无精子症配偶宫颈炎状况及其对宫颈黏液影响的临床研究

Status of Cervicitis and Its Effect on Cervical Mucus in Azoospermic Men's Wives

目的:探讨无精子症配偶宫颈炎状况及宫颈炎对宫颈黏液的影响。方法:对在我院助孕的无精子症配偶500例,取阴道分泌物及宫颈管黏液行病原体检查、白细胞检测;同时抽静脉血行ELISA法抗精子抗体(AsAb)、单纯疱疹病毒(HSV)、巨细胞病毒(CMV)检测。围排卵期进行宫颈黏液评分,血AsAb升高者进一步行围排卵期宫颈黏液毛细管测试及精子-宫颈黏液接触试验。结果:①按照诊断标准,500例妇女分为宫颈炎组92例(18.4%),对照组408例(81.6%)。②宫颈炎组宫颈黏液CT、UU、BV、HPV感染率较对照组明显增高,差异均有高度统计学意义(P<0.01)。宫颈炎组血HSV、CMV感染率较对照组明显增高,差异均有统计学意义(P<0.05)。③宫颈炎组围排卵期宫颈黏液评分较对照组(9.32±1.91分对12.67±2.14分)增加,差异有统计学意义(P<0.05)。两组宫颈黏液的量、成丝性、羊齿化结晶程度比较差异无统计学意义(P>0.05);而宫颈炎组较对照组宫颈黏液黏稠、黏液细胞数明显增多,差异均有高度统计学意义(P<0.01)。④宫颈炎组血AsAb阳性检出率33.7%(31/92),明显高于对照组9.8%(40/408),差异有高度统计学意义(P<0.01)。宫颈炎组宫颈黏液毛细管测试及精子-宫颈黏液接触试验异常率分别为10.7%(10/92)、9.8%(9/92),均较对照组1.2%(5/408)、1.2%(5/408)增加,差异有高度统计学意义(P<0.01)。结论:宫颈炎可能造成宫颈黏液理化性状改变及宫颈免疫学功能异常,通过多个环节影响精子的存活、活动、储存和获能,从而导致不孕。育龄妇女应该积极治疗宫颈炎。

Objective：To investigate the status of cervicitis and its effect on cervical mucus in azoospermic men＇s wives. Methods：During June 2010 to October 2010, 500 Azoospermic men＇s wives who were treated in Infertility Clinic of Guangdong Provincial Family Planning Research Institute were recruited and examined for the pathogen and leukocyte from cervical secretions and vaginal discharge. Serum antisperm antibodies （AsAb） , herpes simple virus （HS.V） and cytomegalovirus （CMV） were examined by ELISA , meanwhile cervical mucus score（ CMS） was recorded during periovulatory phase. Kremer＇s test and sperm-cervical mucus contact （SCMC） test were checked in women with high AsAb level. Results：According to the diagnostic creteria, 500 women were divided into two groups： cervicitis group （ n = 92, 18.4%） and the control group （ n =408, 81.6% ）. The positive rates of chlamydia trachomatis（CT）, ureaplasma urealyticum （ UU）, bacterial vaginosis（BV）and HPV in cervical mucus in cervicitis group were significantly higher than those in the control group （P 〈0.01）. Serum HSV and CMV positive rates in cervicitis group were also higher than those in control group（ P〈0.05）. The cervical mucus score in cervicitis group was significantly higher than that in the control group （9.32±1.91 vs. 12.67±2. 14, P〈O.05）. There were no significant differences in cervical mucus volume, elasticity and fern crystals between the two group（ P 〉 0.05）, while there were significant differences in cervical mucus viscosity and cell quantity between the two group （ P 〈 0.01 ）. The positive rate of serum AsAb level in the cervicitis group was significantly higher than that in the control group （33.7% vs. 9.8%, P〈0.01 ）. The abnormal rates of Kremer＇s test （10.7% vs. 1.2%） and SCMC test （9.8% vs. 1.2% ） in the cervicitis group were also significantly higher than those in the control group（ P 〈0.01 ）. Conclusions：Cervicitis may result in some changes of physiochemical characteristic of cervical mucus and immunological dysfunction of cervix, and induce infertility through several aspects such as the effect on the sperm viability, motility, storage and capacitation. It is important to early diagnose and treat cervicitis in reproductive aged women.