【作者】 王国强；

【导师】 张明；

【作者基本信息】 吉林大学 ， 临床医学硕士（外科学）（专业学位）， 2020， 硕士

【摘要】 目的:探讨慢性前列腺炎(chronic prostatitis,CP)对精索静脉曲张(varicocele,VC)合并不育症(male infertility,MI)患者的精子质量的影响,并分析VC的分级与CP症状的分度之间的相关性,进一步增加临床工作者对于VC和CP对男性不育影响的认识。研究方法与对象:选择在2018年9月-2019年6月因不育症就诊于我院泌尿外科、男科以及生殖中心的180名青年(25-35岁)患者作为观察组,其中包括60例单纯VC合并不育症患者、60例VC合并CP的不育症患者以及60例单纯CP合并不育症的患者,将其分别命名为单纯VC组、合并组以及单纯CP组;并在体检中心选取无生育疾病的60例同龄健康男性作为对照组,分析记录各组患者精液的重要参数。利用单因素方差分析的统计学方法以及SPSS 25.0统计学软件,比较各组精液的液化时间、精子浓度、精子活率、精子活力、精液量五项因素,P<0.05可以视为差异具有统计学意义。对于合并组中的患者根据中国泌尿外科临床诊断指南将VC分为四个等级(0级-III级),应用美国国立卫生研究所制定的慢性前列腺炎症状指数(National Institute of Health-chronic prostatitis symptom index,NIHCPSI)将CP分为轻度、中度以及重度三种严重程度,通过Spearman秩相关分析精索静脉曲张程度的分级与慢性前列腺炎症状之间的相关关系。实验结果:1、精液质量分析结果:(1)液化时间:单纯VC组与对照组相比无明显差别(P=0.094);单纯CP组以及合并组与对照组相比其精液的液化时间均明显延长(P<0.05),具有统计学意义;合并组与单纯VC组相比其液化时间显著延长P<0.05),合并组与单纯CP组的液化时间相比无统计学意义(P=0.219)。(2)精液浓度:三个观察组的精液浓度与对照组比较都存在显著差异(P<0.05);合并组的精液浓度与单纯CP组相比存在统计差异(P<0.05);合并组与单纯VC组相比两者的精液浓度无统计学差异(P=0.30)。(3)精子活率:三个观察组的精子活率与对照组相比都有显著差别(P<0.05);合并组和单纯VC组的精子活率存在显著差别(P<0.05);合并组和单纯CP组的精子活率亦有显著差别(P<0.05)。(4)精子活力:三个观察组的精子的活力与对照组精子的活力相比都存在统计学差别(P<0.05);合并组和单纯VC组相比其精子活力存在显著差异(P<0.05);合并组和单纯CP组相比亦存在较大差异(P<0.05)。(5)精液量:不同组别的精液量无明显差异,统计数据无统计意义(F值=1.582,P=0.194)。2、VC的分级与CP症状的分度之间的相关性:VC的分级与CP的症状严重程度呈现显著正相关关系(Rs=0.368,P<0.05)。结论:1、CP能够延长精液的液化所需的时间,能够引起精子浓度、精子活率以及活力的下降,而对精液量的影响不大。2、VC能够显著影响精液的浓度、精子的活率和活力,对液化时间及精液量无明显影响。3、VC患者若同时合并CP可进一步损伤精液质量,使精液的液化时间、精子的活率以及活力进一步下降,而对精液的浓度及精液量的影响并不明显。4、VC的临床分级与CP症状的严重程度之间存在显著正相关关系。若VC患者同时伴发CP,随着VC临床分级的增加,患者的CP症状也会进一步加重。更多还原

【Abstract】 Objective:To explore the effect of chronic prostatitis(CP)on sperm quality of patients with varicocele(VC)and male infertility(MI),and to analyze the correlation between the grading of VC and the grading of CP symptoms,so as to further increase understanding of the effect of VC and CP on male infertility.Methods and Objects:We selected 180 young patients(25-35 years old)who were hospitalized in the department of urology,andrology and reproductive center of our hospital from September 2018 to June 2019 due to infertility as the observation group,including 60 patients with simple VC and infertility,60 patients of infertility with VC and CP,60 patients with simple CP and infertility.They were named as the simple VC group,the combined group and the simple CP group,respectively;Meanwhile,60 healthy men of the same age without fertility diseases were selected as the control group in the physical examination center.And the important parameters of semen were analyzed and recorded.Using the statistical method of one-way ANOVA and SPSS 25.0 statistical software,we compared the five factors of semen liquefaction time,sperm concentration,sperm viability,sperm activity and sperm volume in each group,P<0.05 can be regarded as the difference of statistical significance.The patients in the combined group were divided into four grades(grade 0-III)according to guidelines for diagnosis and treatment of urological diseases in China.The CP was divided into three severity levels: mild,moderate and severe by the National Institute of Health-chronic prostatitis symptom index(NIH-CPSI).The correlation between the grading of varicocele and the symptoms of chronic prostatitis was analyzed by Spearman rank correlation.Results:1.The results of semen quality analysis:(1)Liquefaction time: there was no significant difference between the VC group and the control group(P=0.094);the liquefaction time of semen in the CP group and the combined group was significantly longer than that in the control group(P<0.05);The liquefaction time of the combined group was significantly longer than that of the simple VC group(P<0.05),and there was no significant difference between the combined group and the simple CP group(P =0.219).(2)Semen concentration: the semen concentration of the three observation groups was significantly different from that of the control group(P<0.05);the semen concentration of the combined group was statistically different from that of the simple CP group(P<0.05);there was no statistical difference between the combined group and the simple VC group(P=0.30).(3)Sperm viability: there was significant difference between the three groups and the control group(P<0.05);there was significant difference between the combined group and the simple VC group(P<0.05);there was also significant difference between the combined group and the simple CP group(P<0.05).(4)Sperm motility: the sperm motility of the three observation groups was statistically different from that of the control group(P<0.05);the sperm motility of the combined group was significantly different from that of the simple VC group;the sperm motility of the combined group was also significantly different from that of the simple CP group(P<0.05).(5)Semen quantity: there was no significant difference in semen quantity between different groups,and the statistical data was not statistically significant(F=1.582,P=0.194).2.The correlation between the grade of VC and the score of CP symptoms: there was a significant positive correlation between the grade of VC and the severity of CP symptoms(Rs=0.368,P<0.05).Conclusion:1.CP can prolong the time needed for semen liquefaction,and can cause the decrease of sperm concentration,viability and motility,but has little effect on semen quantity.2.VC can significantly affect the concentration of semen,sperm viability and motility,but not the liquefaction time and semen volume.3.VC combined with CP can further damage the quality of semen,further reduce the liquefaction time,sperm viability and motility,but have no obvious effect on the concentration and quantity of semen.4.There is a significant positive correlation between the clinical grade of VC and the severity of chronic prostatitis.If patients with VC have CP symptoms at the same time,with the increase of clinical grade of VC,the CP symptoms of patients will be further aggravated.更多还原