手术治疗对精索静脉曲张不育患者精浆瘦素水平及精子凋亡率的影响  

Effect of varicocele surgical treatment of level of leptin in seminal plasma and sperm apoptosis

作　　者：朱宏[1] 陈斌[1] 吕逸清[1] 王鸿祥[1] 胡凯[1] 金炎[1] 杨昊[1] 冯坦[1] 韩银发[1] 王益鑫[1] 黄翼然[1] 

机构地区：[1]上海交通大学医学院附属仁济医院泌尿外科,上海市男科学研究所,上海200001

出　　处：《中国男科学杂志》2013年第11期19-22,26,共5页Chinese Journal of Andrology

基　　金：国家自然科学基金资助项目（81270741）;上海市浦东新区卫生系统重点学科群建设项目（PWZxkq2010-03）

摘　　要：目的：探究精索静脉曲张（varicocele, VC）男性不育症患者显微外科治疗后精浆瘦素（Leptin）水平与精子凋亡率的改变并分析两者的相关性。方法选取2011年1月至2011年12月在仁济医院泌尿男科就诊左VC伴少、弱精子症患者50例进行精索内静脉显微结扎治疗，另选取因女方因素不孕而采用体外受精-胚胎移植（In vitro fertilisation-Embryo Transfer，IVF-ET）处理、并成功使配偶怀孕的精液30份作为对照组。检测各组常规精液参数，放射免疫法检测精浆Leptin，Annexin＋PI法测定精子凋亡率。观察比较VC患者术前及术后3个月以上指标变化情况，对数据进行统计学分析。结果 VC组术前精子浓度、活力及活率均显著低于对照组（P＜0.01），精子凋亡率及精浆Leptin水平显著高于对照组（P＜0.01），精子凋亡率与精子浓度及精子活力之间存在负相关性（P＜0.01、P＜0.05），精浆Leptin水平与精子凋亡率之间存在显著正相关性（P＜0.01）。VC术后3个月精子浓度显著升高（P＜0.01），精子活力及活率升高有统计学意义（P＜0.05），精子凋亡率显著低于术前（P＜0.01），精浆Leptin水平亦显著低于术前（P＜0.01）。结论 VC患者精浆精子凋亡率及精浆Leptin水平均显著增高，VC显微外科治疗有助于改善生精环境、降低凋亡，提高精液质量。另外，精浆Leptin水平与精子凋亡之间存在一定相关性，Leptin可能是促精子凋亡因子之一。Objective To detect the microsurgery treatment effect for male infertility patients with varicocele including the level of Leptin in seminal plasma and the percentage of sperm apoptosis, moreover, explore their correlation. Methods Total of 50 left varicocele male infertility with oligospermia and asthenospermia were treated with microscopic ligation of internal spermatic vein in Renji hospital from January 201 lto December 2011, and 10 IVF sperm samples were taken as the control. The sperm parameters were detected by computer assisted sperm analysis （CASA）. The semen plasma leptin were measured using RIA kits and the sperm apoptosis rate were assessed using AnnexinV/PI staining. Results A significant decrease in sperm concentration, （A＋B） grade sperm percentage and sperm viability was found in patients with varicocele compared with that of the control （P〈0.01）. The level of semen plasma leptin in varicoceles group was significantly higher than thatof the control group （P〈0.01） while the sperm apoptosis rate in varicoceles group was also higher than that of the control group （P〈0,05）. The sperm apoptosis rate was negatively correlated with the sperm concentration and （A＋B） grade sperm percentage （P〈0.01, P〈0.05）. The level of leptin in semen plasma was positively correlated with the sperm apoptosis rate （P〈0.05）. The increase of semen parameters were found in the patients after microsurgery （P〈0.05）. The level of leptin in semen plasma was decreased after microsurgery （P〈0.05）, while the sperm apoptosis rate was also decreased （P〈0.05）. Conclusion Varicocele might contribute to the high level of Leptin in seminal plasma and the sperm apoptosis, whereas, microsurgery will bring benefit for the condition. Leptin has significant correlation with the sperm apoptosis rate in both pre- and after microsurgery. So Leptin may be one of the pro-apoptotic factors to the sperm.

关 键 词：精索静脉曲张 外科学 瘦素 精子 细胞凋亡 

分 类 号：R697.24[医药卫生—泌尿科学] R698.2[医药卫生—外科学]