精索静脉曲张患者睾丸微循环变化对精子生成的影响

Effect of testicular microcirculation on spermatogenesis in patients with varicocele

目的探讨精索静脉曲张患者睾丸微循环变化对精子生成的影响。方法选取2018年6月至2019年6月间郑州大学第一附属医院收治的70例精索静脉曲张患者为观察组,同时期的35例生育健康男性为对照组。采用彩色多普勒超声测定两组睾丸包膜动脉的血流动力学参数,检测两组精子密度、精子活率、向前运动比例、精子畸形率,分析睾丸微循环变化与精子质量间的相互关系。结果观察组的精子密度、精子活率及向前运动比率明显低于对照组,精子畸形率明显高于对照组,差异具有统计学意义(P<0.05)[(58.64±6.29)10^(6)个/mL vs(72.35±6.81)10^(6)个/mL;(54.28±5.47)%vs(65.72±5.93)%;(28.19±3.06)%vs(37.52±3.21)%;(37.54±4.12)%vs(25.66±4.37)%];观察组血流动力学参数(PSV、EDV、RI及PI)明显高于对照组,差异具有统计学意义(P<0.05)[(9.28±2.25)cm/s vs(7.37±2.08)cm/s;(3.47±1.01)cm/s vs(3.09±0.57)cm/s;(0.69±0.07)vs(0.51±0.04);(0.97±0.11)vs(0.82±0.12)];Pearson相关分析表明血流参数(PSV、EDV、RI及PI)与精子密度(-0.419、-0.378、-0.413及-0.395)、精子活率(-0.476、-0.483、-0.392及-0.375)之间呈负相关。结论精索静脉曲张患者存在不同程度的睾丸微循环损伤。睾丸微循环与精子生成关系密切,改善睾丸微循环可作为精索静脉曲张治疗的新途径。但目前睾丸微循障碍的相关机制尚不明确,需进一步进行研究论证,进而为精索静脉曲张相关疾病的治疗提供理论支持。

Objective To investigate the effect of varicocele on spermatogenesis in patients with varicocele.Methods Totally 70 patients with varicocele treated in our hospital from June 2018 to June 2019 were selected as the observation group,while 35 fertile healthy men were selected as the control group.The hemodynamic parameters of testicular envelope artery in the two groups were measured by color Doppler ultrasound.The sperm density,sperm motility,forward movement ratio and sperm deformity rate in the two groups were measured,and the relationship between testicular microcirculation and sperm quality was analyzed.Results The sperm density,sperm motility and forward movement rate of the observation group were significantly lower than those of the control group,and the deformity rate was significantly higher than that of the control group(P<0.05)[(58.64±6.29)10^(6)/mLvs(72.35±6.81)10^(6)/mL;(54.28±5.47)%vs(65.72±5.93)%;(28.19±3.06)%vs(37.52±3.21)%;(37.54±4.12)%vs(25.66±4.37)%];The hemodynamic parameters(PSV,EDV,RI,PI)in the observation group were significantly higher than those in the control group(P<0.05)[(9.28±2.25)cm/s vs(7.37±2.08)cm/s;(3.47±1.01)cm/s vs(3.09±0.57)cm/s;(0.69±0.07)vs(0.51±0.04);(0.97±0.11)vs(0.82±0.12)];Pearson correlation analysis showed that blood flow parameters(PSV,EDV,RI and PI)were negatively correlated with sperm density(-0.419,-0.378,-0.413 and-0.395),sperm motility(-0.476,-0.483,-0.392 and-0.375).Conclusion Patients with varicocele have different degrees of testicular microcirculation injury.Testicular microcirculation was closely related to spermatogenesis.Improving testicular micro-circulation could be used as a new way to treat varicocele.However,at present,the relevant mechanism of testicular microcirculation disorder was not clear,which needed further research and demonstration,so as to provide theoretical support for the treatment of varicocele related diseases.