死精子症不同诊断方法的探讨及其程度与DFI相关性分析  

Different diagnostic methods for necrospermia and correlation between the severity of sperm necrosis and sperm DNA fragmentation index

作　　者：范烺[1] 张国琼[2] 谭玉秋 朱文星 伍细言 FAN Lang;ZHANG Guo-qiong;TAN Yu-qiu;ZHU Wen-xing;WU Xi-yan(Reproductive Center,Maternal and Child Health Hospital of Hunan Province,Changsha,Hunan 410008,China;Reproductive Center,Maternal and Child Health Hospital of Hubei Province,Wuhan,Hubei 430070,China;Male Reproductive Health Laboratory,Zhanjiang Jiuhe Hospital,Zhanjiang,Guangdong 524000,China;Department of Laboratory Medicine,Xiangya Third Hospital of Central South University,Changsha,Hunan 410013,China)

机构地区：[1]湖南省妇幼保健院生殖中心,湖南长沙410008 [2]湖北省妇幼保健院生殖科,湖北武汉430070 [3]湛江久和医院生殖中心,广东湛江524000 [4]中南大学湘雅三医院检验科,湖南长沙410013

出　　处：《中华男科学杂志》2024年第10期872-877,共6页National Journal of Andrology

基　　金：湖南省卫生健康委课题(D202311006150)。

摘　　要：目的:探讨伊红-苯胺黑试验(E-N试验)和低渗膨胀试验(HOST)诊断死精子症的价值,并分析精子坏死程度与精子DNA碎片指数(DFI)、精子高可染性指数(HDS)的相关性。方法:采用CASA检测2023年5月至2024年7月在湖南省妇幼保健院就诊的7 333例男性精子活力,选择弱精子症男性行E-N试验、HOST评估精子存活率,再筛选死精子症男性行计算机辅助精子分析(CASA)测精子DFI、HDS。根据精子PR%(20%~<30%、10%~<20%、<10%)分组,探讨两种方案对死精子症的诊断价值及精子坏死程度与DFI、HDS的相关性。结果:7 333例男性中弱精子症1374例(18.74%)。轻度、中度、重度弱精子症患者死精子症发生率:E-N试验为0.55%(5/913)、3.80%(12/316)、35.86%(52/145)、总发生率0.94%(69/7 333);HOST试验为0.99%(9/913)、6.96%(22/316)、46.21%(67/145)、总发生率为1.34%(98/7 333)。两种诊断方案无统计学差异(χ^(2)=0.97,P>0.5)。两种方法确定的死精子症病例均显示精子DFI与精子存活率呈负相关(r=-0.366,r=-0.333,P<0.05),精子HDS与精子存活率亦呈负相关,但无统计学意义。结论:当男性精子PR%<30%时应进行精子存活率检测,优先推荐E-N试验诊断死精子症。精子坏死可能与精子核染色质损伤互为危险因素。Objective:To assess the value eosin-nigrosine(E-N) staining and hypo-osmotic swelling test(HOST) in the diagnosis of necrospermia and investigate the correlation of the degree of sperm necrosis with sperm DNA fragmentation index(DFI) and high DNA stainability(HDS).Methods:Using computer-assisted sperm analysis(CASA),we examined the sperm motility of 7 333 males seeking medical care in Maternal and Child Health Hospital of Hunan Province from May 2023 to July 2024,detected the sperm viability of those with asthenozoospermia by E-N staining and HOST,and measured the sperm DFI and HDS of those with necrospermia by sperm chromatin structure assay(SCSA).Based on sperm progressive motility(PR%),we divided the asthenozoospermia patients into three groups(PR% 20%-<30%,PR% 10%-<20% and PR% <10%),assessed the value of E-N staining and HOST in the diagnosis of necrospermia,and analyzed the correlation of the severity of sperm necrosis with sperm DFI and HDS.Results:Asthenozoospermia was diagnosed in 1 374(18.74%) of the 7 333 males.The incidence rates of necrospermia revealed by E-N staining in the mild,moderate and severe asthenozoospermia groups were 0.55%(5/913),3.80%(12/316) and 35.86%(52/145),respectively,with a total incidence of 0.94%(69/7333),while those detected by HOST were 0.99%(9/913),6.96%(22/316) and 46.21%(67/145),respectively,with a total incidence of 1.34%(98/7333).There were no statistically significant differences in the results of diagnosis between the two methods(χ~2 = 0.97,P > 0.05).Both E-N staining and HOST showed that sperm DFI in the necrospermia males was negatively correlated with sperm viability(r =-0.366,r=-0.333,P < 0.05),and so was sperm HDS,though with no statistically significant difference(P > 0.05).Conclusion:For males with PR% <30%,sperm viability test should be conducted,with E-N staining as the choice of priority for the diagnosis of necrospermia.Sperm necrosis and sperm nuclear chromatin damage may be interactive risk factors.

关 键 词：弱精子症 死精子症 伊红-苯胺黑试验 低渗膨胀试验 精子DNA碎片指数 

分 类 号：R446.9[医药卫生—诊断学] R698.2[医药卫生—临床医学]