蔡大偉　潘春雨　劉學(xué)鋒　卜仁戈　王　俠　吳　斌

【摘 要】 目的:探討慢性前列腺炎對(duì)精索靜脈曲張患者精液質(zhì)量的影響。方法:收集160例精液常規(guī)異常的精索靜脈曲張患者。術(shù)前檢查患者精索靜脈曲張程度,其中II度曲張89例, III度曲張71例;術(shù)前均行精液常規(guī)及前列腺液常規(guī)檢查,其中符合慢性前列腺炎診斷者47例。結(jié)果:不伴有慢性前列腺炎的精索靜脈曲張III度患者與II度患者的精子活率及活力存在差異(P<0.05),精子密度及精液液化時(shí)間無顯著差異(P>0.05);伴有慢性前列腺炎的精索靜脈曲張患者與不伴有慢性前列腺炎的精索靜脈曲張患者的精子密度、精子活率和精子活力無顯著差異(P>0.05),而精液液化時(shí)間均存在差異(P<0.05)。結(jié)論:隨著精索靜脈曲張程度的加重,精液質(zhì)量會(huì)隨之下降;伴有慢性前列腺炎可能會(huì)加重精索靜脈曲張對(duì)精液質(zhì)量的影響,尤其會(huì)延長(zhǎng)精液液化時(shí)間,從而影響精子活率、活力及穿透宮頸粘液的能力,影響男性生育。所以術(shù)后精液質(zhì)量無明顯好轉(zhuǎn)的精索靜脈曲張患者應(yīng)注意排除慢性前列腺炎的可能。

【關(guān)鍵詞】 精索靜脈曲張; 男性不育; 精液分析

The study of semen parameters of varicocele patients with or without chronic prostatitis

CAI Dawei, PAN Chunyu, LIU Xuefeng, BU Renge, WANG Xia, WU Bin

Department of Urology, Sheng Jing Hospital,China Medical University,Liaoning, Shenyang, 110004 China

【Abstract】 Objectives: To explore the effect of chronic prostatitis on Semen Parameters of patients with varicocele. Methods: 160 patients with varicocele were selected with abnormal semen analysis. The degree of varicosity were examined before operation. There were 89 patients with degree II and 71 patients with degree III. They received semen analysis and prostatic fluid analysis before operation. And 47 patients are with chronic prostatitis. Results: The sperm motility and sperm vitality of varicocele III patients without chronic prostatitis were different from those of varicocele II patients without chronic prostatitis(P<0.05), but not difference in sperm density and liquefaction time(P>0.05); The sperm density, sperm motility and sperm vitality of varicocele patients without chronic prostatitis were not different from those of varicocele patients with chronic prostatitis (P>0.05), but difference in liquefaction time (P<0.05). Conclusion: With aggravate of varicosity degree in varicocele, it will lead to a decline in semen parameters; with chronic prostatitis may lead to the deterioration in semen parameters, especially liquefaction time will be delayed, thus affecting the sperm motility, sperm vitality and the ability to penetrate the cervical mucus, which could further affect male fertility. So if the semen parameters of varicocele patients were not improved after operation, the possibility of chronic prostatitis should be considered.

【Key words】 Varicocele; Male infertility; Semen analysis

精索靜脈曲張(varicocele, VC)多發(fā)生在青壯年男性,患者常因患側(cè)陰囊墜脹痛或/和不育就診查體時(shí)被發(fā)現(xiàn)。精索靜脈曲張?jiān)谝话隳行匀巳褐邪l(fā)生率約為9%～23%,但是在原發(fā)性和繼發(fā)性不育癥患者中的發(fā)病率分別高達(dá)35%～40%和75%～80%[1]。在臨床工作中發(fā)現(xiàn)很多精索靜脈曲張的患者同時(shí)伴有慢性前列腺炎(chronic prostatitis, CP),關(guān)于慢性前列腺炎對(duì)精索靜脈曲張患者精液質(zhì)量影響的研究還很少。本文收集精液常規(guī)檢查存在異常的精索靜脈曲張患者160例,同時(shí)行前列腺液常規(guī)檢查,分析慢性前列腺炎對(duì)精索靜脈曲張患者精液參數(shù)的影響。

1 資料與方法

1.1 臨床資料

1999年9月～2008年9月我院收治的精索靜脈曲張患者160例,年齡18～36歲,平均25.6歲;其中II度曲張89例, III度曲張71例。所有患者術(shù)前均行精液常規(guī)檢查和前列腺液常規(guī)檢查,其中符合慢性前列腺炎診斷者47例。所有患者均排除梗阻性無精子癥及隱睪等其它可能影響精液質(zhì)量的因素。

1.2 方 法

精液收集及檢測(cè):受檢者精液檢查前暫停性生活4～5d,取精室內(nèi)手淫法取精并于30min內(nèi)送檢。根據(jù)WHO《人類精液及精子-宮頸粘液相互作用實(shí)驗(yàn)室檢驗(yàn)手冊(cè)》標(biāo)準(zhǔn)[2],測(cè)定精液常規(guī)各項(xiàng)參數(shù)值,包括精子密度、精子活率(a+b+c)、精子活力(a+b)及精液液化時(shí)間。

1.3 統(tǒng)計(jì)學(xué)分析

實(shí)驗(yàn)結(jié)果均以±s表示,組間均數(shù)比較采用t檢驗(yàn)。所有資料均采用SPSS15.0 統(tǒng)計(jì)軟件包進(jìn)行分析,P值取0.05作為顯著性標(biāo)準(zhǔn)。

2 結(jié)果

2.1 不伴有慢性前列腺炎的III級(jí)精索靜脈曲張患者與II級(jí)精索靜脈曲張患者相比(表1),精子活率和精子活力具有統(tǒng)計(jì)學(xué)差別(t=2.35, t=2.51, P<0.05);而精子密度和精液液化時(shí)間無統(tǒng)計(jì)學(xué)差別(t=1.94, t=1.36, P>0.05)。

2.2 伴有慢性前列腺炎的精索靜脈曲張患者與不伴有慢性前列腺炎的精索靜脈曲張患者相比(表2),精子密度、精子活率和精子活力無統(tǒng)計(jì)學(xué)差別(t=1.50, t=1.47, t=1.73, P>0.05);而精液液化時(shí)間具有統(tǒng)計(jì)學(xué)差別(t=7.52, P<0.05)。

3 討論

精索靜脈曲張可影響精子產(chǎn)生和精液質(zhì)量,被認(rèn)為是導(dǎo)致男性不育的重要原因之一,其在一般男性人群中發(fā)生率約為9%～23%,但是在原發(fā)性和繼發(fā)性不育癥患者中的發(fā)病率分別高達(dá)35%～40%和75%～80%[1],但其導(dǎo)致男性不育的機(jī)制尚不完全清楚。目前普遍認(rèn)同以下觀點(diǎn):精索靜脈曲張引起精索靜脈擴(kuò)張淤血,睪丸微循環(huán)發(fā)生障礙,睪丸組織內(nèi)二氧化碳蓄積和缺氧,可致睪丸內(nèi)支持細(xì)胞和生精干細(xì)胞功能不良;精索靜脈擴(kuò)張淤血睪丸局部溫度升高,可使曲細(xì)精管變性,不利于精子生成,畸形率升高;由于靜脈返流,血內(nèi)腎及腎上腺的代謝產(chǎn)物如兒茶酚胺、皮質(zhì)醇、前列腺素的濃度增加,導(dǎo)致睪丸血管收縮和生精細(xì)胞凋亡;附睪是精子貯存及成熟獲能的重要場(chǎng)所,精索靜脈曲張可致附睪上皮細(xì)胞排列紊亂、微絨毛稀疏和脫落等組織學(xué)改變,使精子成熟障礙及精子運(yùn)動(dòng)、代謝、能量供給不足,從而影響精子的成熟和活力[3]。綜合的結(jié)果是睪丸生精功能下降,精子密度、活率、活力下降,畸形精子增加[4]。

慢性前列腺炎(chronic prostatitis, CP)是中青年男性的常見疾病,近年來慢性前列腺炎對(duì)男性生育的影響受到越來越多的關(guān)注,很多學(xué)者認(rèn)為慢性前列腺炎可通過多種途徑影響精液質(zhì)量,但其機(jī)制尚不完全清楚。前列腺的分泌液是精液的重要組成部分,約占精液量的1/3。研究表明前列腺組織細(xì)胞內(nèi)存在對(duì)鋅的主動(dòng)轉(zhuǎn)運(yùn)機(jī)制,使精液中鋅的濃度遠(yuǎn)高于血漿[5],精液中鋅濃度與精子濃度、精子活率和精子活力等密切相關(guān),慢性前列腺炎患者精液中鋅的含量降低,造成精子活率和活力下降;慢性前列腺炎患者前列腺分泌的液化因子減少[6],酶活性下降,導(dǎo)致精液液化時(shí)間延長(zhǎng),甚至不液化;致病菌及其產(chǎn)生的各種毒性代謝產(chǎn)物、炎性分泌物能夠消耗精液中營(yíng)養(yǎng)物質(zhì)及氧氣,同時(shí)破壞精子膜和頂體,造成精子活力下降和畸形率增加。

WHO[7]及Lenkem B等[8]報(bào)道精索靜脈曲張患者精液參數(shù)經(jīng)常顯示異常,重度較輕度更普遍。本組研究亦得出上述結(jié)論,精子活率及精子活力隨精索靜脈曲張程度的加重而下降。但本組研究并未得出精液液化時(shí)間隨精索靜脈曲張程度的加重而延長(zhǎng)。本組研究發(fā)現(xiàn)伴有慢性前列腺炎的精索靜脈曲張患者其精液液化時(shí)間較不伴有慢性前列腺炎的精索靜脈曲張患者明顯延長(zhǎng),具有統(tǒng)計(jì)學(xué)意義;而精子密度、精子活率和精子活力無明顯差別。本實(shí)驗(yàn)雖然不能直接說明慢性前列腺炎對(duì)精子密度、精子活率和精子活力的影響,但可以得出慢性前列腺炎能夠延遲精液液化時(shí)間的結(jié)論,從而間接影響精液質(zhì)量。所以如果精索靜脈曲張患者術(shù)后精液質(zhì)量不見好轉(zhuǎn),要考慮到其患有慢性前列腺炎的可能,并進(jìn)一步治療。

參考文獻(xiàn)

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3 Weinbengj B, Doty E, Bonaventura J. Nitinc Oxide Inhibition of Human Sperm Motility[J]. Fertil Steril, 1995, 64(2):408-413.

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5 張翼飛, 梁朝朝, 郝宗耀, 等. 慢性前列腺炎合并男性不育患者精漿生化指標(biāo)的變化[J].中國(guó)男科學(xué)雜志, 2007,21(9):12-15.

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[收稿日期:2009-06-22]