不同肥胖指标对孕前男性精液质量影响的研究

Effects of obesity on semen quality in males at pre⁃pregnancy stage

目的研究肥胖对孕前男性精液质量的影响。方法孕前男性367例,分别测量身高、体质量、腰围(waist circumference,WC)、臀围(hip circumference,HC),计算体质量指数(body mass index,BMI)、腰臀比(waist-to-hip ratio,WHR),进行精液分析、精子形态分析、精子DNA碎片率(DNA fragmentation index,DFI)检测。按BMI、WC和WHR进行分组,比较不同BMI、WC和WHR组间各项精液质量参数的差异,以及BMI、WC和WHR与各项精液质量参数的相关性。结果不同BMI组间前向运动精子百分率有显著性差异(F=4.794,P<0.05),两两比较体质量正常组与肥胖组间有显著性差异(P<0.05),正常组与超重组、超重组与肥胖组间无显著性差异(P>0.05,P>0.05);不同BMI组间正常形态精子百分率有显著性差异(F=4.813,P<0.05),正常组与肥胖组间有显著性差异(P<0.05),正常组与超重组、超重组与肥胖组间无显著性差异(P>0.05,P>0.05);不同BMI组间DFI有显著性差异(F=5.371,P<0.025),三组间两两比较有显著性差异(P<0.05);不同BMI组间精子浓度无明显差异(F=2.316,P>0.05)。WC≥90 cm组前向运动精子、正常形态精子均低于WC<90 cm组(t=2.366,P<0.025;t=1.276,P<0.05),DFI高于对照组(t=2.471,P<0.025),精子浓度无明显差异(t=0.791,P>0.05)。WHR≥0.9组前向运动精子、正常形态精子均低于WHR<0.9组(t=2.617,P<0.005;t=2.423,P<0.025),DFI高于对照组(t=2.579,P<0.001),精子浓度无明显差异(t=0.746,P>0.05)。BMI与前向运动精子百分率、正常形态精子百分率呈负相关(r=-0.121,P<0.05;r=-0.128,P<0.05),与DFI呈正相关(r=0.119,P<0.05),与精子浓度无相关性;WC与前向运动精子百分率、正常形态精子百分率呈负相关(r=-0.129,P<0.05;r=-0.131,P<0.05),与DFI呈正相关(r=0.128,P<0.05),与精子浓度无相关性;WHR与前向运动精子百分率、正常形态精子百分率呈负相关(r=-0.132,P<0.05;r=-0.137,P<0.05),与DFI呈正相关(r=0.221,P<0.01),与精子浓度无相关性(P>0.05)。结论肥胖与男性精液质量下降有关,在三个肥胖指标中WHR与精子质量指标相关性最强。

Objective To investigate the effects of obesity on semen quality in preconception males.Method Total of 367 preconception males were recruited at the andrology clinic in the study.Their body mass index(BMI),waist circumference(WC),waist⁃to⁃hip ratio(WHR),the parameters of semen quality include routine semen parameters,percentage of normal sperm morphology,sperm DNA fragmentation index(DFI)were measured,and the correlation between the BMI,WC,WHR and parameters of semen quality were comparatively analyzed.Results Among different BMI groups,there were significant differences in forward motility sperm rate(F=4.794,P<0.05),and in pairwise comparison analysis,there was a significant difference between normal weight group and obesity group(P<0.05),and no significant difference between normal weight group and overweight group,and between overweight group and obesity group(P>0.05,P>0.05).Among different BMI groups,there were significant differences in normal morphology sperm rate(F=4.813,P<0.05),and in pairwise comparison analysis,there were significant differences between normal weight group and obesity group(P<0.05),and no significant difference between normal weight group and overweight group,and no significant differences between overweight group and obesity group(P>0.05,P>0.05).There were significant differences in DFI among different BMI groups(F=5.371,P<0.025),and there were significant differences in pairwise comparison analysis(P<0.05).There was no significant difference in sperm concentration among different BMI groups(F=2.316,P>0.05).The level of forward motility sperm rate,normal morphology sperm rate in WC≥90 cm group was significantly lower than those in WC<90 cm group(t=2.366,P<0.025;t=1.276,P<0.05),and DFI was significantly higher than that in WC<90 cm group(t=2.471,P<0.025).There were no significant differences in sperm concentration between two groups.The level of forward motility sperm rate,normal morphology sperm rate in WHR≥0.9 group was significantly lower than those in WHR<0.9 group(t=2.617,P<0.005;t=2.423,P<0.025),and DFI was significantly higher than that in WC<90 cm group(t=2.579,P<0.05).There were no significant differences in sperm concentration between two groups(t=0.746,P>0.05).BMI was negatively correlated with the forward motility sperm rate,normal morphological sperm rate(r=-0.121,P<0.05;r=-0.128,P<0.05)and positively correlated with DFI(r=0.119,P<0.05).WC was negatively correlated with the forward motility sperm rate,normal morphological sperm rat(r=-0.129,P<0.05;r=-0.131,P<0.05),and positively correlated with DFI(r=0.128,P<0.05).WHR was negatively correlated with the forward motility sperm rate,normal morphological sperm rate(r=-0.132,P<0.05;r=-0.137,P<0.05),and positively correlated with DFI(r=0.221,P<0.01).Conclusion Obesity may result in the decline of male semen quality.Among three obesity indicators,WHR is the strongest correlation indicator for semen quality.