【作者】 刘铭；

【导师】 徐祗顺；

【作者基本信息】 山东大学 ， 外科学， 2014， 硕士

【摘要】 研究背景及目的睾丸微石症(Testicular microlithiasis, TM)作为临床上比较少见的一种男性生殖系统疾病,特点是弥散分布于睾丸实质内的多发点状钙化。在临床工作中,睾丸微石症常可以分为两种不同的疾病类型：即限制型睾丸微石症(Limited testicular microlithiasis, LTM)和经典型睾丸微石症(Classic testicular microlithiasis, CTM)。目前的研究对于TM发生率有逐渐升高的趋势已经逐步达成共识。当前,多数研究者倾向于将TM视为一种与男性生精功能有关的、具有临床意义的生殖系统疾病。针对TM包括其两种不同类型(CTM和LTM)的具体病因、发病机制等等而言,特别是和男性生育功能的关系,已经引起了很多研究者和临床医生的重视。因此,探讨睾丸微石症及其不同类型(CTM/LTM)和成年男性精子质量之间的关系是一项非常重要并有临床意义的研究,分析其相关性以及不同类型之间是否具有差异,可为今后临床工作中诊疗决策的实施提供帮助。资料与方法1.回顾性分析41例经超声检查诊断为睾丸微石症,并且精液常规检查发现精子的成年男性患者(即TM组)的临床资料。全部41例患者分为经典型睾丸微石症(CTM)和限制型睾丸微石症(LTM)两组。2.另收集经超声检查诊断不伴有睾丸微石症并接受精液常规检查发现精子的11例成年男性(即非TM组)的临床资料进行分析。3.采用SPSS18.0统计软件进行统计分析,两组独立样本均数间的两两比较采用Student’s t检验,多组独立样本均数间的比较采用单因素方差分析(One-Way ANOVA),以P<0.05为差异有统计学意义。结果1.全部41例TM患者中,共31例(75.61%)患者最终诊断为CTM,其他10例(24.39%)患者诊断为LTM。2.TM组平均年龄是29.49±4.97岁,平均体质量指数(Body Mass Index, BMI)是25.39±4.07kg/m2,平均睾丸体积是16.94±3.59ml。其中CTM组的平均年龄是30.06±5.28岁,平均BMI是25.54±4.33kg/m2,平均睾丸体积是16.66±3.39ml；而LTM组的平均年龄是27.70±3.47岁,平均BMI是24.92±3.27kg/m2,平均睾丸体积是17.81±4.21ml。非TM组平均年龄是27.82±3.34岁,平均BMI是25.46±3.57kg/m2,平均睾丸体积是17.90±2.91ml。3.TM组和非TM组两组在精子浓度(48.59±25.44×106/ml vs.89.06±36.03×106/ml)、精子总数(182.95±127.72×106vs.309.92±123.15×106)和非前向运动精子率(12.17±5.21%vs.18.10±7.27%)等三个方面的比较,差异均有统计学意义(P=0.000,0.005,0.003)。4.CTM组、LTM组和非TM组三组在精子浓度(44.89±26.14×106/ml vs.60.06±20.16×106/ml vs.89.06±36.03×106/ml)、精子总数(160.33±106.50×106vs.253.05±165.74×106vs.309.92±123.15×106)、精子总活力(53.37±21.43%vs.71.28±16.96%vs.70.77±21.61%)、前向运动精子率(41.47±17.79%vs.58.28±15.73%vs.52.67±20.19%)、非前向运动精子率(11.90±5.63%vs.13.00±3.71%vs.18.10±7.27%)和不活动精子率(46.63±21.43%vs.28.72±16.96%vs.29.25±21.60%)等六个方面的比较,差异均有统计学意义(F=10.522,6.789,4.540,3.994,4.797,4.536; P=0.000,0.002,0.016,0.025,0.013,0.016)。5.其中,CTM组与非TM组在精子浓度(44.89±26.14×106/ml vs.89.06±36.03×106/ml)、精子总数(160.33±106.50×106vs.309.92±123.15×106)、精子总活力(53.37±21.43%vs.70.77±21.61)、非前向运动精子率(11.90±5.63%vs.18.10±7.27%)和不活动精子率(46.63±21.43%vs.29.25±21.60%)等五个方面的比较,差异均有统计学意义(P=0.000,0.001,0.021,0.003,0.021)。6.同时,LTM组与非TM组在精子浓度(60.06±20.16×106/ml vs.89.06±36.03×106/ml)和非前向运动精子率(13.00±3.71%vs.18.10±7.27%)等两个方面的比较,差异均有统计学意义(P=0.020,0.047)。7.此外,CTM组和LTM组在精子总数(160.33±106.50×106vs.253.05±165.74×106)、精子总活力(53.37±21.43%vs.71.28±16.96%)、前向运动精子率(41.47±17.79%vs.58.28±15.73%)和不活动精子率(46.63±21.43%vs.28.72±16.96%)等四个方面的比较,差异均有统计学意义(P=0.043,0.021,0.013,0.021)。结论1.睾丸微石症能够影响到成年男性的精子质量。2.与限制型睾丸微石症相对比,经典型睾丸微石症对成年男性精子质量的影响更显著。3.睾丸微石症和成年男性精子质量之间存在关联,微石的程度与精子质量之间呈现出负相关的关系。更多还原

【Abstract】 BACKGROUD AND OBJECTIVETesticular microlithiasis (TM), an uncommon pathologic condition, is characterized by calcium deposits within the seminiferous tubules. Currently, people with TM could be classified into two different types, limited testicular microlithiasis (LTM) and classic testicular microlithiasis (CTM). At present, researchers have gradually reached a consensus on the increasing trend of TM incidence. Although the prevention and treatment of TM is still rarely reported, the etiology and pathogenesis, especially correlation with male reproductive function, have attracted people’s attention. TM is hypothesized to be clinically relevant because it is associated with spermatogenesis failure. Therefore, it is important and of significance to investigate the clinical characteristics of the testicular microlithiasis and the association, especially the two different types (CTM/LTM), with sperm quality in adult males.PATIENTS AND METHODS1. We retrospectively reviewed the sperm quality of41adult males diagnosed with TM. Patients were divided into two groups:CTM and LTM. The clinical data, especially the sperm parameters, were collected and analyzed.2. Moreover, control group including11males without TM (i.e. non-TM group) were collected to compare with patients.3. Data analyses were performed with analysis of variance (ANOVA) and Student’s t-test by SPSS18.0software (SPSS Inc., USA). And P<0.05was considered statistically significant.RESULTS 1. There were31patients (75.61%) diagnosed with CTM and10(24.39%) with LTM of the whole41TM males.2. The mean age, BMI and testicular volume of TM ones was29.49±4.97years old,25.39±4.07kg/m2, and16.94±3.59ml, respectively. Moreover, the mean age, BMI and testicular volume of CTM/LTM was (30.06±5.28vs.27.70±3.47) years old,(25.54±4.33vs.24.92±3.27) kg/m2, and (16.66±3.39vs.17.81±4.21) ml, respectively. While, the mean age, BMI and testicular volume of non-TM ones was27.82±3.34years old,25.46±3.57kg/m2, and17.90±2.91ml, respectively.3. The differences of sperm concentration (48.59±25.44×106/ml vs.89.06±36.03×106/ml), total sperm number (182.95±127.72×106vs.309.92±123.15×106), and percentage of non-progressively motile (12.17±5.21%vs.18.10±7.27%), between TM and non-TM were statistically significant (P<0.05).4. The differences of sperm concentration (44.89±26.14×106/ml vs.60.06±20.16×106/ml vs.89.06±36.03×106/ml), total sperm number (160.33±106.50×106vs.253.05±165.74×106vs.309.92±123.15×106), total motility (53.37±21.43%vs.71.28±16.96%vs.70.77±21.61%), percentage of progressively motile (41.47±17.79%vs.58.28±15.73%vs.52.67±20.19%), non-progressively motile (11.90±5.63%vs.13.00±3.71%vs.18.10±7.27%) and immotile (46.63±21.43%vs.28.72±16.96%vs.29.25±21.60%), between three groups (i.e. CTM, LTM and non-TM) were statistically significant (P<0.05).5. The differences of sperm concentration (44.89±26.14×106/ml vs.89.06±36.03×106/ml), total sperm number (160.33±106.50×106vs.309.92±123.15×106), total motility (53.37±21.43%vs.70.77±21.61%), percentage of non-progressively motile (11.90±5.63%vs.18.10±7.27%) and immotile (46.63±21.43%vs.29.25±21.60%), between CTM and non-TM were statistically significant (P<0.05).6. And the differences of sperm concentration (60.06±20.16×106/ml vs.89.06±36.03×106/ml) and percentage of non-progressively motile (13.00±3.71%vs.18.10±7.27%) between LTM and non-TM were statistically significant (P<0.05). 7. Furthermore, the differences of total sperm number (160.33±106.50×106vs.253.05±165.74×106), total motility (53.37±21.43%vs.71.28±16.96%), percentage of progressively motile (41.47±17.79%vs.58.28±15.73%) and immotile (46.63±21.43%vs.28.72±16.96%), between CTM and LTM were statistically significant (P<0.05).CONCLUSIONSThe sperm quality of CTM males is poorer than that of LTM males. Testicular microlithiasis is associated with worse sperm parameters in adult males. Moreover, the extent of microlithiasis and the sperm quality in adult males show a negative correlation relationship.更多还原