优选后精子畸形指数、顶体异常率、DNA碎片指数预测IVF受精失败的价值

Values of the sperm deformity index,acrosome abnormity rate,and sperm DNA fragmentation index of optimized sperm in predicting IVF fertilization failure

目的:探讨优选后精子畸形指数(SDI)、顶体异常率(AAR)、DNA碎片指数(DFI)预测常规体外受精(IVF)失败的价值。方法:选取2013年6月至2015年6月因单纯输卵管性不孕行常规IVF的695个周期,以受精率<25%为受精失败分为受精正常组(603个周期)和受精失败组(92个周期)。取卵日分别采用快速染色法(Diff-Quik)、豌豆凝集素-异硫氰酸荧光素染色法(PSA-FITC)和精子染色质扩散实验(SCD),对授精剩余精子进行形态、顶体和DNA碎片检测。Logistic方程建立联合预测因子(JP),受试者工作特征(ROC)曲线分析各指标对IVF受精失败的预测价值。结果:SDI、AAR、DFI均与IVF受精率呈负相关,r分别为-0.07、-0.49、-0.21(P分别为0.03、<0.01、<0.01)。受精正常组SDI、AAR、DFI水平分别为1.24±0.20、(7.75±2.28)%、(7.87±3.15)%,受精失败组SDI、AAR、DFI水平分别为1.42±0.15、(12.02±3.06)%、(13.32±4.13)%,差异均有统计学意义(P均<0.05)。SDI、AAR、DFI都是IVF受精失败的危险因素,OR分别为2.68、14.11、3.85(P分别为0.01、<0.01、<0.01)。SDI、AAR、DFI及JP的ROC曲线下面积(AUC)分别为0.651±0.033、0.895±0.019、0.789±0.022、0.915±0.017。根据约登指数得出SDI、AAR、DFI的预测阈值分别约为1.45、10%、12%。结论:优选后精子SDI、AAR、DFI与IVF受精率密切相关,对IVF受精失败均有预测价值,本实验室的适宜参考阈值分别为1.45、10%、12%。单项指标以AAR的预测价值最大,但JP优于AAR。

Objective ： To investigate the values of the sperm deformity index （ SDI）, acrosome abnormity rate （ AAR）, and DNA fragmentation index （DFI） of optimized sperm in the prediction of fertilization failure （fertilization rate 〈25% ） in conventional in vitro fertilization （IVF）. Methods： We selected 695 cycles of conventional IVF for pure oviductal infertility in this study, inclu- ding 603 cycles of normal fertilization and 92 cycles of fertilization failure. On the day of oocvte retrieval, we examined sperm morphology, acrosome morphology, and DNA fragmentation using the Diff-Quik, PSA-FITC and SCD methods. We established the joint predictor （JP） by logistic equation and analyzed the values of different parameters in predicting fertilization failure with the receiv- er operating characteristic （ROC） curve. Results ： The fertilization rate was negatively correlated with SDI （ r = - 0. 07 ; P = 0.03）, AAR （r = -0.49; P〈0. O1）, andDFI （r = -0.21; P〈0.01）. The SDI, AAR, and DFlinthe normal fertilization group were 1.24 ± 0. 20, （7.75 ±2.28）% , and （7.87 ± 3.15 ）% , and those in the fertilization failure group were 1.42 ± 0.15, （ 12.02 ± 3.06） %, and （ 13.32 ± 4.13 ） %, respectively, all with statistically significant differences between the two groups （ P 〈 O. 05）. SDI, AAR, and DFI were all risk factors of fertilization failure （ OR = 2.68, 14. 11, and 3.85 ; P = O. 01, 〈 0.01, and 〈 0. O1 ）. The areas under the ROC curves for SDI, AAR, DFI, and JP were O. 651 ± 0. 033, 0. 895 ± O. 019, O. 789 ± 0. 022, and 0.915 ±0.017, respectively. According to the Youden index, the optimal cut-off values of SDI, AAR, and DFI obtained for the pre- diction of fertilization failure were approximately 1.45, 10% , and 12%. Conclusion ： The SDI, AAR and DFI of optimized sperm are closely associated with the fertilization rate, and all have the value for predicting fertilization failure in IVF. The AAR is more valu- able than the other single predictors, but JP is more effective than the AAR.