摘要目的:探讨生殖道病原菌感染、微小RNA-200c(miR-200c)及血浆中抗顶体蛋白酶抗体(AcrAb)诊断及鉴别不孕症的价值。方法:本研究为前瞻性研究，选取2018年6月至2020年6月新乡市中心医院(新乡医学院第四临床学院)生殖医学科收治的190例女性不孕症患者作为不孕组，年龄(30.71±4.32)岁，年龄范围为21~49岁。另选取同期新乡市中心医院(新乡医学院第四临床学院)体检科体检的190名健康女性作为健康组，年龄(30.74±4.36)岁，年龄范围为22~50岁。比较分析两组纳入者生殖道病原菌感染、miR-200c及AcrAb与不孕症的相关性。结果:不孕组生殖道1种菌种感染率[76.3%(145/190)]高于健康组[26.3%(50/190)]；2种及以上菌种感染率[22.6%(43/190)]高于健康组[1.6%(3/190)]，差异有统计学意义( P<0.05)。不孕组沙眼衣原体[18.9%(36/190)]、解脲支原体[14.2%(27/190)]、滴虫率[12.6%(24/190)]和假丝酵母菌感染率[54.2%(103/190)]均高于健康组[5.8%(11/190)、4.7%(9/190)、4.7%(9/190)、12.6%(24/190)]，差异有统计学意义( P<0.05)。不孕组miR-200c(3.17±0.70)及AcrAb水平[( 3.58±0.58)μg/L]高于健康组[(1.03±0.18)、(1.52±0.21)μg/L]，差异有统计学意义( P<0.05)。受试者操作特征(ROC)曲线分析显示，生殖道病原菌感染(解脲支原体和假丝酵母菌)、miR-200c和AcrAb联合诊断不孕症价值高于单一生殖道病原菌感染(解脲支原体和假丝酵母菌)、miR-200c和AcrAb诊断。继发性不孕患者解脲支原体[36.4%(32/88)]和假丝酵母菌感染率[69.3%(61/88)]高于原发性不孕[4.9%(5/102)、47.1%(48/102)]；继发性不孕患者miR-200c及AcrAb水平[(2.15±0.13)、(2.80±0.24)μg/L]低于原发性不孕患者[(3.62±0.16)、(3.92±0.27)μg/L]，差异有统计学意义( P<0.05)。 结论:不孕症患者生殖道病原菌感染风险明显增加，且miR-200c、AcrAb水平显著上升，联合生殖道病原菌感染、miR-200c及AcrAb三项指标能提升诊断及鉴别不孕症价值。原发性不孕患者解脲支原体和假丝酵母菌感染率较低，而miR-200c及AcrAb水平较高，有利于与继发性不孕进行鉴别诊断。

abstractsObjective:To investigate the diagnostic value of genital tract bacterial infection, miR-200C and plasma anti acrosin antibody(AcrAb)in infertility.Methods:This study was a prospective study, a total of 190 females patients with infertility in the reproductive medicine department of Xinxiang Central Hospital(the Fourth Clinical College of Xinxiang Medical College)from June 2018 to June 2020 as infertile group, aged(30.71±4.32)years old, ranging from 21 to 49 years old.Select the same period 190 females healthy women in the physical examination department of Xinxiang Central Hospital(the Fourth Clinical College of Xinxiang Medical College)as healthy group, aged(30.74±4.36)years old, ranging from 22 to 50 years old.Comparison the relationship between two group about infertility and genital tract infection, miR-200c and AcrAb was analyzed.Results:The infection rate of 1 strain in infertile group[76.3%(145/190)]was higher than that in healthy group[26.3%(50/190)]; The infection rate of 2 or more kinds of bacteria[22.6%(43/190)]was higher than that in healthy group[1.6%(3/190)], the difference was statistically significant( P<0.05). The rates of Chlamydia trachomatis, Ureaplasma urealyticum, trichomoniasis and Candida infection in the infertile group[18.9%(36/190), 14.2%(27/190), 12.6%(24/190), 54.2%(103/190)]were higher than those in the healthy group[5.8%(11/190), 4.7%(9/190), 4.7%(9/190), 12.6%(24/190)], the difference was statistically significant( P<0.05). The levels of miR-200c(3.17 ± 0.70)and AcrAb[(3.58 ± 0.58)μg/L]in infertility group were higher than those in healthy group[(1.03±0.18), (1.52±0.21)μg/L], the difference was statistically significant( P<0.05). receiver operator characteristic(ROC)curve analysis shows that, the diagnostic value of combination of genital tract pathogens(Ureaplasma urealyticum and Candida), miR-200c and AcrAb for infertility was higher than that of single genital tract pathogens(Ureaplasma urealyticum and Candida), miR-200c and AcrAb.The rates of Ureaplasma urealyticum[36.4%(32/88)]and Candida[69.3%(61/88)]infection in patients with secondary infertility were higher than those in patients with primary infertility[4.9%(5/102), 47.1%(48/102)]; the levels of miR-200c and AcrAb in patients with secondary infertility[(2.15±0.13), ( 2.80±0.24)μg/L]were lower than those in patients with primary infertility[(3.62±0.16), (3.92±0.27)μg/L], the difference was statistically significant( P<0.05). Conclusions:The risk of genital tract pathogen infection was significantly increased in infertile patients, and the levels of miR-200C and AcrAb were significantly increased.The combination of three indexes of genital tract pathogen infection, miR-200C and AcrAb could improve the value of diagnosis and differential diagnosis of infertility.The rate of Ureaplasma urealyticum and Candida infection in primary infertility was lower, but the levels of miR-200c and AcrAb were higher, which were helpful to differentiate primary infertility from secondary infertility.