精子线粒体膜电位作为综合评估男性生育能力指标的初探  

Preliminary exploration on sperm mitochondrial membrane potential as a comprehensive evaluation of male fertility

作　　者：樊千[1] 常凤娟 陈赟[1] 孙志兴[1] 张星 薛建国[3] FAN Qian;CHANG Feng-juan;CHEN Yun;SUN Zhi-xing;ZHANG Xing;XUE Jian-guo(Jiangsu Provincial Hospital of Traditional Chinese Medicine,Nanjing 210029;Andrology&Reproductive Laboratory,Jiangsu Provincial Hospital of Traditional Chinese Medicine,Nanjing 210029;Nanjing University of Chinese Medicine,Nanjing 210046)

机构地区：[1]江苏省中医院,南京210029 [2]江苏省中医院男科生殖实验室,南京210029 [3]南京中医药大学,南京210046

出　　处：《生殖医学杂志》2024年第2期161-167,共7页Journal of Reproductive Medicine

基　　金：江苏省中医药科技发展计划项目(MS2021021);国家中医药管理局全国名老中医药专家传承工作室建设项目[国中医药人教函(2014)143号]。

摘　　要：目的本研究旨在探讨精子线粒体膜电位(MMP)与精液常规、精子形态学以及精子DNA碎片指数(DFI)之间的关联,以及MMP对于临床评估和预测男性生育能力的价值。方法选择2023年4—7月于江苏省中医院男科进行孕前优生检查、生育咨询以及不育症治疗的患者的精液标本为研究对象,按照世界卫生组织(WHO)第5版标准进行精液常规和精子形态学分析,并通过流式细胞术检测精子DFI和MMP。根据不同精液质量分为两组:精液质量各项指标均正常,即精液量>2 ml、pH值7.2~7.8、精子浓度≥15×106/ml,精子前向运动(PR)≥32%、精子形态正常率≥4%、DFI<30%为精液质量正常组(n=57);PR<32%、精子形态正常率<4%、DFI≥30%为精液质量异常组(n=67),比较两组精液质量各项参数;采用Spearman相关性分析,分析MMP与精子浓度、PR、精子形态正常率以及DFI之间的关系;绘制受试者工作特征曲线(ROC),分析MMP对于临床评估男性生育能力的价值。结果两组间平均年龄、精液量比较均无显著差异(P>0.05),精液质量正常组精子浓度、PR、精子形态正常率、MMP显著高于精液质量异常组(P<0.05),DFI显著低于精液质量异常组(P<0.05);Spearman相关性分析结果显示,MMP与精液量无明显相关性(r=-0.065,P=0.475),与精子浓度(r=0.396,P<0.001)、PR(r=0.471,P<0.001)、精子形态正常率(r=0.468,P<0.001)呈显著正相关,与DFI(r=-0.701,P<0.001)呈显著负相关;ROC分析结果显示,MMP对精液质量整体水平预测的ROC曲线下面积(AUC)为0.891,敏感度87.5%,特异性83.3%,截断值53.69%;MMP对精子浓度预测的AUC为0.787,敏感度82.0%,特异性69.2%,截断值43.97%;MMP对PR预测的AUC为0.741,敏感度65.7%,特异性84.2%,截断值56.33%;MMP对精子形态正常率预测的AUC为0.733,敏感度71.1%,特异性69.1%,截断值56.63%;MMP对DFI预测的AUC为0.809,敏感度89.5%,特异性72.1%,截断值54.78%。结论精子MMP与精子浓度、PR、精子形态正常率呈显著Objective:To explore the association between sperm mitochondrial membrane potential(MMP)and semen parameters,sperm morphology,and sperm DNA fragmentation index(DFI),as well as the clinical value of MMP for evaluation and prediction of male fertility.Methods:The study focused on semen samples of male clients seeking for preconception health assessments,fertility counseling,and treatment of infertility at the Andrology Department of Jiangsu Provincial Hospital of Traditional Chinese Medicine from April 2023 to July 2023.The 5th edition WHO standards for routine semen analysis and sperm morphology was followed.Additionally,the sperm DFI and MMP were assessed with flow cytometry.Based on semen quality,participants were divided into two groups:the normal semen quality group(n=57)and the abnormal semen quality group(n=67).The former exhibited all parameters within normal ranges,namely semen volume>2 ml,pH 7.2-7.8,sperm concentration≥15×106/ml,progressive motility(PR)≥32%,normal sperm morphology rate≥4%,and DFI<30%.The latter demonstrated parameters below the normal thresholds:PR<32%,normal sperm morphology rate<4%,and DFI≥30%.Various parameters of semen quality between the two groups were compared.The Spearman rank correlation analysis was employed to examine the relationship between MMP and the sperm concentration,PR,the normal rate of sperm morphology,and DFI.The receiver operating characteristic(ROC)curves were generated to evaluate the clinical value of MMP in assessing male fertility.Results:There were no significant differences in the average age and semen volume between the two groups(P>0.05).In the normal semen quality group,sperm concentration,PR,normal sperm morphology rate,and MMP were significantly higher than those in the abnormal semen quality group,whereas DFI was significantly lower(P<0.05).The Spearman rank correlation analysis demonstrated that MMP had no correlation with semen volume(r=-0.065,P=0.475),while showed significant positive correlations with sperm concentration(r=0.396,P<0.001),PR

关 键 词：男性不育 精子线粒体膜电位 生育能力 参考值 

分 类 号：R698.2[医药卫生—泌尿科学]