU/106精子vs 61.98 IU/106精子,P<0.01),UI组中顶体酶活性<36 IU/106精子亚组的受精率明显低于顶体酶活性≥36 IU/106精子亚组的受精率(47.7%vs80.3%,P<0.01)。结论:1UI夫妇男方精子顶体酶活性低下导致的受精率低,可能是造成女性不孕的主要原因和潜在因素。2鉴于UI夫妇男方精子顶体酶活性<36 IU/106精子时受精率较低,建议不采用IUI治疗,可选择IVF+短时受精联合早期补救ICSI治疗。Objective： To investigate the clinical significance of sperm acrosin activity detection in selecting the method of assisted reproduction for patients with unexplained infertility（ UI）. Methods： This retrospective study included 49 UI couples treated by IVF-ET（ 49 cycles） after three failures in intrauterine insemination（ IUI） and another 95 couples with uterine tube obstruction（ UTO） treated by IVF（ 131 cycles）. We analyzed the laboratory data,clinical outcomes and sperm acrosin activity in the two groups of patients. According to the level of sperm acrosin activity of the males,we further divided the UI patients into two subgroups,a 36 IU /10-6 sperm group（ 20 cycles） and a ≥36 IU /10-6 sperm group（ 29 cycles）,and compared the fertilization rates between the two groups. Results： Compared with UI couples treated by IVF-ET,the UTO couples treated by IVF had a significantly lower rate of fer-tilization（ 67. 0% vs 76. 4%,P〈0. 05） and a higher rate of remedial intracytoplasmic sperm injection（ ICSI）（ 20. 4% vs 6. 1%,P〈0. 05）,but showed no statistically significant differences in the rates of MII oocytes,available embryos,high-quality embryos,implantation,and clinical pregnancy from the latter group（ P〈0. 05）. The sperm acrosin activity was remarkably lower in the UI than in the UTO patients（ 36. 03 vs 61. 98 IU /10-6,P〈0. 01）,and so was the fertilization rate in the 36 IU/10-6 than in the ≥36 IU /10-6 sperm subgroup（ 47. 7% vs 80. 3%,P〈0. 01）. Conclusion： The low fertilization rate caused by decreased sperm acrosin activity may be the main cause of infertility and the potential factor of UI. When sperm acrosin activity is 36 IU /10-6 sperm,IVF plus short-term fertilization by remedial ICSI should be preferred to IUI.

关 键 词：不明原因不孕 精子 顶体酶活性 体外受精-胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]