男性不育患者精子形态学分析与生殖激素关系的研究

目的:研究男性不育患者精子形态与生殖激素的关系,探讨畸形精子症的发病机制。方法:研究对象为90例男性不育患者,年龄25～40岁,利用Prader睾丸计评估患者睾丸容积,根据世界卫生标准进行精液常规分析,利用化学发光法测定血清生殖激素和性激素结合球蛋白(SHBG)浓度,计算得出游离睾酮和生物活性睾酮的浓度。结果:90例男性不育患者精子浓度均在正常范围,根据精子形态分析结果分为3个研究组,即组1(正常形态精子<4%)、组2(正常形态精子≥4%且<10%)和组3(正常形态精子≥10%),每组30例。3组之间年龄没有统计学差异(P>0.05);左侧睾丸容积分别为(14.27±3.65)ml,(16.90±3.57)ml和(14.57±3.57)ml,P组1,2=0.006,P组1,3=0.741和P组2,3=0.014;右侧睾丸容积分别为(14.60±3.70)ml,(16.60±3.35)ml和(14.67±3.54)ml,P=0.05;血清泌乳素(PRL)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、总睾酮(TT)和SH-BG在3组之间均没有统计学差异(P>0.05);血清游离睾酮(FT)水平分别为(0.25±0.07)nmol/L,(0.29±0.07)nmol/L和(0.31±0.13)nmol/L,P组1,2=0.086,P组1,3=0.010和P组2,3=0.364;生物活性睾酮(Bio-T)水平分别为(5.81±1.58)nmol/L,(6.78±1.55)nmol/L和(7.29±3.02)nmol/L,P组1,2=0.086,P组1,3=0.010和P组2,3=0.364。另外,正常形态精子百分率与血清FT、Bio-T水平之间均存在正相关(P<0.05)。结论:男性不育患者血清FT和Bio-T水平越高,则正常形态精子百分率越高,提示FT和Bio-T可能参与畸形精子症发病过程。

Relationship of sperm morphology with reproductive hormone levels in infertile men

Objective:To investigate the relationship of sperm morphology with reproductive hormones in infertile men and the pathogenesis of teratozoospermia.Methods:This study included 90 infertile men aged 25-40 years.We measured their testis volumes using the Prader orchidometer,conducted routine semen analyses according to the WHO laboratory standard,and determined the concentrations of reproductive hormones and sex hormone-binding globulin(SHBG) by chemiluminescence and the levels of free testosterone(FT) and bioavailable testosterone(BioT).Results:All the subjects showed normal sperm concentration.Based on the results of semen morphology analysis,the 90 infertile men were equally divided into groups 1(morphologically normal sperm <4%),2(morphologically normal sperm ≥4% and <10%),and 3(morphologically normal sperm ≥10%),with no significant differences in age among the three groups(P>0.05).The volumes of the left testis were(14.27±3.65) ml,(16.90±3.57) ml and(14.57±3.57) ml,respectively(P=0.006 group 1 vs group 2,P= 0.741 group 1 vs group 3,P= 0.014 group 2 vs group 3),and those of the right testis were(14.60±3.70) ml,(16.60±3.35) ml and(14.67±3.54) ml,respectively(P=0.050).There were no significant differences among the three groups in prolactin,follicle-stimulating hormone,luteinising hormone,estradiol,total testosterone and SHBG,(P > 0.05).The levels of serum FT were(0.25±0.07) nmol/L,(0.29±0.07) nmol/L and(0.31±0.13) nmol/L(P= 0.086 group 1 vs group 2,P= 0.010 group 1 vs group 3,P= 0.364 group 2 vs group 3),and those of BioT were(5.81±1.58) nmol/L,(6.78±1.55) nmol/L and(7.29±3.02) nmol/L,respectively(P= 0.086 group 1 vs group 2,P= 0.010 group 1 vs group 3,P= 0.364 group 2 vs group 3).The percentage of morphologically normal sperm was positively correlated with the levels of serum FT and BioT(P < 0.05).Conclusion:The higher the levels of serum FT and BioT,the higher the percentage of morphologically normal sperm,which suggests that serum FT and BioT might be involved in the pathogenesis of teratozoospermia.