精索静脉血清抑制素B水平对精索静脉曲张术后睾丸生精功能的预测

Prediction value of inhibin B in spermatic vein serum on spermatogenesis after varicocele surgery

目的探讨精索静脉血清抑制素B(INHB)对精索静脉曲张术后生精功能的预测价值。方法选择108例因精索静脉曲张行手术治疗的少、弱、畸形精子症不育患者为研究对象,按照精索静脉曲张手术后精子参数的改善程度分成无效组(54例)和显效组(54例)。比较两组患者手术前后的精子浓度、前向运动精子总数、正常形态精子百分率、外周血性激素、外周血INHB等参数,分析每组中精索静脉血清INHB的差异。结果显效组术后的精子浓度、精子总数、正常形态精子百分率及外周血INHB均较术前有显著提高(P<0.05),但外周血性激素水平无显著变化(P>0.05);无效组术后的外周血INHB水平较术前有显著提高(P<0.05),其他各项指标手术前后比较差异均无统计学意义(P>0.05)。无效组与显效组比较,术后外周血性激素、外周血INHB、精索静脉曲张的程度和直径均无显著性差异(P>0.05);但显效组术后的精子参数和精索静脉血清INHB水平显著高于无效组(P<0.05)。结论精索静脉血清INHB水平可能对评估精索静脉曲张术后睾丸的生精功能更敏感,能更准确地预测精索静脉曲张手术的疗效,值得进一步分析探讨。

Objective： To investigate the predictive value of serum inhibin B（INHB）of spermatic vein on spermatogenesis after varicocele surgery.Methods： The data of 108 varicocele patients with oligospermia and asthenospermia after varicocele surgery were retrospectively analyzed.The patients were divided into two groups according to the effect of varicocele surgery：ineffective group（n=54）and effective group（n=54）.The sperm concentration,the total number of forward sperm,the percentage of normal morphological sperm,sex hormone in peripheral blood and peripheral serum INHB and serum INHB of spermatic vein were compared before and after the surgery in the two groups.Results：The sperm concentration,total sperm counts,sperm normal morphological percentage,and INHB levels in peripheral blood after surgery were significantly higher than those before surgery（P〈0.05）,but there was no significant change in sex hormone levels in the peripheral blood in the effective group（P〈0.05）.The peripheral serum INHB levels after surgery were significantly higher than before surgery（P〈0.05）,but there was no significant difference among other indexes pre-and post-surgery in the ineffective group（P〉0.05）.There was no significant difference in peripheral serum sex hormones INHB,and the degree and diameter of varicocele after surgery between the ineffective group and the effective group（P〉0.05）;however,the postoperative sperm parameters and INHB of the spermatic vein serum after surgery in the effective group were significantly higher than the ineffective group（P〈0.05）.Conclusions：The INHB of spermatic vein serum may be a more sensitive parameter for predicting spermatogenesis after varicocele surgery,which is worth further investigation.