硒与精液质量的相关性及硒对少弱精子患者精液质量影响

Relationship between serum or seminal selenium level and semen quality in healthy men and its effect on semen quality of patients with oligoasthenozoospermia

目的研究恩施土家族苗族自治州-富硒地区男性血清、精浆硒水平与健康育龄期男性和少弱精子症男性患者精液质量之间的关系。方法选择2018年来我院生殖医学中心就诊的456例富硒地区患者,其中200名患者精液参数正常,256名患者精液参数异常,采用原子吸收光谱检测血清和精浆中硒浓度,并分析血清、精浆中硒浓度与精液质量之间的相关性;少弱精子症患者进行常规治疗(生精胶囊及维生素E胶囊)以及常规治疗+硒元素补充治疗后,比较两种不同方案治疗后精液质量之间的差异。结果精液正常组与精液异常组患者年龄、精液体积无明显差异,而正常组精子浓度(70.03±34.42)、活力(51.12±7.21)和形态(11.75±3.74)明显高于少弱精子症组精子浓度(11.12±7.11)、活力(17.73±11.78)和形态(3.12±1.63),差异均具有显著性(P<0.001);正常组的血清硒(104.22±22.82)和精浆硒(65.35±22.82)均高于少弱精子症组血清硒(74.01±20.86)和精浆硒(49.31±17.17),均具有统计学意义(P<0.001)。同时,无论是正常组患者,还是少弱精子症组患者血清硒(r=0.680, P<0.01)与精浆硒(r=0.651, P<0.01)均呈明显正相关,有统计学差异;血清硒与少弱精子症组精子浓度(r=0.499, P<0.01)、活力(r=0.360, P<0.05)均呈正相关,精浆硒与少弱精子症组精子浓度(r=0.391, P<0.05)、活力(r=0.353, P<0.05)也呈正相关,有统计学意义;将少弱精子症组随机分为常规治疗组及常规治疗+硒元素补充治疗组,两组患者在精子浓度、活力、形态及硒浓度均无显著差异;进行常规治疗后,精子浓度(12.57±8.76)、活力(17.06±14.01)较治疗前精子浓度(10.72±6.99)和活力(15.80±11.87)有一定程度提高,均具有统计学意义(P<0.05);常规治疗+硒元素补充治疗后,精子浓度(12.99±8.19)、活力(21.70±12.54)及形态(3.26±1.48)较常规治疗+硒元素补充前精子浓度(9.60±7.14, p<0.001)、活力(17.62±12.27, P<0.01)和形态(2.61±1.58, P<0.05)明显提高,均具有统计学意义,血清硒(88.44±24.86)及精浆硒(55.06±19.32)浓度较常规治疗+硒元素补充前血清硒(79.39±22.93,P<0.01)及精浆硒(47.08±19.17,P<0.001)有明显升高,差异具有显著性。结论血清硒与精浆硒水平在男性不育症患者中普遍较正常患者偏低,硒元素直接影响精液质量,对少弱精子症患者行补硒治疗可明显提高精液质量。

Objective To study the relationship between serum or seminal selenium level and semen quality in healthy men and oligoasthenospermia patients in semen-rich areas of Enshi Tujia and Miao Autonomous Prefecture. Methods A total of 456 patients in selenium-rich areas who were treated in our hospital’s Reproductive Medicine Center in 2018 were selected in the study. Among them, 200 patients had normal semen parameters, while 256 patients had abnormal semen parameters. The levels of serum and seminal selenium were determined by atomic absorption spectrometry. The correlation between serum/or seminal selenium level and semen quality was analyzed. Patients with oligoasthenozoospermia received conventional treatment(spermatogenic capsules and vitamin E capsules) and the routine treatment plus selenium supplement,and the difference in semen quality between two treatment regimens was comparatively analyzed. Results There were no significant differences in age and semen volume between the normal semen group and the abnormal semen group. The concentration, activity and morphology of semen in the normal group were significantly higher than those in the oligoasthenospermia group(70.03±34.42 vs11.12±7.11;51.12±7.21 vs17.73±11.78;11.75±3.74 vs3.12±1.63, P<0.001). The levels of selenium in serum and seminal in the normal group were all higher than those in the oligoasthenospermia group(104.22 ±22.82 vs74.01 ±20.86;65.35 ±22.82 vs49.31 ±17.17, P<0.001). Meanwhile, serum selenium level was positively correlated with seminal selenium level in both normal group(r=0.680, P<0.01) and oligoasthenospermia group(r=0.651,P<0.01). Serum selenium level was positively correlated with sperm concentration(r=0.499, P<0.01) and sperm motility(r=0.360, P<0.05) in the oligoasthenozoospermia group, seminal selenium was also positively correlated with sperm concentration(r=0.391, P<0.05) and sperm motility(r=0.353, P<0.05) in the oligoasthenozoospermia group. The patients in the oligoasthenospermia group were randomly divided into the conventional treatment group and the conventional plus selenium supplement treatment group. There were no significant differences in sperm concentration, motility, morphology and selenium concentration between the two groups. After conventional treatment, sperm concentration and sperm motility were significantly higher than those before treatment(12.57±8.76 vs10.72±6.99;17.06±14.01 vs15.80±11.87, P<0.05). After conventional plus selenium treatment, the quality of semen was significantly improved, the sperm concentration, motility and morphology were higher than those before treatment(12.99 ±8.19 vs 9.60 ±7.14, P<0.001;21.70 ±12.54 vs17.62 ±12.27,P<0.01;3.26±1.48 vs2.61±1.58, P<0.05). The levels of serum selenium and seminal selenium were all significantly higher than those before conventional plus selenium treatment(88.44 ±24.86 vs 79.39 ±22.93, P<0.01) and seminal selenium(55.06±19.32 vs47.08±19.17, P<0.001). Conclusion The levels of selenium in serum and seminal in male infertility patients are generally lower than those in normal man. Selenium directly affects semen quality. Selenium supplementation can obviously improve semen quality in oligoasthenozoospermia.