精液分析的培训及效果评估

Semen analysis training and its evaluation

目的:初步探索建立新技术人员精液分析标准化培训及效果评估方法,为国内男科学实验室室内质量控制和培训提供参考。方法:在本实验室根据《世界卫生组织人类精液检查与处理实验室手册》第5版推荐标准化精液分析方法对新技术人员进行培训,应用统计学分析的方法对精子浓度和活动率考核结果进行评价。结果:新技术人员按照本实验室建立的理论及实践培训方法培训后,分析高、中、低精子浓度样本的变异系数分别为7.72%、3.38%和4.49%;分析高、中、低精子活动率样本的变异系数分别为7.82%、8.09%和6.62%。Bland-Altman分析,与熟练技术人员比较,新技术人员精子浓度检测有4.77%的点在95%的一致性界限以外,在一致性界限范围内,与熟练技术人员检测结果比较,差值的绝对值最大为8×106/ml;活动率分析中7.15%个点在95%一致性界限以外,在一致性界限范围内,差值的绝对值最大为10%。双因素方差分析,两技术人员精子浓度及活动率差异,差异均不显著(P>0.05)。结论:经过培训,新技术人员精液分析结果精确度较好,与熟练技术人员比较,检测结果有较好的一致性,差异不显著。培训达到预期目标,所建立的考核及评估方法对评价培训效果切实可行。

Objective： To establish the methods for training green-hand laboratorians in standard semen analysis and evaluating the training results, and afford some reference for internal quality control and training in andrology laboratories in China. Methods： We trained the green-hand technicians in standard semen analysis recommended by WHO Laboratory Manual for the Examination and Processing of Human Semen （5th ed）, and evaluated the training results by assessing the trainees＇performance in the examination of sperm concentration and motility by statistic analysis. Results ： After training, the coefficients of variation of the semen samples with high, middle and low sperm concentration achieved by the trainees were 7.72% and 3.38% and 4.49%, and those with high, middle and high motility were 7.82%, 8.09% and 6.62%, respectively. We used Bland-Altman＇s method to evaluate the consistency between the results obtained by the trainees and those by the trainers. For sperm concentration, 4.77% of the datum points were out of the 95% consistency interval, and the absolute value of the biggest difference between the trainees and trainers was 8 × 10^6/ml within the 95% consistency interval. For sperm motility, 7.15% of the data points were out of the 95% consistency interval, and the absolute value of the biggest difference between the trainees and trainers was 10% within the 95% consistency interval. Two-way analysis of variance showed no significant differences in the results of sperm concentration and motility analyses between the trainees and trainers （P 〉 O. 05）. Conclusion ： Training in standard semen analysis significantly improved the precision of semen analysis among the greenhand laboratorians. The training and assessment methods we established proved to be effective and feasible.