重度少精子症的诊治方式研究

Diagnosis and treatment of severe oligozoospermia

目的探讨重度少精子症的诊断方法及治疗原则。方法选择2016年8月至2018年4月于吉林大学第二医院生殖中心男科诊治的连续3次精液常规检查提示重度少精子症、而经睾丸或附睾穿刺证实生精功能正常的302例患者的临床资料作为研究对象,对其进行分析和统计。结果 302例患者中,274例患者精子密度<2×10~6/ml,26例患者<5×10~6/ml。302例患者内分泌、染色体检查均未见明显异常。302例患者中,43例患者自述曾患泌尿生殖道或生殖腺体炎症,56例患者抗精子抗体(AsAb)检测显示阳性。302例患者采用不同生精药物治疗和抗炎治疗,其精液常规检查均未见精液量和精子密度明显增多。将176例经卵浆内单精子注射(ICSI)的患者列为观察组,其中147例患者妻子成功受孕;将126例行人工授精(IUI)患者列为对照组,其中44例患者妻子受孕。结论重度少精子症患者首先应当完成相关检查,明确病因。各项检查均未见明显异常、病因不明的重度少精子症患者在药物治疗无效时,应当首先选用ICSI治疗方法。

ObjectiveTo explore the diagnosis and treatment principles of severe oligospermia. MethodsThe clinical data of 302 patients with severe oligospermia who were confirmed to have normal spermatogenesis by testicular or epididymal puncture in the male department of the reproductive center of the Second Hospital of Jilin University from August 2016 to April 2018 were analyzed and statistically analyzed. ResultsOf the 302 patients, 274 cases had sperm density less than 2 ×10^6/ml and 26 cases had density less than 5 ×10^6/ml. The endocrine and chromosome examination of all the 302 patients showed no obvious abnormality. Of the 302 patients, 43 reported history of genitourinary tract or genital gland inflammation, and 56 tested positive for anti-sperm antibody (AsAb). There was no significant increase in semen volume and sperm density in all the 302 patients treated with different spermatogenic drugs and anti-inflammatory treatments. The wives of 147 patients in the 176 patients received intracytoplasmic single sperm injection (ICSI) were successfully pregnant, and the wives of 44 patients in the 126 cases received artificial insemination (IUI) were successfully pregnant. ConclusionsPatients with severe oligospermia should first complete relevant examinations to identify the etiology and ICSI treatment is preferred when no obvious abnormalities are found and the causes are unclear.