己酮可可碱处理睾丸不动精子行ICSI的临床作用

doi:10.16150/j.1671-2870.2018.01.017

摘要/Abstract

摘要： 目的：探讨采用经己酮可可碱（pentoxifylline,PF）处理后的睾丸不活动精子,行卵细胞胞质内单精子注射（(intracytoplasmic sperm injection,ICSI）的临床效果。方法：选取81例梗阻性无精子症患者,女方常规超促排卵,在取卵日男方行睾丸穿刺抽吸取精术,将经体外孵育处理未获得活动精子作的样本为实验组（32例）,加入含有效成分为PF的稀少精子体外培养液20 min后,挑选出有活动力的精子进行ICSI操作;另选择穿刺可见活动精子的患者为对照组（49例）,直接进行ICSI操作。比较2组的受精率、正常受精率[2原核（2PN）率]、完全受精失败率、卵裂率、可用胚胎率、胚胎种植率、流产率、临床妊娠率等指标。结果：实验组（不动精子组）与对照组（活动精子组）间的成熟卵子百分比（80.2%比82.8%）、受精率（65.9%比65.9%）、异常受精率(7.6%比4.8%)差异无统计学意义(P>0.05)。2组间的受精失败发生率差异亦无统计学意义（3.1%比10.2%,P>0.05）,但2组间的卵裂率差异有统计学意义(91.4%比97.2%,P=0.007)。不动精子组中行非优胚胎囊胚培养的百分比明显高于活动精子组（71.9%比46.9%）,不动精子组可供移植或冷冻的D3或D5胚胎明显少于活动精子组（40.9%比52.2%,P=0.021）。2组间的临床妊娠率（39.1%比39.3%）、胚胎种植率（25.6%比28.0%）及流产率、活产率差异均无统计学意义。冷冻睾丸（附睾）精子中,不动精子组的受精率、卵裂率、可用胚胎率、临床妊娠率、胚胎种植率均有低于活动精子组的趋势,但由于样本量较小,差异尚无统计学意义（P>0.05）;而在新鲜睾丸（附睾）精子中,不动精子组的以上指标均与活动精子组相接近（P>0.05）。结论：在睾丸（附睾）不动精子标本中加入PF,使不运动的精子获得运动能力,可帮助判断并挑选出有活性的精子,达到或接近于睾丸活动精子的水平,而其安全性还需进一步验证。

关键词: 无精子症, 睾丸精子抽吸术, 卵细胞胞质内单精子注射, 己酮可可碱

Abstract: Objective: The testicular sperm from biopsy and frozen/thawed tissue are frequently immotile. The purpose of this study is to assess the effect of short exposure of testicular samples with immotile sperm to pentoxifylline (PF)-a sperm motility stimulator. Method: Eight-one cases with testicular sperm ablation/testicular sperm extraction-intracytoplasmic sperm injection (TESA/TESE-ICSI) cycles in patients with azoospermia were divided into 2 groups. In group A, only immotile sperm were found in biopsies after 2 hours of incubation of tissue in culture medium, and were then treated for 20 minutes with pentoxifylline (PF) and selected the sperm with motility before ICSI(n=32). In group B, ICSI was performed with that having motile sperm found at first (n=49). Oocyte maturity, fertilization rate (2PN rate), total fertilization failure rate, embryo cleavage rate and proportion of transferable embryos as well as pregnancy rate and implantation rate were compared between the two groups. Results: Both groups had the same oocyte maturation rate（80.2% vs 82.8%）, fertilization rate（65.9% vs 65.9%）, proportion of abnormal fertilization (7.6% vs 4.8%), and the similar proportion of total fertilization failure (3.1% vs 10.2%, P>0.05）. However, when compared with that having motile sperm at first group, embryo cleavage rate was significantly lower and proportion of bastocyst culture of poor quality embryos was higher, and transfe-rable embryos was less in the PF group (91.4% vs 97.2%, P=0.007). The clinical pregnancy rate per cycle(39.1% vs 39.3%), implantation rate（25.6% vs 28.0%） and abortion rate and live birth rate were not different between the two groups. Conclusions: Treated with PF in cases of immotile testicular sperm can cause the movement of testicular sperm, allowing easier identification of vital sperm, shortening the procedure, improving the fertilization rates, lowering the chance of total fertilization failure and improving the ICSI outcome.

Key words: Azoospermia, Testicular sperm aspiration, Intracytoplasmic sperm injection, Pentoxifylline

中图分类号:

R698⁺.2

陈智勤, 潘家坪, 滕晓明. 己酮可可碱处理睾丸不动精子行ICSI的临床作用[J]. 诊断学理论与实践, 2018, 17(01): 92-97.

CHEN Zhiqin, PAN Jiaping, TENG Xiaoming. Use of pentoxifylline for activation of immotile testicular sperm before ICSI in patients with azoospermia[J]. Journal of Diagnostics Concepts & Practice, 2018, 17(01): 92-97.

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