精浆弹性蛋白酶与精液常规参数及精子DNA完整性的相关性研究

Correlation of seminal plasma elastase with semen quality and sperm DNA integrity in infertile men

目的:观察男性不育患者精浆弹性蛋白酶水平与精液质量及精子DNA完整性之间的关系,探讨生殖道炎症隐性感染对男性不育的影响。方法:选择202例男性不育患者依照精浆弹性蛋白酶实验结果并结合其他生殖道感染炎症标志物将男性不育分为确认感染组和隐性感染组,选择同期因女方因素不孕前来检查的生育力评估正常,排除生殖道炎症及其他影响生育的致病因素的健康男性32例作为对照组。统计分析不育组与正常对照组、不育组中确认感染组与隐性感染组、不育组中弹性蛋白酶水平正常者与升高者之间精浆弹性蛋白酶水平与精液质量及精子DNA完整性之间的差异。精子浓度及活力用计算机辅助精子分析系统检测,精子形态检查采用Diff-Quik染色法,精子DNA完整性分析用精子染色质扩散法(SCD),精浆弹性蛋白酶用酶联免疫吸附法。结果:正常对照组和不育组的正常形态精子百分率分别为(11.9±9.2)%和(4.1±3.3)%、精子DNA碎片指数(DFI)分别为(10.9±8.7)%和(21.3±12.7)%,精浆弹性蛋白酶分别为(220.9±73.1)ng/ml和(1687.3±1621.2)ng/ml,前向运动精子百分率(PR)分别为(49.7±10.8)%和(19.1±10.3)%,两组相互比较各指标均具有统计学差异(P均<0.05)。不育组中弹性蛋白酶升高者较弹性蛋白酶正常者,PR显著降低,DFI显著升高,差异均具有统计学意义(P<0.05)。隐性感染和确证感染患者间精液量、精子浓度、PR、正常形态精子百分率和DFI的差异均无统计学意义(P均>0.05)。结论:生殖道炎症感染无论是显性或者是隐性有可能导致DNA损伤程度增加,从而影响男性生育。

Objective： To investigate the correlation of the seminal plasma elastase（ SPE） level with semen quality and sperm DNA integrity in infertile men and explore the impact of inapparent genital tract inflammation（ GTI） on male fertility. Methods：Based on the results of SPE tests and markers of GTI,202 infertile men were classified to an apparent and an inapparent GTI group.Another 32 normal fertile men who had no genital tract inflammation and other fertility-affecting pathogenic factors and came to the clinic for their wives＇ infertility were included as controls. The differences in the SPE level,semen quality,and sperm DNA integrity were statistically analyzed between the infertile men and normal controls,apparent and inapparent GTI groups,and normal and elevated SPE groups. Analyses were also performed on the semen parameters by CASA,on sperm morphology by Diff-Qick staining,and on sperm DNA integrity using sperm chromatin dispersion test. The SPE level was determined by ELISA. Results： There were statistically significant differences between the control and infertile groups in the rate of morphologically normal sperm（ MNS）（ [11. 9 ± 9. 2]% vs [4.1 ± 3. 3]%,P 〈0. 05）,the DNA fragmentation index（ DFI）（ [10. 9 ± 8. 7]% vs [21. 3 ± 12. 7]%,P 〈0. 05）,the SPE level（ [220.9 ±73.1]ng/ml vs[1 687.3 ±1 621. 2]ng/ml,P 〈0. 05）,and the rate of progressively motile sperm（ PR）（ [49. 7 ±10. 8]% vs [19. 1 ± 10. 3]%,P 〉0. 05）,so were there between the normal and elevated SPE groups of the infertile men in PR（ [21.0 ±13.1]% vs[14.1 ±10.0]%,P〉 0.05） and DFI（ [19.2 ±14.2]% vs[26.8 ±16.4]%,P 〈0.05）. However,no significant differences were found between the apparent and inapparent GTI groups in semen volume（ [2. 4 ± 0. 9] ml vs [2. 4 ± 1. 0]ml,P 〉0. 05）,sperm concentration（ [74. 5 ± 44. 0]× 10^6/ml vs [2. 4 ± 1. 0] × 10^6/ml,P〉 0. 05）,PR（ [13. 3 ± 9. 7]% vs[14.5 ±11.2]%,P〉 0.05）,MNS（ [3.7 ±3.0]% vs[4.0 ±2.6]%,P 0.05）,and DFI（ [28.0 ±16.7]% vs[26.2 ±15.7]%,P 〉0. 05）. Conclusion： Both apparent and inapparent GTI can increase sperm DNA damage and consequently affect male fertility.