血清睾酮雌二醇比值变化对精子缺陷及生育力的影响

目的 了解血清睾酮(T)/雌二醇(E2)比值变化对精子缺陷程度及男性生育能力的影响.方法对90例已婚育龄男性进行血清T、E2、卵泡刺激素(FSH)、黄体生成素(LH)、催乳素和精液参数、精子形态测定,计算血清T/E2和精子多重缺陷指数.根据血清T/E2分为≤10(1组)、＞10(2组)及＞20(3组)分别比较.结果 1、2、3组精子密度和精子活动力分别为(66.8±39.6)×106、(57.6±33.9)×106、(77.4±26.0)×106/ml和(46.6±16.4)%、(44.9±16.0)%、(53.9±14.4)%,3组间差异无统计学意义(P均＞0.05).1组头部缺陷精子为(81.4±9.4)%,明显高于3组的(74.0±10.7)%(t=2.482,P=0.016);1、2组颈部缺陷精子为(16.9±8.6)%和(12.7±9.8)%,均明显高于3组的(7.1±3.9)%(t=4.113、2.050,P=0.000、0.046);1、2、3组尾部缺陷精子分别为(22.6±14.6)%、(14.6±9.0)%和(6.5±5.7)%,组间差异有统计学意义(t=2.722、3.996、3.110,P=0.008、0.000、0.003).2组精子畸形指数(SDI)(1.4±0.3)明显高于1组(1.3±0.2,t=2.293,P=0.025);2、3组畸形精子指数(TZI)分别为1.6±0.3和1.6±0.2,明显高于1组的1.4±0.2(t=2.285、2.727,P=0.025、0.009).1、2、3组中配偶有生育或妊娠经历者分别为13、16、6例,组间差异无统计学意义(x2=3.285、0.854、0.199,P=0.070、0.355、0.655),但2、3组相对危险度分别为1组的2.4倍和1.8倍.1、2、3组中特发性不育病例分别为25、15、7例,组间差异均无统计学意义(x2=0.735、0.200、0.038,P=0.391、0.655、0.845),1组相对危险度分别为2、3组的1.5倍和1.3倍.相关性分析结果发现,血清T/E2与头、颈和尾部缺陷精子比率呈显著负相关(r=-0.209、-0.316、-0.335,P=0.048、0.002、0.001).结论血清T/E2与精子头、颈及尾部缺陷呈显著负相关,其下降与男性生育概率降低有关,但并不影响精子密度及活动力,表明男性体内维持较高比例的T/E2水平对于精子发生过程中的精子形成阶段及受精能力有重要意义.

Abstract：

Objective To study the effect of the serum testosterone/estradiol ratio (T/E2) alteration on sperm defect and fertility. Methods The testosterone, estradiol, FSH, LH, PRL,sperm parameters and sperm morphology of 90 men were analyzed and the T/E2 and multiple anomalies index (MAI) were calculated. The patients were divided into 3 groups; T/E2≤10 (Ⅰ), T/E2＞10 (Ⅱ), and T/E2＞20 (Ⅲ). Results The sperm concentration and motility among the 3 groups were not significantly different (P＞0. 05). The percentages of the sperm whose head, neck and tail were abnormal declined gradually with the increase of the T/E2 in serum. The percentage of sperm head defeet of group Ⅰ was significantly higher than that of group Ⅲ (t=2. 482, P=0. 016) and that of sperm neck defect of groups Ⅰ and Ⅱ were significantly higher than that of group Ⅲ (t=4.113, 2. 050, P=0.000, 0. 046, respectively). The percentage of sperm tail defect among 3 groups was significantly different (t=2. 722, 3. 996, 3. 110, P=0. 008, 0. 000, 0. 003, respectively). The SDI of group Ⅱ was significantly higher than that of group Ⅰ (t= -2. 293, P= 0. 025). But the TZI increased gradually with the increase of the serum T/E2 and the TZI of groups Ⅱ and Ⅲ were significantly higher than that of group Ⅰ (t=2. 285, 2. 727, P=0. 025, 0. 009, respectively). The percentage of the men in group Ⅰ whose partners became pregnant was 29. 5% and those of groups Ⅱ and Ⅲ were 50% and 42.9%, respectively. Although the percentage among three groups was not different statistically (x2 = 3. 285, 0. 854, 0. 199, P= 0. 070, 0. 355, 0. 655, respectively), the relative risks of groups Ⅱ and Ⅲ were 2.4 and 1.8 times of that of group Ⅰ. There were 25, 15, 7 cases of idiopathic infertility among the 3 groups, respectively. The relative risk of I group was 1.5 and 1.3 times of that of Ⅱ and Ⅲ groups. The correlation analysis showed that the T/E2 in serum had significantly negative correlation with the percent of the sperm head or neck or tail defects (r= -0. 209, -0. 316 and -0. 335,respectively and P= 0. 048, 0. 002 and 0. 001, respectively). Conclusions The decrease of T/E2 in serum was correlative with the decrease of fertility probability, but it did not alter the sperm density and the sperm motility. It showed that the level of the T/E2 in serum was important for spermatogenesis and sperm fertilizing capability.

Effect of the serum testosterone/estradiol ratio alteration on sperm defect and fertility

Objective To study the effect of the serum testosterone/estradiol ratio (T/E2) alteration on sperm defect and fertility. Methods The testosterone, estradiol, FSH, LH, PRL,sperm parameters and sperm morphology of 90 men were analyzed and the T/E2 and multiple anomalies index (MAI) were calculated. The patients were divided into 3 groups; T/E2≤10 (Ⅰ), T/E2＞10 (Ⅱ), and T/E2＞20 (Ⅲ). Results The sperm concentration and motility among the 3 groups were not significantly different (P＞0. 05). The percentages of the sperm whose head, neck and tail were abnormal declined gradually with the increase of the T/E2 in serum. The percentage of sperm head defeet of group Ⅰ was significantly higher than that of group Ⅲ (t=2. 482, P=0. 016) and that of sperm neck defect of groups Ⅰ and Ⅱ were significantly higher than that of group Ⅲ (t=4.113, 2. 050, P=0.000, 0. 046, respectively). The percentage of sperm tail defect among 3 groups was significantly different (t=2. 722, 3. 996, 3. 110, P=0. 008, 0. 000, 0. 003, respectively). The SDI of group Ⅱ was significantly higher than that of group Ⅰ (t= -2. 293, P= 0. 025). But the TZI increased gradually with the increase of the serum T/E2 and the TZI of groups Ⅱ and Ⅲ were significantly higher than that of group Ⅰ (t=2. 285, 2. 727, P=0. 025, 0. 009, respectively). The percentage of the men in group Ⅰ whose partners became pregnant was 29. 5% and those of groups Ⅱ and Ⅲ were 50% and 42.9%, respectively. Although the percentage among three groups was not different statistically (x2 = 3. 285, 0. 854, 0. 199, P= 0. 070, 0. 355, 0. 655, respectively), the relative risks of groups Ⅱ and Ⅲ were 2.4 and 1.8 times of that of group Ⅰ. There were 25, 15, 7 cases of idiopathic infertility among the 3 groups, respectively. The relative risk of I group was 1.5 and 1.3 times of that of Ⅱ and Ⅲ groups. The correlation analysis showed that the T/E2 in serum had significantly negative correlation with the percent of the sperm head or neck or tail defects (r= -0. 209, -0. 316 and -0. 335,respectively and P= 0. 048, 0. 002 and 0. 001, respectively). Conclusions The decrease of T/E2 in serum was correlative with the decrease of fertility probability, but it did not alter the sperm density and the sperm motility. It showed that the level of the T/E2 in serum was important for spermatogenesis and sperm fertilizing capability.