男性不育伴精液量少的临床特点分析  

Analysis of clinical characteristics of male infertility with low semen volume

作　　者：王宇刚 马淑霞 姚晓飞 董波 宋焱鑫 WANG Yu-gang;MA Shu-xia;YAO Xiao-fei;DONG Bo;SONG Yan-xin(Department of Reproductive Medicine,Luoyang Maternal&Child Health Care Hospital,Luoyang 471000)

机构地区：[1]洛阳市妇幼保健院生殖医学科,洛阳471000

出　　处：《生殖医学杂志》2023年第7期997-1002,共6页Journal of Reproductive Medicine

基　　金：2019年度河南省医学科技攻关计划联合共建项目(LHGJ20191238)。

摘　　要：目的探讨男性不育伴精液量少的病因、临床特点及可能机制。方法收集2018年1月至2022年3月洛阳市妇幼保健院生殖中心男科就诊的83例“低精液量”性不育患者的临床资料,结合精液分析、生殖系统彩超、性激素、染色体核型及Y染色体微缺失检测结果及患者的病史,根据精液产生及输送机制,分析相关病因及临床特点。结果所有83例“低精液量”性不育患者在临床特征表现中,合并无精子症占80.72%(67/83)、少/弱精子症占19.28%(16/83);睾丸体积正常占83.13%(69/83)、睾丸发育不良占16.87%(14/83);血清FSH、LH水平正常占84.33%(70/83)。不育类型上,原发不育患者占80.72%(67/83),继发不育占19.28%(16/83)。病变部位上,睾丸前因素(即低促性腺激素性性腺功能减退)有9例(10.84%),睾丸因素3例(3.61%),睾丸后因素65例(78.31%),其他原因6例(7.23%);其中睾丸后因素中,先天性双侧输精管缺如(CBAVD)/单侧输精管缺如(CUAVD)占45.78%(38/83),射精障碍占18.07%(15/83),射精管梗阻占10.84%(9/83),尿道异常占3.61%(3/83)。4种常见病因(低促性腺激素性性腺功能减退、CBAVD/CUAVD、射精障碍、射精管梗阻)占比85.54%(71/83),同时伴无精子症达73.50%(61/83)。结论因涉及精液生成及输送,“低精液量”性不育病因、机制相对复杂,患者以原发不育居多,睾丸后因素为主要病因,常合并无精子症;常见病因包括性腺功能减退、CBAVD/CUAVD、射精障碍、射精管梗阻、尿道结构异常等,仍有少数患者病因不明。Objective:To explore the etiology,possible mechanism and clinical characteristics of male infertility patients with low semen volume.Methods:The clinical data of 83 male infertile patients with low semen volume who were treated at the Andrology Department of Reproductive Center of Luoyang Maternal and Child Health Hospital from January 2018 to March 2022 were retrospectively analyzed.Combined with the results of semen analysis,color ultrasound of reproductive system,sex hormones levels,chromosomal karyotype and Y chromosome microdeletion detection,as well as patients’medical history,the relevant etiology and clinical features were analyzed based on the mechanism of semen production and delivery.Results:Among the 83 infertile patients with low semen volume,80.72%(67/83)were complicated with azoospermia and 19.28%(16/83)with oligospermia.Normal testicular volume accounted for 83.13%(69/83),testis dysplasia accounted for 16.87%(14/83).FSH/LH levels were normal in 84.33%(70/83).In terms of infertility type,primary infertility accounted for 80.72%(67/83)and secondary infertility accounted for 19.28%(16/83).In the etiological analysis,there were 9 patients(10.84%)with pre-testicular factors(hypogonadism),3 patients(3.61%)with testicular factors,65 patients(78.31%)with post-testicular factors and 6 patients(7.23%)with other reasons.Among the post-testicular factors,congenital bilateral absence of vas deferens(CBAVD)/unilateral absence of vas deferens(CUAVD)accounted for 45.78%(38/83),ejaculatory disorders accounted for 18.07%(15/83),and ejaculatory duct obstruction accounted for 10.84%(9/83),and urethral abnormalities accounted for 3.61%(3/83).Four common causes(hypogonadotropic hypogonadism,CBAVD/CUAVD,ejaculatory disorder and ejaculatory duct obstruction)accounted for 85.54%(71/83),and 73.50%(61/83)of patients were accompanied by azoospermia.Conclusions:Because it involves semen production and delivery,the etiology and mechanism of“low semen volume”infertility are relatively complex.The majority of patients are

关 键 词：低精液量 先天性输精管缺如 射精管梗阻 射精障碍 性腺功能减退 

分 类 号：R447[医药卫生—诊断学] R711.6[医药卫生—临床医学]