湖州地区不育男性Y染色体微缺失情况对妊娠结局影响的研究

Effect of Y chromosome microdeletion on pregnancy outcome in infertile men in Huzhou area DING

目的本研究主要是了解湖州地区不育男性患者(非阻塞性无精症或严重少精症)Y染色体微缺失频率分布及其对妊娠结局的影响。方法2016年1月-2020年6月于本院就诊的不育男性进行回顾性队列研究,采集744例不育男性患者精液分析、激素水平、Y染色体微缺失(AZF缺失)、阴囊探查、睾丸活检和精子提取等检测数据。结果744例患者AZF缺失率为7.8%,将精子浓度阈值降低到50万/毫升,敏感度为100%,特异度提高到35%,并显著节约成本。在43例AZFc患者中,7例经TESE后获得睾丸成熟精子(16.3%),经ICSI治疗后,临床妊娠率和胚胎着床率只有25.6%和2.3%,与AZF未缺失不育患者比较,差异有统计学意义(P<0.05)。结论本研究了解了中国湖州地区不育男性患者AZF缺失情况,且发现低精子浓度(50万/毫升)可以在不影响灵敏度情况下提高不育男性AZF基因检测的特异度,从而提高不育患者受精成功率。

Objective The purpose of this study is to investigate the frequency distribution of Y chromosome microdeletion and its effect on pregnancy outcome in infertile male patients(Azoospermia or severe oligospermia)in Huzhou region.Methods This cohort study collected semen analysis,hormone levels,lack of the Y chromosome Microdeletion(AZF deletion),scrotal exploration,testicular biopsy and sperm extraction from 744 patients with infertility male(Azoospermia or severe oligospermia)from January 2016 to June 2020 in our hospital.Results The AZF deletion rate of 744 patients was 7.8%,sperm concentration threshold was reduced to 500000 per mini liter in male with AZF microdeletion,sensitivity was still 100%,specificity was increased to 35%,and significant cost savings were achieved.7 patients of 43 AZFc patients obtained testicular mature sperm after TESE(16.3%).After ICSI treatment,the clinical pregnancy rate and embryo implantation rate were 25.6%and 2.3%,which were lower than those without AZF infertility patients,and the difference was statistically significant(P<0.05).Conclusion This study investigated the situation of AZF in the infertile male patients,and found that low sperm concentration(500000 per mini liter)can improve the sensitivity,specificity and fertilization rate of infertility patients.