生殖支原体感染与男性不育相关性分析

Correlation of Mycoplasma genitalium infection with male infertility

目的:探讨生殖支原体(MG)感染与男性不育的相关性。方法:对2017年就诊的27 314例男性不育患者和200例供精者(已确定有生育能力)的精液进行MG和精液常规的检测,采用实时荧光核酸恒温扩增检测技术检测精液MG的RNA。27 314例不育男性分为无精子症、少精子症、弱精子症、少弱精子症和精液参数正常组;有年龄资料的27 286例患者分为<21、21～25、26～30、31～35、36～40、41～45、46～50、≥51岁组;有明确临床诊断的9 058例患者分为原发性不育和继发性不育,分析不同组MG感染率的差异。对56例MG感染不育患者抗生素治疗2周以上MG转阴者,分析其治疗前后精液参数的改变。结果:少精子症组MG感染率显著高于正常对照组(3. 62%vs 0. 50%,P=0. 024);≥51岁组MG感染率最高(3. 68%),其次为21～25岁(3. 00%),均显著高于正常对照组(P=0. 021、0. 048);男性不育组MG感染率(3. 64%)、显著高于正常对照组(P=0. 011),原发性不育(3. 73%)和继发性不育组(3. 57%)也显著高于正常对照组(P=0. 010、0. 015)。少精子症(OR=7. 471,95%CI,1. 001～55. 784)与MG感染有关,年龄段变化与MG感染无关;原发性不育(OR=7. 704,95%CI,1. 073～55. 309)、继发性不育(OR=7. 362,95%CI,1. 026～52. 837)与MG感染有关。感染组(治疗前)精子浓度和精子总数显著低于未感染组(治疗后),差异有统计学意义(P <0. 05)。结论:MG感染与男性不育相关,会显著降低精液量和精子浓度,但对精子活力没有影响。

Objective： To explore the correlation of Mycoplasma genitalium（ MG） infection with male infertility. Methods：Totally,27 314 males with infertility and 200 fertile sperm donors underwent MG and routine seminal examinations. The infertile men were divided into azoospermia,oligozoospermia,asthenozoospermia,oligoasthenospermia,and normal semen quality groups based on the results of seminal examination,the 27 286 of them with age data into eight age groups（ 21,21-25,26-30,31-35,36-40,41-45,46-50 and ≥51 years old）,and the 9 058 with definite diagnosis into primary and secondary infertility groups. Fifty-six cases of MG infection among the infertile males were treated with antibiotics for 2 weeks and examined for changes of the semen parameters. Results： Compared with the normal controls,the oligozoospermia patients showed a significantly higher rate of MG infection（ 0. 50% vs 3. 62%,P = 0. 024）,the highest in the ≥51 yr group（ 3. 68%,P = 0. 021）,followed by the 21-25 yr group（ 3. 00%,P = 0. 048）,and so did the infertile males（ 3. 64%,P = 0. 011）,the men with primary infertility（ 3. 73%,P =0. 010） and those with secondary infertility（ 3. 57%,P = 0. 015）. MG infection was found to be associated with oligozoospermia（ OR = 7. 471,95% CI： 1. 001-55. 784）,primary infertility（ OR = 7. 704,95% CI： 1. 073-55. 309） and secondary infertility（ OR = 7. 362,95% CI： 1. 026-52. 837） but not with the age of the patients. Both sperm concentration and sperm count were significantly lower in the infected men before treatment than in the non-infection group after treatment（ P〈0. 05）. Conclusion： MG infection is related to male infertility and reduces the semen volume and sperm concentration,but does not affect sperm motility.