Роль клинических факторов, образа жизни и окружающей среды в развитии фрагментации ДНК сперматозоидов

Фрагментация ДНК сперматозоидов является значимым функциональным показателем мужской фертильности, который дополняет стандартное исследование эякулята и отражает повреждение генетического материала гамет.

Цель литературного обзора – систематизировать современные данные о биологических, клинических, поведенческих и средовых факторах, ассоциированных с повышением фрагментации ДНК сперматозоидов.

Проанализированы руководства профессиональных обществ, систематические обзоры, метаанализы и ключевые оригинальные исследования, представленные в PubMed, Scopus и Web of Science. Рассмотрены нарушения ремоделирования хроматина, окислительный стресс, апоптоз и дефекты созревания сперматозоидов, а также влияние возраста, варикоцеле, воспаления, инфекций, метаболических расстройств, онкологических заболеваний, лихорадки, курения, алкоголя, ожирения, физической активности, полового воздержания, теплового воздействия и загрязнителей окружающей среды.

Наиболее последовательная связь с повышенной фрагментацией установлена для варикоцеле, выраженного окислительного стресса, курения, возраста и ряда токсических экспозиций. Гетерогенность лабораторных методов и пороговых значений ограничивает прямое сопоставление исследований. Клиническая интерпретация показателя должна учитывать метод анализа, анамнез пациента и совокупность модифицируемых факторов риска. Особое внимание уделено разграничению доказанных ассоциаций, вероятных механизмов и отдельных клинических предположений.

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