精索静脉曲张患者血清性激素水平与精液质量关系研究

Relationship of hypoandrogenism and ejaculum qualityin patients with varicocele

目的:探讨精索静脉曲张导致的雄激素缺乏与精液质量关系研究。方法:门诊就诊精索静脉曲张病人(varicocele,VC)60人,根据血清睾酮(Totol Testo,TT)水平分为A组低睾酮组(≤12nmol/L)28例,B组正常睾酮组(>12nmol/L)32例,无VC且睾酮正常(>12nmol/L)青年志愿者30例作为对照组C组。测定血清:T、促卵泡成熟激素(FSH)、促黄体生成激素(LH),并结合性激素结合蛋白(sex hormone binding globulin,SHBG),白蛋白(albumin,ALB)。计算游离睾酮(calculated free testosterone,c FT)和生物活性睾酮(Bio-T)百分比;计算机辅助精液分析系统(CASA)检测:精子密度,活动精子、前向运动精子、快速前向运动精子以及畸形精子百分率,精浆生化检查测定精浆酸性磷酸酶ACP、果糖、锌(Zn)含量、a-糖苷酶的含量。结果:1A组与B组比较,A组与C组比较,FSH、LH明显升高,而T明显下降(P<0.05),B组与C组FSH、LH、T差异无统计学意义(P>0.05),但c FT百分比和Bio-T百分比差异有统计学意义(P<0.05)。2A组、B组与C组比较,精子密度、活动精子、前向运动精子、快速前向运动精子百分率均有明显下降,畸形精子百分率升高(P<0.05),精浆锌含量、a-糖苷酶的含量与对照组相比显著下降(P<0.05)。同时A组与B组比较,差异也有显著性(P<0.05)。结论:雄激素缺乏也是VC导致不育的原因之一。

Objectives： To investigate the relationship of hypoandrogenism and ejaculum quality in patients with varicocele（ VC）. Methods： 60 VC patients received treatment in the outpatients were selected and divided into hypoandrogenism group（ Group A,n = 28,TT 12 nmol / L） and normal androgen group（ Group B,n = 32,TT 12nmol / L）. Another 30 young volunteers without VC or hypoandrogenism were selected as control group（ Group C）.The levels of gonadal hormone,such as TT,follicle- stimulating hormone（ FSH）,leuteinizing hormone（ LH）,sex hormone binding globulin（ SHBG）,and albumin were detected. The ejaculum content and activity in the seminal plasma were measured,and the semen parameters of VC were determined by computer- assisted semen analysis（ CASA）. Results： Significant differences were noticed between Group A and the other two in the levels of FSH,LH,TT（ P〈0. 05）. No statistical difference was found in the level of FSH,LH and T between Group B and C while statistical difference was detected in the percentage of CFT and Bio- T（ P〈0. 05）. Compared with Group C,the sperm count,percentages of motile sperm and prorsad motion sperm of Group A and B decreased,and percentage of teratosperm increased（ P〈0. 05）. The content of zincum and a- glycosidase also decreased greatly,with significant differences（ P〈0. 05）. Conclusion： Hypoandrogenism plays an important role in the VC- induced infertility.