过量残留胞浆在精液质量中的评估价值

Evaluation value of excess residual cytoplasm in semen quality

目的 探讨过量残留胞浆与精液质量的相关性,评估其在男性不育中的影响。方法 收集2018年1~4月在本院男科门诊就诊的年龄在22~45岁的男性生育咨询患者为研究对象,共198例。并按照不同过量残留胞浆精子比率进行分组,胞浆残留比率≤7%的为第1组,共68例;胞浆残留比率7.1%~11.0%的为第2组,共66例;胞浆残留比率>11%的为第3组,共64例。比较3组患者间各精液参数的差别,分析精子过量残留胞浆与精液各参数间的相关性,并采用受试者工作特征曲线(ROC曲线)分析精子过量残留胞浆比率对弱精子症和畸形精子症的诊断价值。结果 随着精子过量残留胞浆比例增高,精子的前向运动呈现“下降”趋势,非前向运动上呈“上升”趋势;过量残留胞浆比例与精子浓度(r=-0.170,P<0.05)、精子正常形态率(r=-0.246,P<0.01)呈显著负相关;与禁欲天数(r=0.168)、非前向运动百分比(r=0.173)、头部畸形率(r=0.187)、颈部畸形率(r=0.570)、尾部畸形率(r=0.152)呈显著正相关(P<0.05)。当取过量残留胞浆比例9.1%为cut-off值时,其诊断弱精子症(精子前向运动<32%)的敏感性为64.9%,特异性为54.4%;诊断畸形精子症(精子正常形态率<4%)的敏感性为56.7%,特异性为60.6%,具有统计学意义(P<0.05)。结论 过量残留胞浆比率与男性的精液质量明显相关,胞浆残留比率高会降低精液质量,其可能是造成男性不育的一个重要因素。

Objective : To explore the correlation between excess residual cytoplasm and semen quality and its evaluation value in male infertility. Methods : The semen of 198 male patients aged 22-45 years were collected in the male clinic of our hospital from January to April 2018. According to the sperm ratio of residual cytoplasm,the patients were divide to the three groups:group 1:≤7%( n =68);group 2:7.1%-11.0%( n =66);group 3:>11%( n =64). The semen parameters of patients were compared among the three groups,and the correlation between sperm excess residual cytoplasm ratio and semen parameters was analyzed. The receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of sperm excess residual cytoplasmic ratio for asthenospermia and teratozoospermia. Results : As the proportion of excess residual cytoplasm in semen increased,the semen showed a “decline” trend in the sperm progress motility,a “rising” trend in the sperm non-progress motility. Excess residual cytoplasm ratio was significantly negatively correlated with semen concentration( r =-0.170, P <0.05) and normal sperm morphology rate( r =-0.246, P <0.01). Excess residual cytoplasm ratio were significantly positively correlated with abstinence days( r =0.168),non-progress motility( r =0.173),head deformity rate( r =0.187), neck deformity rate( r =0.570),and tail deformity rate( r =0.152)( P <0.05). When the excess residual cytoplasm ratio was 9.1% as the cut-off value,the sensitivity of the diagnosis of asthenospermia(sperm progress motility <32%) was 64.9%,the specificity was 54.4%;the sensitivity of the diagnosis of teratozoospermia(normal sperm morphology <4%) was 56.7%,the specificity was 60.6%;which was statistically significant( P <0.05). Conclusions : Excess residual cytoplasm ratio is closely related to male semen quality. High rate of excess residual cytoplasm reduces semen quality and may be an important factor in male infertility.