精索静脉曲张与男性不育的关系

Relationship betweenvaricocele and male infertility

目的：探究不同等级精索静脉曲张对男性精液质量的影响。方法经过体检，彩色超声多普勒检查对269例男性不育患者的精索静脉情况进行分组，分别为正常组、Ⅱ级组、Ⅲ级组，对3组精液常规进行分析，探讨精索静脉曲张对男性精液质量的影响。结果Ⅲ级组年龄[（34．1±5．0）岁]大于正常组[（31．8±5．0）岁]和Ⅱ级组[（31．9±5．1）岁]，Ⅲ级组精子浓度[（30．4±28．0）＆#215;106／ml]、精子总数[（80．5±72．4）＆#215;106]、精子活动率[（48．9±24．8）％]、前向运动率[（40．1±23．3）％]及总睾酮水平[（355．8±116．8）ng／dl]均低于正常组，而精子畸形率[（81．4±10．2）％]高于正常组[（76．2±9．7）％]，Ⅱ级组精子浓度[（39．2±34．2）＆#215;106／ml]、精子活动率[（46．5±23．8）％]、前向运动率[（38．0±21．8）％]、睾酮[（377．4±95．9）ng／dl]均低于正常组，差异均有统计学意义；Ⅱ、Ⅲ组精液质量比较，差异均无统计学意义；精索静脉曲张与精子浓度（R ＝－0．259）、精子总数（R ＝－0．185）、精子活动率（R ＝－0．196）、精子前向运动率（R ＝－0．136）、睾酮（R ＝－0．464）呈负相关，与精子畸形率（R ＝0．151）呈正相关，与精液量无关。结论精索静脉曲张可致睾酮下降，精子总数、浓度减少，精子活动率、前向运动率降低，精子畸形率升高，影响男性生育功能。

Objective To examine the association between varicocele and male fertility and characterize semen parameters and testosterone in patients with male infertility. Methods We selected 269 cases of male infertility patients, and performed medical examination,color super color ultrasonic Doppler scanning on spermatic vein,and standard semen analysis.Severity of varicocele was classified into normal group, Ⅰ﹣degree, Ⅱ﹣degree, and Ⅲ﹣degree groups. Results Mean age of the Ⅲ﹣degree group （34.1 ±5.0）years was greater than the normal group （31.8 ±5.0）years and the Ⅱ﹣degree group （31.9 ±5.1）years.Mean sperm concentration （30.4 ±28.0）×10^6 /ml,sperm count （80.5 ± 72.4）×10^6 ,activity rate of sperm （48.9 ±24.8）%,rate of forward movement （40.1 ±23.3）%,and total testosterone level （355.8 ±116.8）ng/dl were all lower than normal group.In contrast,sperm deformity rate （81.4 ±10.2）% was higher than normal group （76.2 ±9.7）%.In the Ⅱ﹣degree group,sperm concentration （39.2 ±34.2 ）×10^6 /ml,sperm activity rate （46.5 ±23.8）%,forward movement rate （38.0 ±21.8）%,and testosterone （377.4 ±95.9）were all lower than normal group. There was no difference between Ⅱ﹣and Ⅲ﹣degree groups in terms of semen quality. Conclusion Varicocele may harm testosterone production and therefore reduce sperm count and motility.