前列腺按摩液/精浆弹性蛋白酶联合诊断ⅢA型前列腺炎合并不育症的价值

Content of neutrophil elastase in EPS and seminal plasma:A combined predictor in the diagnosis of type ⅢA prostatitis with secondary infertility

目的:探讨前列腺按摩液(EPS)/精浆弹性蛋白酶(NE)联合诊断ⅢA型前列腺炎合并不育症的价值。方法:2015年5月至2017年3月分别遴选已生育ⅢA型前列腺炎患者(生育组)62例、ⅢA型前列腺炎合并不育症患者(不育组)67例,和无泌尿生殖道疾病对象(对照组)57例,检测其EPS和精浆中NE含量、精液常规、EPS常规及症状评分(CPSI);二元Logistic回归分析EPS/精浆的NE比值。结果:诊断ⅢA型前列腺炎合并不育症的联合预测因子为(精浆NE-2×EPS NE)。对129例ⅢA型前列腺炎患者(病例组)的相关性分析显示,联合预测因子与EPS的白细胞(WBC)呈负相关(r=-0.914,P<0.01),与症状评分、精子浓度、精子活率、精子活力呈负相关(P均<0.01),与精浆WBC、精液pH值的关联无统计学意义(P>0.05)。该预测因子在生育组、不育组、对照组中均值和95%置信区间分别为-2 238(-2 595,-2 054)、-1 511(-1 778,-1 307)、-148(-181,-118),在病例组(生育组+不生育组)和对照组间、病例组内生育组和不育组间差异有统计学意义(P<0.01)。联合预测因子诊断ⅢA型前列腺炎合并不育症的受试者工作特征曲线(ROC)面积为0.71(P<0.01)。结论:EPS NE和精浆NE含量联合诊断ⅢA型前列腺炎合并不育症有较大诊断价值,使用联合预测因子优于单独采用EPS NE或精浆NE含量诊断IIIA型前列腺炎合并不育症。

Objective： To investigate the value of the content of neutrophil elastase （NE） in the expressed prostatic secretion （EPS） and seminal plasma （SP） as a combined predictor in the diagnosis of type IliA prostatitis witl secondary intrtility.Methods： This study included 62 fathers （group A） and 67 infertile men （group B）, all with type IIIA prostatitis, and another 57 controls with no genitourinary tract disease （ group C）. We measured the NE contents in the EPS and SP, obtained the results of rou- tine semen and EPS examinations and Chronic Prostatitis Symptom Index （ CPSI）, and calculated the ratio of EPS NE/SP NE by binary logistic regression analysis. Results： The combined predictor of type IIIA prostatitis with secondary infertility was SP NE-2 EPS NE. Among the 129 patients with type IIIA prostatitis, the combined predictor was correlated strongly negatively with the WBC count in the EPS （r = - 0. 914, P 〈 0. O1 ）, negatively with CPSI, sperm concentration, sperm mobility and sperm viability （ P 〈 O. 01 ）, but not significantly with the WBC count or pH value in the SP （ P 〉 0.05 ）. The mean values of the combined predictor in groups A, B, andCwere -2 238 （95% CI： -2 595 to -2 054）, -1511 （95% CI： -1778to -1307）, and -148 （95% CI： -181to - 118 ）, respectively, with statistically significant differences between the cases and controls as well as between groups A and B （P 〈 O. 01 ）. The area under the ROC curve of the combined predictor for the diagnosis of type IIIA prostatitis with secondary infertility was O. 71 （ P 〈 O. 001 ）. Conclusion ： The content of neutrophil elastase in the EPS combined with that in the seminal plasma contributes to the diagnosis of type IIIA prostatitis with secondary infertility, which is superior to either the neutrophil elastase content in the EPS or that in the seminal plasma used alone. Nati J Androl, 2017, 23 （9） ： 786 -792