摘要
目的研究肥胖对精索静脉曲张不育症患者临床特征和预后的影响。方法选取200例精索静脉曲张不育症并接受显微镜精索静脉结扎术患者作为研究对象,比较不同体质量指数(BMI)、腰臀比、体脂率患者术前的年龄、病程、精索静脉直径、Valsalva动作时精索静脉直径、精子密度、精子活力、精液量、正常形态精子比例、睾丸容积、睾酮(T)、卵泡生成激素(FSH)、黄体生成激素(LH)等基础资料,比较手术前后所有受试患者以及肥胖患者以上基础资料。记录患者术后随访情况,并分析患者配偶怀孕的影响因素。结果BMI≥22.92 kg/m^(2)的患者术前精子密度(20.21±4.68)×10^(6)/ml、术前正常形态精子比例(3.86±0.78)%相较于BMI<22.92 kg/m^(2)患者的(22.63±6.67)×10^(6)/ml、(4.11±0.89)%更低(Z=-4.770、-2.912,P=0.001、0.004<0.05),精子活力(33.09±11.61)%较BMI<22.92 kg/m^(2)患者的(36.86±13.20)%更差(Z=-2.835,P=0.005<0.05),睾丸容积(10.69±1.87)ml较BMI<22.92 kg/m^(2)患者的(11.25±2.23)ml更小(Z=-3.148,P=0.002<0.05)。腰臀比≥0.85患者术前精子密度(20.53±4.95)×10^(6)/ml、正常形态精子比例(3.84±0.72)%较腰臀比<0.85患者的(22.45±6.66)×10^(6)/ml、(4.15±0.94)%更低(Z=-3.306、-3.450,P=0.001、0.001<0.05),精子活力(33.64±11.67)%较腰臀比<0.85患者的(36.51±13.37)%更差(Z=-2.356,P=0.018<0.05)。体脂率>18%患者术前精子密度(19.11±4.80)×10^(6)/ml相较于体脂率≤18%患者的(23.36±5.99)×10^(6)/ml更低,精子活力(32.40±11.44)%相较于体脂率≤18%患者的(37.12±13.04)%更差,睾丸容积(10.58±1.83)ml相较于体脂率≤18%患者的(11.29±2.21)ml更小(Z=-9.542、-3.892、-3.494,P=0.001、0.001、0.001<0.05)。所有患者手术均顺利完成,术中发生并发症1例(术中出血,后止血满意);术后发生并发症8例(5例为阴囊水肿、2例为术后泌尿系感染、1例为伤口出血),均保守治疗后好转。其配偶怀孕的患者BMI(21.34±3.30)kg/m^(2)、体脂率(17.96±3.58)%相较于配偶未怀孕患者的(23.54±3.16)kg/m^(2)、(18.99±3.27)%更低(Z=-6.205、-2.952,P=0.001、0.003<0.05),腰围(75.33±9.82)cm相较于配偶未怀孕患者的(78.95±10.94)cm更小(Z=-2.932,P=0.003<0.05),精子密度(24.15±7.68)×10^(6)/ml相较于配偶未怀孕患者的(20.67±5.04)×10^(6)/ml更大(Z=-5.006,P=0.001<0.05),精子活力(37.61±13.23)%相较于配偶未怀孕患者的(34.20±12.28)%更高(Z=-2.043,P=0.041<0.05)。将P<0.05的BMI、腰围、体脂率、精子密度、精子活力纳入多因素分析,发现仅BMI为独立影响因素[P=0.001<0.05,OR=0.815,95%CI=(0.746,0.890)]。≥22.92 kg/m^(2)的100例患者中,共10例配偶怀孕(10%)。手术后,所有受试患者以及肥胖患者精索静脉直径、Valsalva动作精索静脉直径、精子密度、精子活力、睾丸容积、T、FSH、LH、精液量均较术前好转(P<0.05)。结论肥胖可能给精索静脉曲张不育症患者带来负面影响,且显微镜精索静脉结扎术对于肥胖的精索静脉曲张不育症患者依然可以改善生育能力。
Objective To study the impact of obesity on the clinical characteristics and prognosis of patients with varicocele-related infertility.Methods 200 patients with varicocele-related infertility who underwent microscopic varicocelectomy were selected as the study subjects.The baseline data such as age,course of disease,spermatic vein diameter,spermatic vein diameter during the Valsalva maneuver,sperm density,sperm motility,semen volume,percentage of sperm with normal morphology,testicular volume,testosterone(T),folliclestimulating hormone(FSH),and luteinizing hormone(LH)were compared among patients with different body mass index(BMI),waist-to-hip ratios and body-fat rates.The above basic data of all subjects and obese patients before and after operation were compared.The postoperative follow-up of patients was recorded,and the factors influencing pregnancy in their spouse were analyzed.Results The preoperative sperm density in patients with BMI≥22.92 kg/m^(2)was(20.21±4.68)×10^(6)/ml and the preoperative percentage of sperm with normal morphology was(3.86±0.78)%,which were lower than(22.63±6.67)×10^(6)/ml and(4.11±0.89)%in patients with BMI<22.92 kg/m^(2)(Z=-4.770,-2.912;P=0.001,0.004<0.05).The sperm motility was(33.09±11.61)%in patients with BMI≥22.92 kg/m^(2),which was worse than(36.86±13.20)%in patients with BMI<22.92 kg/m^(2)(Z=-2.835,P=0.005<0.05).The testicular volume was(10.69±1.87)ml in patients with BMI≥22.92 kg/m^(2),which was smaller than(11.25±2.23)ml in patients with BMI<22.92 kg/m^(2)(Z=-3.148,P=0.002<0.05).The preoperative sperm density in patients with waist-to-hip ratio≥0.85 was(20.53±4.95)×10^(6)/ml and the preoperative percentage of sperm with normal morphology was(3.84±0.72)%,which were lower than(22.45±6.66)×10^(6)/ml and(4.15±0.94)%in patients with waist-to-hip ratio<0.85(Z=-3.306,-3.450;P=0.001,0.001<0.05).The sperm motility was(33.64±11.67)%in patients with waist-to-hip ratio≥0.85,which was lower than(36.51±13.37)%in patients with waist-to-hip ratio<0.85(Z=-2.356,P=0.018<0.05).Patients with body fat rate>18%had lower preoperative sperm density of(19.11±4.80)×10^(6)/ml than(23.36±5.99)×10^(6)/ml in patients with body fat rate≤18%,worse sperm motility of(32.40±11.44)%than(37.12±13.04)%in patients with body fat rate≤18%,and smaller testicular volume of(10.58±1.83)ml than(11.29±2.21)ml in patients with body fat rate≤18%(Z=-9.542,-3.892,-3.494;P=0.001,0.001,0.001<0.05).All patients'surgeries were successfully completed,with 1 patient with intraoperative complication(intraoperative bleeding,which was satisfactorily stopped afterward);8 patients with postoperative complications(5 cases of scrotal edema,2 cases of postoperative urinary tract infection,and 1 case of wound hemorrhage),all of which were improved after conservative treatment.BMI in patients whose spouses were pregnant was(21.34±3.30)kg/m^(2)and the body fat rate was(17.96±3.58)%,which were lower than(23.54±3.16)kg/m^(2)and(18.99±3.27)%in patients whose spouses were not pregnant(Z=-6.205,-2.952;P=0.001,0.003<0.05).The waist circumference was(75.33±9.82)cm in patients whose spouses were pregnant,which was smaller than(78.95±10.94)cm in patients whose spouses were not pregnant(Z=-2.932,P=0.003<0.05).The sperm density was(24.15±7.68)×10^(6)/ml in patients whose spouses were pregnant,which was higher than(20.67±5.04)×10^(6)/ml in patients whose spouses were not pregnant(Z=-5.006,P=0.001<0.05).The sperm motility was(37.61±13.23)%in patients whose spouses were pregnant,which was higher than(34.2±12.28)%in patients whose spouses were not pregnant(Z=-2.043,P=0.041<0.05).BMI,waist circumference,body fat percentage,sperm density,and sperm viability with P<0.05 were included in the multifactorial analysis,and only BMI was found to be an independent influence[P=0.001<0.05,OR=0.815,95%CI=(0.746,0.890)].Of the 100 patients with BMI≥22.92 kg/m^(2),10 cases(10%)had a pregnant spouse.After operation,the spermatic vein diameter,spermatic vein diameter during the Valsalva maneuver,sperm density,sperm motility,testicular volume,T,FSH,LH and semen volume in all subjects and obese patients were improved compared with those before operation(P<0.05).Conclusion Obesity may negatively affect patients with varicocele-related infertility,yet microscopic varicocelectomy could improve their fertility.
作者
刘建家
曾健文
LIU Jian-jia;ZENG Jian-wen(Qingyuan People's Hospital,Qingyuan 511518,China)
出处
《中国现代药物应用》
2024年第10期26-31,共6页
Chinese Journal of Modern Drug Application
基金
清远市科技计划项目(项目编号:190912204569354),项目名称:肥胖与合并精索静脉曲张的男性不育症患者特征和预后的关系。
关键词
精索静脉曲张
肥胖
男性不育症
临床特征
预后
Varicocele
Obesity
Male infertiliy
Clinical characteristics
Prognosis
