Sergerie M, Laforest G, Bujan L, Bissonnette F, Bleau G
Département d'Obstétrique-Gynécologie, Centre hospitalier de l'Université de Montréal (CHUM) - Hôpital Saint-Luc, Montréal, Québec, Canada.
Hum Reprod. 2005 Dec;20(12):3446-51. doi: 10.1093/humrep/dei231. Epub 2005 Aug 5.
The extent of sperm DNA fragmentation, which can be measured by the TUNEL assay, is one of the determinants of male fertility. However, the clinical application of this test to in-vivo situations is difficult owing to the absence of a statistically validated threshold value.
The aim of this study was to compare the results of TUNEL assay applied to semen samples from men of proven fertility (n = 47) and patients from an infertile population (n = 66), in order to establish a discriminating threshold value.
Infertile patients had a higher mean level of DNA fragmentation than men of proven fertility (40.9 +/- 14.3% versus 13.1 +/- 7.3%, respectively; P < 0.001). The area under the receiver operating characteristics curve was 0.93 for 20% sperm DNA fragmentation. The calculated threshold value for TUNEL assay to distinguish between fertile controls and infertile men was 20%. At this threshold, specificity was 89.4 [95% confidence interval (CI) 83.7-95.1] and sensitivity was 96.9% (95% CI 93.8-100). The positive and negative predictive values of the 20% sperm DNA fragmentation threshold were high: 92.8% (95% CI 87.9-97.5) and 95.5% (95% CI 91.6-99.3), respectively.
This study demonstrates that sperm DNA fragmentation, as measured by TUNEL assay, is a highly valuable indicator of male fertility.
精子DNA碎片化程度可通过TUNEL检测法进行测量，是男性生育能力的决定因素之一。然而，由于缺乏经过统计学验证的阈值，该检测方法在体内情况下的临床应用存在困难。
本研究旨在比较TUNEL检测法应用于已证实具有生育能力的男性（n = 47）和不育人群患者（n = 66）精液样本的结果，以确定一个区分阈值。
不育患者的DNA碎片化平均水平高于已证实具有生育能力的男性（分别为40.9 +/- 14.3%和13.1 +/- 7.3%；P < 0.001）。精子DNA碎片化率为20%时，受试者工作特征曲线下面积为0.93。计算得出的用于区分可育对照组和不育男性的TUNEL检测法阈值为20%。在此阈值下，特异性为89.4 [95%置信区间（CI）83.7 - 95.1]，敏感性为96.9%（95% CI 93.8 - 100）。精子DNA碎片化率20%这一阈值的阳性和阴性预测值较高，分别为92.8%（95% CI 87.9 - 97.5）和95.5%（95% CI 91.6 - 99.3）。
本研究表明，通过TUNEL检测法测量的精子DNA碎片化是男性生育能力的一个极具价值的指标。
