采用3级分类方法评估睾丸微石症与精液参数间的关系

The evaluation of the semen parameters for patients with testicular microlithiasis using a Three-Grade classification

目的:采用3级分类方法评估男性睾丸微石症患者的精液参数。方法:回顾性分析山东大学生殖医学研究中心297例经阴囊超声诊断为睾丸微石症患者的临床资料。依据B超图像一个切面点状强回声数量的多少,将患者分为3个级别:1级(1个~5个),2级(6个~20个)以及3级(> 20个),统计并分析各级别TM患者的精液参数。结果:本组患者年龄(29. 21±4. 82)岁,年龄范围21岁~46岁,睾丸体积(15. 68±3. 82) ml,睾丸体积范围3. 55 ml^26. 03ml。其中1级TM患者为95例、2级127例、3级75例,各级别TM患者主要精液参数如精子浓度、总活力、前向运动精子比例分别为(53. 54±38. 46百万/ml、48. 76±37. 08百万/ml、35. 70±28. 92百万/ml,P=0. 004),(55. 78±22. 74%、51. 49±24. 35%、44. 05±22. 50%,P=0. 005)以及(43. 72±19. 66%、40. 24±21. 04%、34. 34±19. 69%,P=0. 011)。2级TM的精液参数与3级相比有差异,与1级比没有差异。结论:与传统分类方法相比,将睾丸微石症分为3级可以更好地评估睾丸微石症程度与精液参数之间的关系。睾丸微石症的分级越高,精液质量相对较差。睾丸微石症2级患者的精液参数不稳定。

Objective： To evaluate the semen parameters of testicular microlithiasis（ TM） with a ThreeGrade classification for patients with fertility intention. Methods： Medical records of 297 patients diagnosed with TM by scrotal ultrasound were reviewed retrospectively. According to the maximum number of microliths with any image,patients were divided into three grades： Grade 1（ 1-5 microliths）,Grade 2（ 6-20 microliths） and Grade 3（ 〉20 microliths）. Semen parameters of each grade were collected and analyzed. Results： The mean age was 29. 21 ±4. 82 years（ range,21-46 yrs.） while mean testicular volume was 15. 68 ± 3. 82 ml（ range,3. 55-26. 03 ml）.There were 95 patients in Grade 1,127 patients in Grade 2 and 75 patients in Grade 3. Main semen parameters such as sperm concentration,total motility and percentage of progressively motile of each grade was（ 53. 54 ± 38. 46 million/ml vs. 48. 76 ± 37. 08 million/ml vs. 35. 70 ± 28. 92 million/ml,P = 0. 004）,（ 55. 78 ± 22. 74% vs.51. 49 ± 24. 35% vs. 44. 05 ± 22. 50%,P = 0. 005） and（ 43. 72 ± 19. 66% vs. 40. 24 ± 21. 04% vs. 34. 34 ±19. 69%,P = 0. 011）,respectively. Most semen parameters of Grade 2 showed statistically significant differences with that of Grade 3 yet no differences with Grade 1. Conclusions： TM could be classifed as three grades for patients with fertility intention,comparing with the conventional classification,which could better represent the association of TM and semen parameters. The semen parameters correlates inversely with grades. Grade 2 could be considered as a gray area which presents amphibolous semen parameters.