男性血清和精浆HCY水平与精液参数的相关性及其对复发性自然流产的影响

Correlation of serum and seminal plasma HCY levels with semen parameters in men and its effect on recurrent spontaneous abortion

目的:探讨男性血清和精浆同型半胱氨酸(Hcy)水平与精液参数的相关性及其对配偶复发性自然流产(RSA)的影响。方法:研究对象为2021年3月至2022年9月于西安市人民医院(西安市第四医院)生殖中心男科门诊孕前检查患者103例,检测其血清、精浆Hcy水平与精液参数,并对其相关性进行分析;根据其配偶有无RSA将其分为流产组(RSA,n=43例)和未流产组(NRSA,n=60例),观察两组患者Hcy水平及精液参数差异。结果:患者血清与精浆Hcy水平的关联性无统计学差异(r=-0.041,P=0.723);血清Hcy与精子DNA碎片指数(DFI)的关联性存在着统计学差异(r=0.316,P=0.005),与其他精液参数的关联性无统计学差异(P>0.05);精浆Hcy与精液参数的关联性无统计学差异(P>0.05)。与NRSA组患者[14.65(12.00,18.20)umol/L]相比较,RSA组患者血清Hcy中位数[18.39(13.02,42.84)umol/L]明显升高,两组总体血清Hcy分布存在着统计学差异(Z=-2.20,P=0.028);与NRSA组[13.00%(11.00%,18.50%)]相比较,RSA组患者精子DFI中位数[25.00%(12.50%,37.25%)]显著升高,两组总体精子DFI分布存在着统计学差异(Z=-2.74,P=0.006)。结论:血清Hcy与精子DFI呈正相关性;配偶RSA患者血清Hcy与精子DFI均明显升高,其有望作为配偶RSA的男性患者临床筛查指标。

Objective:To investigate the correlation of serum and seminal plasma homocysteine(Hcy)levels with semen parameters in men and its effect on recurrent spontaneous abortion(RSA)in their spouses.Methods:The study included 103 males subjects undergoing preconception examination in the reproduction center from March 2022 to June 2023.According to whether their spouses had a history of RSA or not,we divided their subjects into an RSA(n=43)and a non-RSA group(NRSA,n=60),obtained their serum and seminal plasma Hcy levels and semen parameters,and analyzed their correlation.Results:The serum Hcy level was significantly correlated with the sperm DNA fragmentation index(DFI)(r=0.316,P=0.005),but not with the seminal plasma Hcy level(r=-0.041,P=0.723)and other semen parameters of the subjects(P>0.05).There was no significant correlation between seminal plasma Hcy and semen parameters(P>0.05).The median serum Hcy was significantly higher in the RSA than in the NRSA group(18.39[13.02,42.84]vs 14.65[12.00,18.20]μmol/L),with statistically significant difference in the overall distribution of serum Hcy between the two groups(Z=-2.20,P=0.028),so was the median sperm DFI in the former than in the latter group(25.00%[12.50%,37.25%]vs 13.00%[11.00%,18.50%]),with statistically significant difference in the overall sperm DFI distribution between the two groups(Z=-2.74,P=0.006).Conclusion:The serum Hcy level was positively correlated with sperm DFI,and both serum Hcy and sperm DFI were significantly elevated in men with spousal RSA,which is expected to be used as a clinical screening indicator for males with spousal RSA.