血清及精浆中乙型肝炎病毒的存在情况对精子质量的影响  

Influence of presence of hepatitis B virus in serum and seminal plasma on sperm quality

作　　者：周海速[1,2] 王佩玉[1] 余蓉[1] 黄学锋[1] 费前进[1] 郑九嘉[1] ZHOU Hai-su;WANG Pei-yu;YU Rong;HUANG Xue-feng;FEI Qin-jin;ZHENG Jiu-jia(Reproductive Medicine Center,the First Hospital of Wenzhou Medical University,Wenzhou 325000;Nursing Department,the First Hospital of Wenzhou Medical University,Wenzhou 325000)

机构地区：[1]温州医科大学附属第一医院生殖医学中心,温州325000 [2]温州医科大学附属第一医院护理部,温州325000

出　　处：《生殖医学杂志》2023年第12期1820-1825,共6页Journal of Reproductive Medicine

基　　金：温州市科技局基金项目(Y2020007)。

摘　　要：目的探讨血清及精浆中乙型肝炎病毒存在的情况与精子参数、形态学及精子DNA完整性等精子质量的相关性。方法收集2016年1月至2021年12月在温州医科大学附属第一医院生殖医学中心就诊男性的精液标本,采用微粒子酶免疫分析法检测血清乙肝标志物滴度、荧光定量PCR技术检测血清和精浆中HBV-DNA拷贝水平,同时所有精液标本进行精液参数、精子形态学及精子DNA碎片指数(DFI)分析。根据HBV病毒检测情况将患者分为4组:A组(HBsAg阴性,n=1122)、B组(血清HBsAg阳性,而HBeAg、HBV-DNA和精浆HBV-DNA拷贝数均阴性,n=460)、C组(血清HBsAg、HBeAg和HBV-DNA拷贝均阳性,而精浆HBV-DNA拷贝阴性,n=81)和D组(血清HBsAg、HBeAg和HBV-DNA拷贝均阳性,且精浆HBV-DNA拷贝阳性,n=112),比较各组之间的基本资料、肝功能及精子质量的差异。结果根据纳排标准纳入2063例患者,HBV感染者(HBsAg阳性检出者)占45.6%(941/2063),最终纳入分组分析的患者共1775例。与未感染者(A组)相比,HBV感染者(B、C、D组)的谷丙转氨酶(ALT)和谷草转氨酶(AST)水平均显著升高(P<0.05),而精子浓度、前向运动精子比例(PR)均显著下降(P<0.05),不活动精子比例(IM)显著增加(P<0.05)。进一步组间分析发现,D组的精子浓度[(55.5±41.4)×106/ml]、前向运动精子比例[(45.8±22.1)%]均显著低于B组[(66.9±46.3)×106/ml,(51.5±18.6)%]和C组[(80.9±65.1)×106/ml,(53.0±20.4)%](P<0.05),不活动精子比例则显著高于B组和C组(P<0.05);A组的精子浓度[(103.4±74.6)×106/ml]和前向运动精子比例[(58.4±17.8)%]为4组中最高(P<0.05)。精子形态学分析结果显示,B、C、D组的正常精子形态比例分别为(2.5±1.7)%、(2.1±1.4)%和(2.4±2.0)%]均显著低于A组[(3.1±1.9)%](P<0.05),但B、C、D三组间的正常精子形态率差异无统计学意义(P>0.05);与A组比较,B、C、D组的精子DNA碎片指数(DFI)均显著增加(P<0.05),尤其是D组的DFI最高(26.2±15.7)%,显著高于BObjective:To investigate the correlation between the presence of hepatitis B virus in serum and seminal plasma and sperm quality such as sperm parameters,morphology and sperm DNA integrity.Methods:The semen samples from males who were treated at the Reproductive Medicine Center in Reproductive Medicine Center of First Hospital of Wenzhou Medical University from January 2016 to December 2021 were selected.The serum hepatitis B marker titer was detected by microparticle enzyme immunoassay.Serum and seminal plasma HBV-DNA was detected by the fluorescent quantitative PCR.All semen samples were analyzed for semen parameters,sperm morphology and sperm DNA-fragmetation-index(DFI).The patients were divided into four groups based on their HBV testing status:Group A(HBsAg negative,n=1122),Group B(serum HBsAg positive,but HBeAg,HBV-DNA and seminal plasma HBV-DNA copy negative,n=460),Group C(serum HBsAg,HBeAg and HBV-DNA copy positive,but seminal plasma HBV-DNA copy negative,n=81),Group D(serum HBsAg,HBeAg and HBV-DNA copy positive,and seminal plasma HBV-DNA copy positive,n=112).The basic information,liver function and sperm quality differences were compared among the groups.Results:Among the 2063 patients who were initially enrolled,45.6%(941/2063)were infected with HBV,and 1775 patients were finally included in the analysis.Compared with non-infected individuals(Group A),the levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in HBV infected individuals(Groups B,C and D)were significantly increased(P<0.05),while sperm concentration and percentage of progressively motile(PR)sperm were significantly decreased(P<0.05),while percentage of immotile(IM)sperm was significantly increased(P<0.05).Further inter-group analysis revealed that the sperm concentration in group D[(55.5±41.4)]×106/ml]and the percentage of progressively motile sperm[(45.8±22.1)%]were significantly lower than those in Group B[(66.9±46.3)×106/ml,(51.5±18.6)%]and Group C[(80.9±65.1)×106/ml,(53.0±20.4)%](P<0.05),the percentage of

关 键 词：乙型肝炎病毒(HBV) 精子活力 精子形态 精子DNA损伤 

分 类 号：R711.6[医药卫生—妇产科学]