中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
18期
8226-8232
,共7页
郭小桥%余波澜%周华%司沙沙%曹定娅%刘见桥%孙筱放
郭小橋%餘波瀾%週華%司沙沙%曹定婭%劉見橋%孫篠放
곽소교%여파란%주화%사사사%조정아%류견교%손소방
受精,体外%精子顶体反应率%精子顶体酶总活性%精液参数%男性生育力
受精,體外%精子頂體反應率%精子頂體酶總活性%精液參數%男性生育力
수정,체외%정자정체반응솔%정자정체매총활성%정액삼수%남성생육력
Fertilization in vitro%Sperm acrosome reaction rate%Sperm total acrosin activity%Semen parameters%Male fertility
目的：研究钙离子载体A23187诱发精子顶体反应率、顶体酶总活性与精液参数及体外受精（IVF）结局的关系，初步探讨钙离子载体A23187诱发精子顶体反应、顶体酶总活性预测男性生育力及IVF结局的价值，比较这两种检验方法的临床应用价值。方法应用钙离子载体A23187在体外诱发精子顶体反应，采用改良Kennedy法检测精子顶体酶总活性。研究IVF-ET治疗150周期患者及各亚组中男方的精子顶体反应率、顶体酶总活性与正常形态精子百分率、精子浓度、活动率及体外受精率的关系。分析IVF妊娠组与非妊娠组的顶体反应率、顶体酶总活性的差别是否有统计学意义，应用ROC曲线拟定顶体反应率、顶体酶总活性预测IVF妊娠结局的阈值。结果150例样本中，精子顶体反应率与精子浓度、前向运动精子百分数、正常形态精子百分数、IVF受精率之间无相关性，r分别为：0.120，0.018，0.084，0.054，P均＞0.05；顶体反应率与畸形精子指数呈负相关，r＝-0.183，P＝0.025。顶体酶总活性与精子浓度、前向运动精子百分数、正常形态精子百分数呈正相关，r分别为：0.172，0.306，0.222，P均＜0.05；顶体酶总活性与畸形精子指数、IVF受精率无相关性，r分别为-0.027，0.039，P均＞0.05。精液正常组（85例）、畸精症组（44例）、弱精症组（6例）的顶体反应率与IVF受精率无相关性，r分别为：-0.039，0.185，-0.725，P均＞0.05。精液正常组、畸精症组、弱精症组的顶体酶总活性与IVF受精率无相关性，r分别为：0.057，-0.156，-0.319， P均＞0.05。妊娠组的顶体反应率为（23.65±16.60）%，比未妊娠组的[（17.96±11.00）%]高，P＝0.024，差别有统计学意义；妊娠组的顶体酶总活性为（78.84±38.52）μIU/106，比未妊娠组的[（64.72±31.67）μIU/106]的高，P＝0.031，差别有统计学意义。顶体反应率预测IVF妊娠结局的阈值为17.85%，灵敏度为0.550，特异度为0.549；顶体酶总活性预测IVF妊娠结局的阈值为59.84 IU/106精子，灵敏度为0.662，特异度为0.570。结论钙离子载体A23187诱发的精子顶体反应预测男性生育力及IVF结局的价值低；精子顶体酶总活性可能是预测男性生育力的良好指标之一，但预测IVF结局的价值低；钙离子载体A23187诱发的精子顶体反应的临床应用价值并不比顶体酶总活性的高。
目的：研究鈣離子載體A23187誘髮精子頂體反應率、頂體酶總活性與精液參數及體外受精（IVF）結跼的關繫，初步探討鈣離子載體A23187誘髮精子頂體反應、頂體酶總活性預測男性生育力及IVF結跼的價值，比較這兩種檢驗方法的臨床應用價值。方法應用鈣離子載體A23187在體外誘髮精子頂體反應，採用改良Kennedy法檢測精子頂體酶總活性。研究IVF-ET治療150週期患者及各亞組中男方的精子頂體反應率、頂體酶總活性與正常形態精子百分率、精子濃度、活動率及體外受精率的關繫。分析IVF妊娠組與非妊娠組的頂體反應率、頂體酶總活性的差彆是否有統計學意義，應用ROC麯線擬定頂體反應率、頂體酶總活性預測IVF妊娠結跼的閾值。結果150例樣本中，精子頂體反應率與精子濃度、前嚮運動精子百分數、正常形態精子百分數、IVF受精率之間無相關性，r分彆為：0.120，0.018，0.084，0.054，P均＞0.05；頂體反應率與畸形精子指數呈負相關，r＝-0.183，P＝0.025。頂體酶總活性與精子濃度、前嚮運動精子百分數、正常形態精子百分數呈正相關，r分彆為：0.172，0.306，0.222，P均＜0.05；頂體酶總活性與畸形精子指數、IVF受精率無相關性，r分彆為-0.027，0.039，P均＞0.05。精液正常組（85例）、畸精癥組（44例）、弱精癥組（6例）的頂體反應率與IVF受精率無相關性，r分彆為：-0.039，0.185，-0.725，P均＞0.05。精液正常組、畸精癥組、弱精癥組的頂體酶總活性與IVF受精率無相關性，r分彆為：0.057，-0.156，-0.319， P均＞0.05。妊娠組的頂體反應率為（23.65±16.60）%，比未妊娠組的[（17.96±11.00）%]高，P＝0.024，差彆有統計學意義；妊娠組的頂體酶總活性為（78.84±38.52）μIU/106，比未妊娠組的[（64.72±31.67）μIU/106]的高，P＝0.031，差彆有統計學意義。頂體反應率預測IVF妊娠結跼的閾值為17.85%，靈敏度為0.550，特異度為0.549；頂體酶總活性預測IVF妊娠結跼的閾值為59.84 IU/106精子，靈敏度為0.662，特異度為0.570。結論鈣離子載體A23187誘髮的精子頂體反應預測男性生育力及IVF結跼的價值低；精子頂體酶總活性可能是預測男性生育力的良好指標之一，但預測IVF結跼的價值低；鈣離子載體A23187誘髮的精子頂體反應的臨床應用價值併不比頂體酶總活性的高。
목적：연구개리자재체A23187유발정자정체반응솔、정체매총활성여정액삼수급체외수정（IVF）결국적관계，초보탐토개리자재체A23187유발정자정체반응、정체매총활성예측남성생육력급IVF결국적개치，비교저량충검험방법적림상응용개치。방법응용개리자재체A23187재체외유발정자정체반응，채용개량Kennedy법검측정자정체매총활성。연구IVF-ET치료150주기환자급각아조중남방적정자정체반응솔、정체매총활성여정상형태정자백분솔、정자농도、활동솔급체외수정솔적관계。분석IVF임신조여비임신조적정체반응솔、정체매총활성적차별시부유통계학의의，응용ROC곡선의정정체반응솔、정체매총활성예측IVF임신결국적역치。결과150례양본중，정자정체반응솔여정자농도、전향운동정자백분수、정상형태정자백분수、IVF수정솔지간무상관성，r분별위：0.120，0.018，0.084，0.054，P균＞0.05；정체반응솔여기형정자지수정부상관，r＝-0.183，P＝0.025。정체매총활성여정자농도、전향운동정자백분수、정상형태정자백분수정정상관，r분별위：0.172，0.306，0.222，P균＜0.05；정체매총활성여기형정자지수、IVF수정솔무상관성，r분별위-0.027，0.039，P균＞0.05。정액정상조（85례）、기정증조（44례）、약정증조（6례）적정체반응솔여IVF수정솔무상관성，r분별위：-0.039，0.185，-0.725，P균＞0.05。정액정상조、기정증조、약정증조적정체매총활성여IVF수정솔무상관성，r분별위：0.057，-0.156，-0.319， P균＞0.05。임신조적정체반응솔위（23.65±16.60）%，비미임신조적[（17.96±11.00）%]고，P＝0.024，차별유통계학의의；임신조적정체매총활성위（78.84±38.52）μIU/106，비미임신조적[（64.72±31.67）μIU/106]적고，P＝0.031，차별유통계학의의。정체반응솔예측IVF임신결국적역치위17.85%，령민도위0.550，특이도위0.549；정체매총활성예측IVF임신결국적역치위59.84 IU/106정자，령민도위0.662，특이도위0.570。결론개리자재체A23187유발적정자정체반응예측남성생육력급IVF결국적개치저；정자정체매총활성가능시예측남성생육력적량호지표지일，단예측IVF결국적개치저；개리자재체A23187유발적정자정체반응적림상응용개치병불비정체매총활성적고。
Objective To investigate the association between the calcium ionophore A23187 induced sperm acrosome reaction rate, total acrosin activity and semen parameters and the IVF outcome, and to compare the predictive value for the male fertility and the outcome of IVF between calcium ionophore A23187 induced sperm acrosome reaction rate and sperm total acrosoin activity. Methods Sperm acrosome reaction was induced by calcium ionophore A23187,while sperm acrosin activity was determined by the modified Kennedy method. In this study, 150 cycles of IVF-ET were included, which were divided into Normal semen Group (85 cycles), Teratospermia Group (44 cycles), Asthenozoospermia Group (6 cycles). Compare the association between the calcium ionophore A23187 induced sperm acrosome reaction rate, total acrosin activity and normal morphology sperm percentage, concentration, activity in the 150 cycles and subgroups. Analyze the difference of the sperm acrosome reaction rate and total acrosin activity in Pregnancy Group and Non-pregnancy Group. Use the Receiver Operating Characteristic curve to make out the threshold of the sperm acrosome reaction rate and total acrosin activity for predicting the IVF pregnancy outcomes. Results In this 150 samples, there are no statistically significant differences between sperm acrosome reaction rate and sperm concentration, progressive velocity rate, the percentage of normal sperm morphology, fertility rate, and their related coefficient are respectively as follow:0.120, 0.018, 0.084, 0.054(P>0.05). But the negative correlation is statistically significant different between sperm acrosome reaction rate and teratozoospermia index(r=-0.183, P=0.025). There are significant correlations between sperm acrosin activity and sperm concentration(r=0.172, P<0.05), progressive velocity rate (r=0.306, P<0.05), sperm percentage normal morphology(r=0.222, P<0.05). There are no statistically significant differences between total sperm acrosin activity and teratozoospermia index(r=-0.027, P>0.05) and fertility rate(r=0.039, P>0.05). There are no statistically significant differences between sperm acrosome rate and fertility rate in Normal semen Group(r=-0.039, P>0.05), Teratospermia Group(r=0.185, P>0.05), Asthenozoospermia Group(r=-0.725, P>0.05). There are no statistically significant differences between total sperm acrosin activity and fertility rate in Normal semen Group (r=0.057, P>0.05), Teratospermia Group(r=-0.156, P>0.05), Asthenozoospermia Group(r=-0.319, P>0.05). The acrosome reaction rate is(23.65±16.60)%, which is significant higher than (17.96±11.00)%in Non-pregnancy Group(P=0.024). The total acrosin activity is (78.84±38.52)μIU/106 in Pregnancy Group, which is much higher than(64.72±31.67)μIU/106 in Non-pregnancy Group are statistically significant(P=0.031). The threshold value of acrosome reaction rate for predicting IVF pregnancy outcomes is 17.85%, and the sensitivity is 0.550, the specificity is 0.549. The threshold value of total acrosin activity for predicting IVF pregnancy outcomes is 59.84 IU/106, and the sensitivity is 0.662, the specificity is 0.570. Conclusion The value of calcium ionophore A23187 induce acrosome reaction rate to predict the male fertility and IVF outcomes are low. The acrosin activity may be a good predictor for male fertility, but not for IVF outcomes. The clinical value of calcium ionophore A23187 induced acrosome reaction may not be better than the total sperm acrosin activity.
