精索静脉曲张合并睾丸功能损害的危险因素及预后分析

Analysis of risk factors and prognosis of varicocele complicated with testicular dysfunction

目的探讨精索静脉曲张(VC)合并睾丸功能损害的危险因素及手术预后。方法取2009年1月至2020年1月收治入院的VC患者388例为研究对象,根据其精液浓度及精子活力分为正常组和异常组,分析与睾丸功能损害相关的危险因素;其中手术治疗3个月后复查精液常规的患者135例,分析与睾丸功能恢复相关的预后因素。结果精液浓度异常患者63例(16.3%),精子活力异常患者313例(80.7%)。精液浓度异常患者较精液浓度正常组年龄更大(OR=0.45,P=0.04),精子活力异常患者较精子活力正常患者临床症状分度更低(OR=1.90,P=0.04)且中性粒细胞/淋巴细胞比(NLR)更高(OR=0.54,P=0.02),差异有统计学意义;手术治疗后精液浓度改善组患者的基线精液浓度(OR=2.87,P<0.01)和基线精子活力(OR=2.81,P<0.01)较精液浓度未改善组高;精子活力改善组患者年龄较精子活力未改善组低(OR=0.18,P<0.01),基线精子活力更差(OR=0.54,P<0.01)。结论VC合并睾丸功能损害的患者年龄和血常规NLR值较高;手术后精液浓度改善的患者基线精液浓度高,精子活力改善患者年龄较低。

Objective To investigate the risk factors of varicocele(VC)combined with testicular dysfunction and the prognosis of surgery.Methods A total of 388 patients with VC who were admitted to the hospital from January 2009 to January 2020 were selected as the research objects.According to their semen concentration and sperm motility,they were divided into the normal group and the abnormal group,and risk factors related to testicular dysfunction were analyzed.135 patients who finished surgery and routine semen dectetion three months after surgery were reviewed,and the prognostic factors related to the recovery of testicular function were analyzed.Results Sixty-three patients(16.3%)with abnormal semen concentration and 313 patients(80.7%)with abnormal sperm motility.Patients with abnormal semen concentration were older than those with normal semen concentration(OR=0.45,P=0.04),and patients with abnormal sperm motility had a lower clinical symptom score than those with normal sperm motility(OR=1.90,P=0.04),and the neutral granulocyte/lymphocyte ratio(NLR)of patients with abnormal sperm motility was higher than those of normal sperm motitity,the difference was statistically significant(OR=0.54,P=0.02).The baseline semen concentration(OR=2.87,P<0.01)and baseline sperm motility(OR=2.81,P<0.01)of patients in the improved group of semen concentration after surgery were higher than those in the unimproved group;Patients in the improved group of sperm motility were younger(OR=0.18,P<0.01),and the baseline sperm motility was worse(OR=0.54,P<0.01)than those in unimproved group.Conclusion Patients with VC and testicular dysfunction have a older age and higher NLR value.Patients with improved semen concentration after surgery have a higher baseline sperm concentration,and those with improved sperm motility are younger.