精子鞭毛多发形态异常的形态特征与表型分析  

Morphological characteristics and phenotypic analysis of multiple morphological abnormalities in sperm flagella

作　　者：王家雄[1] 杨晓玉[2] 程洪波[1] 沈丽燕[1] 王改改[1] 史轶超[1] 李红[1] 杨慎敏[1] 

机构地区：[1]南京医科大学附属苏州市立医院生殖遗传中心,215002 [2]南京医科大学附属第一医院生殖医学中心

出　　处：《中华医学杂志》2017年第48期3806-3811,共6页National Medical Journal of China

基　　金：江苏省妇幼健康重点资助项目（F201521）;盐城市医学科技发展计划项目（YK2014058）;苏州市临床重点病种诊疗技术专项（lczx201411）;苏州市临床医学中心（Szzx201505）;苏州市男性生殖研究重点实验室（SZS201718）;苏州市“科教兴卫”青年科技项目（KJXW2017028）

摘　　要：目的分析鞭毛多发形态异常（MMAF）患者精子的形态学特点，对其共同特征和表型进行分析。方法对28例表现为鞭毛多发形态异常的患者进行精液分析，光镜下初步形态分析，并通过扫描电镜和透射电镜进一步明确其超微结构特点，对其中一例睾丸组织进行组织病理分析。结果28例患者中仅13例（46．4％）患者检测到活动精子，其中12例精子活动率〈10％，精子存活率9．0％-80．0％。光镜和扫描电镜下可见MMAF精子鞭毛缺失、短、卷曲、弯折和不规则宽度等多种畸形及其组合，透射电镜表现为精子鞭毛纤维鞘、线粒体鞘等多种结构组装异常，中心微管缺失率41．4％-84．6％。动力蛋白臂缺失或存在，内、外侧动力蛋白臂均缺失的2例患者精液中无活动精子。射精中无活动精子和存在活动精子的两组患者间，各种鞭毛畸形构成比例的差异无统计学意义。结论MMAF就是精子鞭毛特异性异常的一种，光镜观察可以初步诊断，利用透射电镜观察可见以中心微管缺失为主要特征的整个鞭毛组装异常，进行明确分析。通过形态学的分析和研究，可以进行具体分型，为明确诊断提供有力依据。Objective To analyze the sperm morphological characteristics of multiple morphological abnormalities of the sperm flagella （MMAF）, and to analyze their common features and subtypes. Methods Twenty-eight patients with abnormal morphology of flagella were analyzed by semen analysis. The morphological characteristics were analyzed by scanning electron microscopy and transmission electron microscopy. Histological observation of one case of testicular tissue was performed. Results Of the 28 patients, only 13 patients （46.4%） had motile spermatozoa, t2 of which had a sperm motility rate of 〈 10% and a sperm survival rate of 9. 0% - 80. 0%. Under light and scanning electron microscope, sperm with absent, short, coiled, bent and irregular width flagella or their combinations were observed. Transmission electron microscopy showed structural abnormalities of sperm fibrous sheath, mitochondrial sheath. Loss rate of central microtubule was 41.4% - 84. 6%. The semen of the 2 patients with the absence or presence of the kinetic protein arm and both the inner and lateral motilin arms missing had no motile spermatozoa. There was no statistically significant difference in the proportion of flagellar malformations between the two groups of patients （ without motile sperm vs with motile spermatozoa）. Conclusion MMAF is a kind of sperm flagella specific abnormalities. Initially diagnosis can be carried out using light microscopy. Clear diagnosis could be conduct using transmission electron microscopy, and the central microtubule loss of the sperm could be seen as the main feature of the flagella abnormalities. Through the morphological analysis and research, MMAF could be precisely classified, which provide a strong basis for the diagnosis.

关 键 词：精子鞭毛多发形态异常 超微结构 形态学 弱精子症 

分 类 号：R698.2[医药卫生—泌尿科学]