解脲支原体感染对不育男性精液质量及生育能力的影响

Effects of Ureaplasma Urealyticum Infection on the Quality of Semen in Patients of Male Sterility

目的探讨解脲支原体（UU）感染对不育男性精液质量及生育能力的影响。方法回顾性分析本院生殖中心就诊的男性不育患者298例，根据患者精液是否存在解脲支原体感染分为病例组（n=109）和对照组（n=189），并对两组患者的精液质量进行分析。同时，对uu感染患者予以阿奇霉素治疗．随访1年观察治疗后病例组患者生育情况。结果与对照组相比，病例组患者精子总活力、前向运动率（PR）、精子存活率显著降低，精子正常形态率显著降低，精子头部畸形率显著增高（P均〈0．05），而两组患者的精子畸形指数、畸形精子指数、体部畸形率和尾部畸形率差异无统计学意义。与对照组相比，病例组精子顶体酶活性显著降低．而顶体酶异常率、精浆弹性蛋白酶显著高；精浆弹性蛋白酶诊断解脲支原体感染的敏感性为67．8％（95％cI：47．1％～87．4％），特异性为66．7％（95％cI：43．5％～86．8％），ROC曲线下面积为0．71（95％CI：0．57～0．86）；病例组78例接受了阿奇霉素治疗2周，1年内妻子受孕率明显高于对照组（HR=2．76，95％CI：1．26—6．06，P〈0．05）。结论解脲支原体感染可影响男性精液质量，是导致不育的重要原因之一，抗解脲支原体治疗可提高患者生育机会。

Objective To evaluate the effects of ureaplasma urealyticum（UU） infection on the quality of semen in patients of male sterility. Methods 298 cases of male sterility diagnosed in this study in our hospital were retrospectivel. The semen was diveided into case group（ n = 109） and control group （n = 189） accoding to whether or not infected with UU. The semen quality of the two groups were tested, the patients of case group received Azithromycin treatment and follow up for one year.The fertility rate was analyzed in the cases grop. Results Compared with the control group, the total sperm activity, the forward movement rate and survival rate spermatozoa was significantly lower, while sperm concentration between the two groups had no significant difference ; The morphology normal rate of sperm in the case group was significantly lower than that in the control group （P〈0.05） ,the abnormal rate of sperm head in the case group was significantly higher, But the sperm deformity index, abnormal sperm index, sperm head deformity rate, central deformity rate and tail deformity rate were not statistically significant between the two groups （P〉0.05）.Compared with the control group, sperm terminal enzyme ac- tivity of the case group was significantly lower （P〈0.05） ,but the abnormal rate of sperm terminal enzyme and the seminal plasma elastase was significantly higher （P〈0.05）.According to plasma elastase,the diagnosis of UU infection of urinary and reproductive tract was 67.8% （ 95% C1：47.1% - 87.4% ）, and 66.7% （ 95% C1：43.5% -86.8% ）, for sensitivity and spe- cificity with area under the ROC curve of 0.71 （95%CI：0.57 - 0.86）.In the case group,78 cases were treated with azithro-mycin for 2 weeks and with 1 year follow up, the wife＇s pregnancy rate was significantly higher than that of the control group,and the difference was statistically significant （HR=2.76,95%CI： 1.26 - 6.06,P〈0.05）. Conclusion Ureaplas- ma urealyticum infection can affect the quality of semen in patients with sterility, which could be one of the reasons for ste- rility.Anti treatment of ureaplasma urealyticum can elevated the rate of fertility.