不育男性抗苗勒管激素与生殖激素及精液质量参数关系的研究

Correlation of anti-Müllerian hormone with reproductive hormones and semen quality parameters in infertile men

目的探讨男性不育患者精浆和血清抗苗勒管激素(AMH)与血清生殖激素及精液参数之间关系。方法选取2018年9~12月于我院生殖中心就诊的男性不育患者107例,按照《世界卫生组织人类精液检查与处理实验室手册(第五版)》操作规范检测精液体积、精子浓度、前向运动精子(PR)百分比、精子顶体酶、精子DNA完整性、正常形态精子率,根据精液参数分为4组:少精子症组(n=15)、弱精子症组(n=26)、少弱精子组(n=31)、正常精子组(n=35),比较各组患者精浆和血清AMH及血清FSH、LH、催乳素(PRL)、T、E 2之间的差异,并对精浆和血清AMH与生殖激素及精液参数的相关性进行统计分析。结果弱精子症组血清AMH水平高于其他3组,但各组间差异无统计学意义(P>0.05);正常精子组精浆AMH水平[中位数(四分位距)]为1.28(7.71)ng/ml,显著高于少精子症组[0.11(1.26)ng/ml]和少弱精子组[0.16(2.15)ng/ml](P<0.05)。相关性分析显示,血清AMH与生殖激素及精液参数不存在相关(P>0.05);精浆AMH与血清FSH、LH呈负相关(P<0.05),与血清T呈正相关(P<0.05);精浆AMH与精子总数、精子浓度、PR%呈正相关(P<0.05),与其他精液参数不相关(P>0.05)。结论不育男性精浆AMH与血清生殖激素及精子浓度、活力具有一定的相关性,一定程度上反映睾丸生精功能,对男性不育的诊断和治疗有一定的参考作用。

Objective:To explore the correlation of anti-Müllerian hormone(AMH)in seminal plasma or serum with serum reproductive hormones&parameters of semen quality in infertile men.Methods:A total of 107 infertile men who visited the reproductive center of our hospital from September to December 2018 were selected.Seminal volume,sperm concentration,progressive sperm rate(PR),acrosomal enzyme,sperm DNA integrity,and sperm normal morphology rate were measured according to WHO laboratory manual for the examination and processing of human semen(5 th edition).According to the seminal parameters,the patients were divided into 4 groups:oligozoospermia group(n=15),asthenospermia group(n=26),oligoasthenozoospermia group(n=31),normozoo spermia group(n=35).Reproductive hormones including FSH,LH,PRL,T and E 2 in serum,as well as AMH in serum or seminal plasma were detected and compared among the groups.The correlation of AMH with reproductive hormones&sperm quality parameters was analyzed.Results:In asthenospermia group,the serum AMH levels were higher than those in other groups,but the difference was not significant among the groups(P>0.05).The median and interquartile range of AMH levels in seminal plasma of normozoospermia group[1.28(7.71)ng/ml]was significantly higher than that in oligozoospermia group[0.11(1.26)ng/ml]and oligoasthenozoospermia group[0.16(2.15)ng/ml](P<0.05).Serum AMH level was not correlated with the serum reproductive hormones and the semen parameters(P>0.05),while AMH level in seminal plasma was negatively correlated with serum FSH and LH level,and positively correlated with serum T level(all P<0.05).There were a positive correlation between AMH in seminal plasma and total sperm count,sperm concentration,and progressive sperm rate(P<0.05),but no correlation with other semen parameters(P>0.05).Conclusions:The level of AMH in seminal plasma is correlated with serum reproductive hormones,the sperm concentration and the progressive sperm rate,and it reflects the testicular spermatogenesis function to a certain extent and can be used for the reference in the diagnosis and treatment of male infertility.