生殖系统感染对男性精液质量影响的研究

Impact of male reproductive tract infection on semen quality

目的:探讨泌尿生殖系统感染对男性精液参数和精子DNA损伤的影响。方法:2013年6月至2014年6月在本院生殖医学中心就诊的1 084例男性分为生殖系统感染患者300例和对照者784例两组。根据世界卫生组织标准(WHO,1999年)对其进行精液常规参数(精子浓度和精子活动力)和精子形态学测定,采用精子染色质结构分析(SCSA)检测精子DNA损伤水平,即精子DNA碎片指数(DFI)。结果:感染组和对照组的精液量、(a+b)级精子、d级精子和精子总数分别为(2.58±1.20)ml和(3.00±2.10)ml、(50.6±17.2)%和(53.2±15.8)%、(39.8±17.8)%和(36.5±16.2)%、(218.5±185.0)×106/1次射精和(278.5±375.5)×106/1次射精,两组相比差异有统计学意义(P<0.05),两组男性的年龄、精子浓度和p H比较差异均无统计学意义(P>0.05);感染组的正常形态精子百分率为(3.46±2.90)%,显著低于对照组的(4.61±3.60)%(P<0.05);感染组和对照组的精子DFI分别为(19.4±11.4)%和(15.2±8.8)%,同时感染组中DFI>30%者占13.0%,DFI<10%占16.0%,而在对照组中分别占5.74%和28.0%,组间比较均具有统计学意义(P<0.01);精浆弹性蛋白酶水平与精子浓度、精子总数、正常形态精子百分率呈显著负相关(P<0.05),与DFI和d级精子呈显著正相关(P<0.05或P<0.01)。结论:男性生殖系统感染对精液参数和精子DNA损伤都具有一定的影响,生殖系统感染的排查对男性不育有重要的诊断价值。

Objective： To investigate the association of male reproductive tract infection（ RTI） with semen parameters and sperm DNA damage. Methods： We classified 1 084 males attending the infertility clinic into an RTI group（ n = 300） and a non-RTI control group（ n = 784）. According to the WHO standards,we obtained routine semen parameters,detected sperm morphology,and determined the sperm DNA fragmentation index（ DFI） by sperm chromatin structure assay. Results： There were statistically significant differences between the RTI and control groups in the semen volume（ [2. 58 ± 1. 20] vs [3. 00 ± 2. 10] ml）,grade a ＋ b sperm（ [50. 6 ± 17. 2]vs [53. 2 ± 15. 8]%）,grade d sperm（ [39. 8 ± 17. 8] vs [36. 5 ± 16. 2]%）,and total sperm count（ [218. 5 ±185. 0] vs [278. 5 ± 375. 5] ×10^6/ ejaculate）（ all P〈0. 05）,but not in the males ＇ age,sperm concentration or p H value（ P〈0. 05）. The percentage of morphologically normal sperm was significantly lower（ [3. 46 ± 2. 90] vs [4. 61 ± 3. 60%,P〈0. 05） but the DFI was markedly higher in the RTI group than in the control（ [19. 4 ± 11. 4]vs [15. 2 ± 8. 8]%,P〈0. 01）. The percentage of the cases with DFI 30% was remarkably higher（ 13. 0 vs 5. 74%） while that of the cases with DFI 10% dramatically lower in the former than in the latter（ 16. 0 vs 28. 0%）. The level of seminal plasma elastase was correlated negatively to sperm concentration,sperm count,and the percentage of morphologically normal sperm（ P〈0. 05） but positively to DFI and grade d sperm（ P〈0. 05 or P〈0. 01）. Conclusion： Male reproductive tract infection not only affects semen parameters and sperm morphology but also causes serious sperm DNA damage.