精索静脉曲张显微手术后抗精子抗体水平与精子质量相关性分析

Correlation analysis of antisperm antibody level and sperm quality after varicocele microsurgery

目的:探讨精索静脉曲张(VC)患者行显微精索静脉结扎术前后抗精子抗体(AsAb)水平与精子质量的相关性。方法:选择2015年1月至2017年12月行经外环口显微精索静脉结扎术的精索静脉曲张患者67例为病例组,同期同年龄层次育前检查未发现精索静脉曲张者67例为对照组。测定记录病例组手术前、术后(3、6、12个月)及对照组的AsAb阳性率、精液量、精子浓度、精子活动率、向前运动精子率以及精子畸形率,分析各项检测指标变化情况。结果:对照组与病例组术前AsAb阳性率、精子质量5项指标差异均有统计学意义(P<0.05)。病例组术后3个月AsAb阳性率与术前差异无统计学意义,术后6、12个月AsAb阳性率均降低,与术前差异有统计学意义(P<0.05)。病例组手术后各时间点及对照组精液量均无明显变化。病例组术后精子浓度、精子活动率、向前运动精子率、精子畸形率4项精子质量指标均较术前明显改善,差异有统计学意义(P<0.05)。病例组术后12个月精子浓度、精子活动率均较术后6个月、3个月进一步改善,差异有统计学意义(P<0.05);病例组术后6个月与术后3个月精子浓度、精子活动率差异无统计学意义。病例组术后各时间点精子畸形率差异无统计学意义。病例组术后12个月、6个月向前运动精子率较术后3个月进一步改善,差异有统计学意义(P<0.05);术后12个月与术后6个月向前运动精子率差异无统计学意义。Pearson相关性分析显示,手术前后AsAb阳性率降低与精子浓度、精子活动率改善明显负相关(P<0.05)。结论:显微精索静脉结扎术后患者AsAb阳性率明显降低,精子浓度、精子活动率、向前运动精子率及精子畸形率改善明显,且随时间延长,AsAb水平的降低程度与精子浓度、精子活动率改善明显相关,有助于术后疗效的评估。

Objective:To analyze the anti-sperm antibody(AsAb)and semen quality in microsurgical varicocelectomy.Methods:A total of 67 varicocele patients treated by microsurgical varicocelectomy in our hospital from January 2015 to December 2017 were included in the study.At the same time,67 cases with no varicocele found by pre-natal examination at the same age level were taken as control group.AsAb positive rate,sperm volume,sperm concentration,sperm motility,rate of sperm with forward movement,sperm abnormality rate were comparatively analyzed before surgery,3 months,6 months,and 12 months post-operation.Results:There was statistical difference in preoperative AsAb positive rate and semen quality between the two groups(P<0.05).The 6-and 12-month postoperative AsAb positive rates reduced compared with the corresponding preoperative rates(P<0.05),but no difference was found regarding the 3-month postoperative rates.There were no significant changes in sperm volume before and after operation between the two group.Sperm concentration,sperm activity rate,forward movement sperm rate,and sperm malformation rate were significantly improved in the case group after operation and before operation,and the difference was statistically significant(P<0.05).Sperm concentration and sperm motility rate improved further 12 months after operation compared with 6 months and 3 months after operation,and the difference was statistically significant(P<0.05),but there was no statistically significant difference between 6 months after operation and 3 months after operation.There was no significant difference in sperm malformation rate between the two groups after operation.The sperm rate of forward movement at 12 months and 6 months after operation is further improved than that at 3 months after operation,the difference was statistically significant(P<0.05),but there was no statistically significant difference between 12 months after operation and 6 months after operation.Pearson correlation analysis showed that the decrease of AsAb positive rate before and after operation was significantly negatively correlated with the improvement of sperm concentration and sperm activity rate(P<0.05).Conclusions:The positive rate of AsAb in patients undergoing microsurgical varicocele ligation was significantly reduced,and the sperm concentration,sperm activity rate,forward motility sperm rate,and sperm malformation rate were significantly improved.With the extension of time,the reduction degree of AsAb level was significantly correlated with the improvement of sperm concentration and sperm activity rate,which was helpful for the evaluation of postoperative efficacy.