精子DNA碎片对宫腔内人工授精妊娠结局的影响及其干预策略

doi:10.12280/gjszjk.20250375

摘要/Abstract

摘要：

宫腔内人工授精（intrauterine insemination，IUI）因其操作简便、成本效益高而成为一线辅助生殖方案，但其成功率多停滞在10%~15%。精子DNA碎片（sperm DNA fragmentation，SDF）是评估精子功能的重要指标，其形成机制涉及内源性因素（如氧化应激、凋亡异常和染色质重塑异常）和外源性因素（如环境、生活方式及医源性影响）。常用的几种SDF检测方法因其临界值不统一，给检测结果的解读带来了挑战。SDF升高对IUI结局具有显著影响，包括降低受精率、妊娠率，并增加不良妊娠结局风险。目前针对高SDF可采取的干预策略有生活方式调整、药物或手术治疗，以及合理选择辅助生殖技术。临床上建议对反复IUI失败或不明原因不孕的夫妇进行SDF检测，并采取个体化综合治疗策略，以改善生育结局。

关键词: 精子, DNA碎片裂, 授精，人工, 不育，男（雄）性, 生殖技术，辅助, 妊娠结局

Abstract:

Intrauterine insemination (IUI) has become a first-line method of assisted reproduction, due to its simple operation and low cost. However, the success rate of IUI has been stagnant at 10%-15% for many years. Sperm DNA fragmentation (SDF) is an important indicator for evaluating sperm function, and its formation mechanism involves endogenous factors (such as oxidative stress, abnormal apoptosis, and abnormal chromatin remodeling) and exogenous factors (such as environment, lifestyle, and iatrogenic influences). The common SDF detection methods pose challenges to the interpretation of detection results due to their inconsistent critical values. The elevated SDF rate has a significant impact on IUI outcomes, including reduced fertilization rates, pregnancy rates, and increased the risk of adverse pregnancy outcomes. At present, the intervention strategies for high SDF rate include lifestyle adjustments, medication or surgical treatment, and rational selection of assisted reproductive technologies. Clinical recommendations include SDF testing for couples with repeated IUI failures or unexplained infertility, and individualized comprehensive treatment strategies to improve fertility outcomes.

Key words: Spermatozoa, DNA fragmentation, Insemination, artificial, Infertility, male, Reproductive techniques, assisted, Pregnancy outcome

陈家浪, 张云山, 王光腾, 庞泽辉. 精子DNA碎片对宫腔内人工授精妊娠结局的影响及其干预策略[J]. 国际生殖健康/计划生育杂志, 2026, 45(1): 40-44.

CHEN Jia-lang, ZHANG Yun-shan, WANG Guang-teng, PANG Ze-hui. The Impact of Sperm DNA Fragmentation on Intrauterine Insemination Outcomes and Intervention Strategies[J]. Journal of International Reproductive Health/Family Planning, 2026, 45(1): 40-44.

图/表 1

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检测方法	简述	核心优势	主要局限性
SCD	完整DNA在特定实验条件下，染色质扩散形成“光环”，而损伤精子无光环或光环不完整^[15]；阈值*为17.0％~27.3%^[16]	操作较简单；成本较低；易于推广	无法区分SSB/DSB；结果判读主观性较强^[17]
TUNEL	末端转移酶（terminal deoxynucleotidyl transferase，TdT）将荧光标记dUTP连接到DNA断裂末端（3'-OH）^[17]；阈值为4％~20%^[16]	敏感度高（可达96%）^[18]；能区分SSB/DSB^[18]	需流式细胞仪等昂贵设备^[17]；样本固定可能影响DNA结构
SCSA	吖啶橙染色：变性后单链DNA发红光，双链DNA发绿光，流式细胞仪检测红绿荧光比计算DFI^[19]；阈值为11.3％~30.3%^[16]	自动化程度高；标准化好；重复性佳	反映染色质稳定性，不是直接检测DNA链断裂
彗星试验	细胞裂解后电泳：在碱性条件下电泳，受损DNA片段向阳极迁移形成“彗尾”，尾长等参数反映损伤程度^[20]；阈值为44％~56%^[16]	可检测少量精子细胞的DNA损伤	操作复杂，条件控制严格；标准化困难，重现性受多因素影响

检测方法	简述	核心优势	主要局限性
SCD	完整DNA在特定实验条件下，染色质扩散形成“光环”，而损伤精子无光环或光环不完整^[15]；阈值*为17.0％~27.3%^[16]	操作较简单；成本较低；易于推广	无法区分SSB/DSB；结果判读主观性较强^[17]
TUNEL	末端转移酶（terminal deoxynucleotidyl transferase，TdT）将荧光标记dUTP连接到DNA断裂末端（3'-OH）^[17]；阈值为4％~20%^[16]	敏感度高（可达96%）^[18]；能区分SSB/DSB^[18]	需流式细胞仪等昂贵设备^[17]；样本固定可能影响DNA结构
SCSA	吖啶橙染色：变性后单链DNA发红光，双链DNA发绿光，流式细胞仪检测红绿荧光比计算DFI^[19]；阈值为11.3％~30.3%^[16]	自动化程度高；标准化好；重复性佳	反映染色质稳定性，不是直接检测DNA链断裂
彗星试验	细胞裂解后电泳：在碱性条件下电泳，受损DNA片段向阳极迁移形成“彗尾”，尾长等参数反映损伤程度^[20]；阈值为44％~56%^[16]	可检测少量精子细胞的DNA损伤	操作复杂，条件控制严格；标准化困难，重现性受多因素影响