精子释放时精子质量的检测方法

Tests to Measure the Quality of Spermatozoa at Spermiation

评价新修订的《世界卫生组织人类精液分析实验室技术手册》(简称手册)中涉及精子释放(精子脱离支持细胞从睾丸中排出)时的精子特征。修订手册的目的是在不影响临床应用的情况下改善"精液分析的质量"。手册指出,精液分析还有助于①研究男性生殖状态。②在男性生殖调节期间和之后监测精子的发生状态。但是,如果对射精精液精子的分析是用于上述②的目的,那么就必须识别出精子释放时的异常精子。手册未提出精子释放时精子质量的检测方法。相反,采用了精子穿过宫颈黏液或到达受精位置这一"金标准"。这个标准虽然适合于判断个体使其伴侣妊娠的可能性,但却不适用于研究睾丸本身的疾病。因此,手册介绍的测定精子质量的方法无法鉴别精子异常是发生在精子释放同时还是之后。基于活动或"活"精子的百分率评价精子释放时的精子质量是没有意义的。介绍了能反映精子释放时精子质量的其他特征,基于射出精液中单个精子的质量特征评价精子释放时精子质量可采用以下方法:①采用新的精子质量形态评估体系。②采用现代技术评价一定样本中单个精子的几个合适和独立的特征,以便更准确地确定异常精子的比例。

This commentary is to critique the revised World Health Organization （WHO） semen analysis manual as it pertains to characteristics of a spermatozoon at spermiation. The aims of the revised WHO manual include improving the ＇quality of semen analysis＇ without any restriction to clinical use. Furthermore, the manual states that semen analysis may be useful for （a） ＇investigating male fertility status＇ and（b） ＇monitoring spermatogenesis during and following male fertility regulation.＇ However, if the analysis of ejaculated spermatozoa is intended for the purposes described in （b）, then cells that are abnormal at spermiation must be identified. This paper takes the position that the manual does not identify methods to estimate the quality of spermatozoa at spermiation. Instead, it uses a ＇gold standard＇ of sperm passing through the cervical mucus or arriving near the site of fertilization. Although this standard is appropriate for drawing conclusions regarding the probability that an individual could impregnate his partner, it is not appropriate for studying illness of the testes per se. Herein, the measures of sperm quality presented in the WHO manual are critiqued with respect to the detection of spermatozoa that were abnormal at spermiation vs. those that became abnormal subsequently. Quality assessments based on the percentage of motile or ＇viable＇ spermatozoa are meaningless. Alternative quality attributes defining spermatozoa at spermiation are presented in this paper. In conclusion, assessment of spermatozoal quality at spermiation, on the basis of quality attributes of individual ejaculated spermatozoa, is best achieved through application of （a） a new paradigm for the morphological evaluation of sperm quality and （b） modem analytical techniques to evaluate, in an adequate sample, several appropriate independent attributes in each spermatozoon in order to more accurately identify the proportion of abnormal spermatozoa.