基于中医证候与精液质量相关参数构建精子DNA碎片预测模型与验证  

Prediction model and verification of sperm DNA fragments based on traditional Chinese medicine syndrome and semen quality-related parameters

作　　者：周超 庾广聿[1] 阳绍华 高磊磊 金珍 蒋月园 李欢 Zhou Chao;Yu Guangyu;Yang Shaohua;Gao Leilei;Jin Zhen;Jiang Yueyuan;Li Huan(Reproductive Center,Nanxishan Hospital of Guangxi Zhuang Autonomous Region,Guilin 541000,Guangxi Zhuang Autonomous Region,China;Reproductive Center of Zhejiang Provincial People’s Hospital,Hangzhou 310000,Zhejiang Province,China;Laboratory Department of 924 Hospital of the Joint Logistics Support Force of the People’s Liberation Army of China,Guilin 541000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西壮族自治区南溪山医院生殖中心,广西壮族自治区桂林市541000 [2]浙江省人民医院生殖中心,浙江省杭州市310000 [3]中国人民解放军联勤保障部队第九二四医院检验科,广西壮族自治区桂林市54100

出　　处：《中国组织工程研究》2025年第13期2661-2668,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(82001539),项目负责人:高磊磊;广西科技计划项目(2022AC04004),项目参与人:蒋月园;广西壮族自治区卫生健康委员会自筹课题(Z20211100),项目负责人:周超。

摘　　要：背景:中医证候与精液质量相关参数相结合,共同预测精子DNA碎片指数(DNA fragmentation index,DFI)异常增高的发生并绘制列线图,能显著提高临床的实操性与应用效能,为临床全面评估精液质量,采取积极干预措施以改善临床结局及制定个体化医疗方案提供依据。目的:探讨基于中医证候与精液质量相关参数构建精子DNA碎片的预测模型与验证。方法:回顾性分析2019年7月至2021年7月在广西壮族自治区南溪山医院中医男科接受中医证候诊断及精子DNA碎片率检查的不育患者共420例,据《人类精液检查与处理实验室手册》(第6版),将其中137例精子DFI>30%患者纳入精子DFI异常增高组,将283例精子DFI≤30%作为对照组;首先采用单因素分析筛选精子DFI异常增高的影响因素,然后采用套索算法(LASSO)校正因子共线性问题并筛选出最佳匹配因子后,将其纳入多因素向前逐步Logistic回归找出其独立影响因素并绘制列线图,最后采用受试者工作曲线、校准曲线、临床决策曲线、临床影响曲线对该预测模型进行区分度与准确度及临床应用效能验证。结果与结论:①单因素分析结果显示,年龄、体质量指数、前向运动率、精子总活率、精子浓度、精子形态学、肾阳虚衰证、湿热下注证、肾精不足证为引发精子DFI异常增高的影响因子(P<0.05);②通过LASSO回归进一步筛选出的最佳匹配因素为年龄、体质量指数、精子总活率、精子浓度、精子形态学、肾阳虚衰证、湿热下注证、肾精不足证(P<0.05);③多因素向前逐步Logistic回归结果显示年龄、体质量指数、精子浓度、精子总活率、湿热下注证、肾阳虚衰证共6项为引发精子DFI异常增高的独立影响因素;④受试者工作曲线显示,模型组曲线下面积为0.760(0.713,0.806),验证组曲线下面积为0.745(0.714,0.776),说明该预测模型具有较好的区分度;⑤校准曲线平均绝对误�BACKGROUND:The combination of traditional Chinese medicine syndrome and semen quality-related parameters can jointly predict the occurrence of abnormal increase in sperm DNA fragmentation index(DFI)and draw a column chart,which can significantly improve clinical practicality and application efficiency,provide a basis for comprehensive evaluation of semen quality in clinical practice,take active intervention measures to improve clinical outcomes,and formulate personalized medical plans.OBJECTIVE:To explore the prediction model and verification of sperm DNA fragments based on traditional Chinese medicine syndrome and semen qualityrelated parameters.METHODS:Retrospective analysis was made on 420 infertile patients who received traditional Chinese medicine syndrome diagnosis and sperm DNA fragment rate examination in the Department of Traditional Chinese Medicine Andrology,Nanxishan Hospital of Guangxi Zhuang Autonomous Region from July 2019 to July 2021.According to the Manual of Human Semen Examination and Treatment Laboratories(6th Edition),137 patients with sperm DFI>30%were included in the group of abnormally high sperm DFI,and 283 patients with sperm DFI≤30%were taken as the control group.First,univariate analysis was used to screen the influencing factors of the abnormal increase of sperm DFI.Then,the best matching factor was selected by using the collinearity problem of LASSO correction factors.Then,it was included in the multifactor forward stepwise logistic regression to find out its independent influencing factors and draw a nomogram.Finally,the receiver operating characteristic curve,calibration curve,decision curve analysis and clinical impact curve were used to verify the differentiation and accuracy of the prediction model and its clinical application effectiveness.RESULTS AND CONCLUSION:(1)The results of the univariate analysis showed that age,body mass index,forward motion rate,total sperm motility,sperm concentration,sperm morphology,kidney yang deficiency syndrome,damp heat downpour syndrome,and

关 键 词：精子DNA碎片 精子DNA完整性 中医证候 精子DNA碎片指数 预测模型 

分 类 号：R459.9[医药卫生—治疗学] R321.1[医药卫生—临床医学] R698.2