解脲脲原体及沙眼衣原体对男性不育患者精液质量的影响

Effects of ureaplasma urealyticum and chlamydia trachomatis infection on the semen quality of infertile males

目的:研究解脲脲原体(UU)、沙眼衣原体(CT)感染对男性精液参数的影响,探讨男性感染UU、CT与不育的关系。方法:对2021年1月至2022年3月就诊的335名男性患者首段尿液标本进行UU与CT检测后分组,收集患者精液335例,比较各组精液参数之间的差异。结果:335例精液标本分为4组:UU感染组(98例,29.25%)、CT感染组(30例,8.96%)、UU合并CT感染组(25例,7.46%)、对照组(无感染组,182例,54.33%)。UU感染降低精子密度、精子总数、精子前向运动率、精子总活力(P<0.05);UU感染对精液体积、精液pH、精子正常形态率影响较小(P>0.05)。CT感染主要降低精子密度、精子总数、精子正常形态率(P<0.05)。与单一UU感染组及CT感染组对比,在UU合并CT感染组中,精子前向运动率、精子总活力、精子正常形态率下降的幅度更大,差异显著(P<0.05)。单一UU感染组、单一CT感染组及UU合并CT感染组的白细胞计数均显著高于对照组(P<0.05)。CT感染组中精子头部缺陷率、精子中段缺陷率、畸形精子指数(TZI)均高于对照组,差异显著(P<0.05)。在CT感染标本中,精子头部畸形主要类型是:36.36%以顶体区<40%或无顶体为主、27.27%以小头畸形为主,21.82%属于多重头部缺陷。结论:UU与CT感染导致精液质量下降,是引起男性不育的重要因素之一。而CT感染多引起精子头部畸形,主要以顶体区缺失和小头畸形为主。

Objective:To clarify the effect of ureaplasma urealyticum(UU)and chlamydia trachomatis(CT)infection on routine semen parameters of infertile males,and to explore the relationship between male infertility and UU and CT infection.Methods:First catch urine of clinic patients at department of reproductive medicine in our hospital was collected for UU and CT detection.We evaluated semen parameters of a total of 335 infertile males.Results:Based on the results of UU and CT detection,the subjects were divided into four groups:UU-positive group(98 people,29.25%),CT-positive group(30 people,8.96%),UU-CT-positive group(25 people,7.46%),and control group(no infection,182 people,54.33%).Compared to control group,UU-positive group showed difference in sperm concentration,total sperm count,sperm progressive motility,and motility(P<0.05),but showed no difference in semen volume,pH,and proportion of sperm with normal morphology.CT infection decreased sperm concentration,total sperm count,and proportion of sperm with normal morphology(P<0.05).The sperm progressive motility,motility ability,proportion of sperm with normal morphology declined obviously in UU-CT-positive group when compared with UU-positive group and CT-positive group.The level of seminal leukocytes was significantly increased in CT-positive,UU-positive and UU-CT-positive groups(P<0.05).In CT-positive group,the percentages of deformity of sperm head,midpiece and TZI were significantly higher compared with those of control group(P<0.05).There were three main types of sperm head deformity of samples with CT infection,including less than 40%of acrosome area or no acrosome(36.36%),sperm microcephaly(27.27%)and multiple head deformity(21.82%).Conclusion:Either UU or CT infection decrease the quality of sperm,which is one of the important factors for occurrence of male infertility.Most notably,CT infection mainly leads to acrosome defect and sperm microcephaly.