不同分型的慢性前列腺炎对精液质量的影响

目的：研究不同分型的慢性前列腺炎对精液质量恶化的影响。方法：根据目前存在感染和（或）针对前列腺的自身细胞免疫反应情况．将49例慢性前列腺炎患者进行分组。健康正常的个体作为对照组。检查包括精子密度、死亡率、形态、前列腺与精囊标记物、抗精浆抗体、白细胞计数与伴随的炎症前细胞因子。结果：最严重的畸形见于无明显感染而有针对前列腺的自身细胞免疫患者。此外,在此类患者的精浆中检测到炎症前细胞因子水平显著升高。结论：伴有针对前列腺的自身细胞免疫反应的慢性前列腺炎患者的精液质量参数有重要改变,并因此而引起不育。     

慢性前列腺炎患者精液参数的变化及意义

目的　了解前列腺慢性炎症对患者精液参数及生育的影响。　方法　检查 86例慢性前列腺炎患者和 32名正常生育者的精液 ,并对两组精液主要参数进行比较。　结果　慢性前列腺炎患者的精液量、精子密度、精子活动百分率及精子正常形态百分率平均分别为 2 .0 8ml、91.76× 10 6、6 5 .4 3%和 6 2 .14 %。其精液量、精子活动百分率、精子正常形态百分率显著低于正常生育者 (P =0 .0 0 3,P <0 .0 0 1和P <0 .0 0 1) ,精子密度与正常生育者比较差别无显著性意义 (P =0 .92 2 )。　结论　慢性前列腺炎患者的精液部分主要参数较正常生育者明显降低 ,未发现其对患者的生育有明显影响。     

慢性前列腺炎治疗过程中精液质量变化的观察

目的研究慢性前列腺炎对男性生育力的影响。方法对112例男性前列腺炎患者（CP组）和96例相同年龄组健康人群（NCP组）的精液进行比较、分析;对CP组患者行口服抗生素＋α受体阻滞剂治疗之后复查精液,对比治疗前、后数据。结果慢性前列腺炎患者精液中反映生育功能的关键指标与健康男性差异有统计学意义,对慢性前列腺炎患者行口服抗生素＋α受体阻滞剂治疗之后,精液质量有显著改善。结论慢性前列腺炎对男性的精液质量有不利影响;治疗慢性前列腺炎有助于男性提高精液质量。     

Seminal oxidative stress in patients with chronic prostatitis

Prostatitis has been associated with abnormal semen parameters and may be the cause of infertility in some patients. Sperm antibodies and impaired sperm motility have been observed in the semen of patients with prostatitis. More recently, seminal oxidative stress has been detected in patients with prostatitis or accessory gland infection. Oxidative stress is the result of elevated Reactive Oxygen Species (ROS) or depressed Total Anti-oxidant Capacity, or both. Granulocytes, in prostatic fluid may be responsible for the generation of ROS, which are known to impair sperm function. Abnormal levels of ROS, however, have also been detected in the absence of leucocytospermia. Several investigators have observed significant oxidative stress in the semen or prostatic fluid from patients with bacterial and abacterial forms of prostatitis, comparable with levels reported in men with recognized infertility. Whether prostatitis is a risk factor for infertility or not, remains controversial. Therefore, the role of seminal oxidative stress as either the result of prostatic inflammation or the cause of infertility is likewise debatable, but plausible. We summarize the results of our studies, as well as those of others who are dedicated to the research of prostatitis, and its potential effects on semen quality.     

应用他莫昔芬治疗Ⅲ型前列腺炎合并少精症的初步研究

目的 初步研究枸橼酸他莫昔芬治疗Ⅲ型前列腺炎合并少精症的效果.方法 28例诊断为Ⅲ型前列腺炎合并少精症患者,给予枸橼酸他莫昔芬10 mg,每日2次,连续12周,对比分析患者治疗前后的症状、EPS常规、NIH-CPSI评分、精液常规分析、国际勃起功能评分(IIEF-5评分).结果 治疗前后患者前列腺炎常规检查总WBC计数,精液常规中精子量、精子计数比较,差别有统计学意义(P＜0.05);治疗前后患者排尿症状评分、生活质量评分、疼痛评分及NIH-CSPI总评分,A+B级精子相比较,差别无统计学意义(P＞0.05).结论 枸橼酸他莫昔芬对Ⅲ型前列腺炎合并少精症有一定的治疗效果,但仍需要进一步的深入研究.     

Coryneform bacteria in semen of chronic prostatitis patients

Our aim was to compare the presence and species composition of coryneform bacteria in chronic prostatitis patients and controls. Semen of 50 men with inflammatory prostatitis and 59 controls (without pelvic pain/discomfort complaints and leukocytospermia) was investigated. First-catch urine was additionally investigated in 36 men (30 with and 6 without prostatitis). Coryneform bacteria were found in semen of 76% men with inflammatory prostatitis and 83% controls. More than half of the isolates were identified as Corynebacterium seminale. Prostatitis patients with severe leukocytospermia (>1 million white blood cells per ml) harboured significantly more Corynebacterium group G (33% vs. 2%, p = 0.0003) and Arthrobacter sp. (17% vs. 2%, p = 0.03) in comparison with controls. Nine species of coryneforms with high concentration (>or=10,000 CFU per ml) were found in prostatitis patients as against only four species in controls. Half of the men harboured corynebacteria in semen as well as in urine, 22% of men in semen only, and 3% in urine only. The total concentration of coryneforms was greater in semen than in urine (median 5000 vs. 100 CFU per ml, p = 0.053). We suggest that although coryneforms are generally considered as saprophytes, they are not uniform and some species (Corynebacterium group G and Arthrobacter sp.) may be associated with inflammatory prostatitis.     

精路炎症对精子密度和活率的影响

目的　了解精路炎症患者精子密度和活率的变化及其对生育影响。方法　选取慢性前列腺炎患者 5 0例 ,慢性附睾炎患者10例和正常生育者 10例 ,对其精液常规参数进行比较。结果　前列腺炎组的精子密度与正常组无显著差异 ,而精子活率显著低于正常组 (P <0 .0 5 ) ;附睾炎组精子密度和精子活率与正常组均无显著差异。结论　慢性前列腺炎患者的精子活率较正常生育者明显降低 ,而附睾炎患者无变化 ,提示慢性前列腺炎对生育可能有影响     

Seminal microflora in asymptomatic inflammatory (NIH IV category) prostatitis

OBJECTIVES: To prove the need for the quantitative full-microflora semen analysis for determining the role of microorganisms in the etiology of asymptomatic inflammatory prostatitis, and to correlate the seminal white blood cell (WBC) counts with interleukin 6 (IL-6) levels. METHODS: Thirty-seven men with asymptomatic inflammatory (National Institutes of Health [NIH] IV category) prostatitis and 32 controls were investigated by using routine semen analysis, IL-6 levels of seminal plasma, and quantitative microbiological analysis of semen. RESULTS: The IL-6 concentration in seminal plasma was significantly higher in NIH IV category prostatitis patients than in the controls, and was in good correlation with the WBC count in semen (r=0.74, p<0.001). In most of the specimens, the counts of anaerobic microorganisms were equal to or outnumbered the aerobic ones. One to eight different microorganisms could be found in any particular semen sample, and the total concentration of microorganisms ranged from 2.0 to 7.5log(10)CFU/ml. Both parameters were significantly higher in NIH IV category prostatitis patients than in controls (median: 4.8 vs. 3.9log(10)CFU for total concentration, p<0.001; median: 5 vs. 3 for number of different species, p=0.004). CONCLUSIONS: Unlike the controls the NIH IV category prostatitis patients harbour abundant polymicrobial microbiocenosis in their semen, containing anaerobic, microaerophilic and aerobic bacteria. Detection of IL-6 in seminal plasma serves as an additional tool for diagnosing NIH IV category prostatitis.     

慢性前列腺炎伴不孕不育患者精液结果及精浆PSA和果糖的分析研究

目的：探讨慢性前列腺炎（CP）伴不孕不育患者精液质量及果糖和PSA的变化。方法：研究对象均为男性CP患者。根据精液液化时间是否大于60min分为两组：精液液化正常组22例,精液延迟液化组20例;另选择正常对照组15例。分析各组精液理化指标,并测定各组精浆中果糖和PSA的含量。结果：精液液化正常组、精液延迟液化组在精子密度、精子活率、活动A级和活动A＋B级较正常对照组差异有统计学意义（P〈0．01）;PSA浓度较正常对照组差异有统计学意义（P〈0．01）。精液延迟液化组果糖含量较正常对照组差异有统计学意义（P〉0．05）。结论：CP可以引起精子质量降低和化学组分的改变,有可能影响精液的液化过程,导致男性不育。     

Effects of semen processing on the generation of reactive oxygen species and mitochondrial membrane potential of human spermatozoa

This study was designed to evaluate the effects of semen processing on the generation of intracellular reactive oxygen species (ROS) and mitochondrial membrane potential (MMP) in spermatozoa, and to develop reliable indexes for the evaluation of sperm quality during sperm preparation. Swim-up and density gradient centrifugation methods were used to separate semen in oligoasthenoteratozoospermia (OAT), leucocytospermia (LC) and normozoospermia groups. Levels of ROS and MMP were measured by flow cytometry. Before preparation, the patients with abnormal semen parameters had a lower MMP and higher ROS, and there was a negative correlation between MMP and ROS. The levels of MMP and ROS increased significantly, especially ROS produced by swim-up. A significant difference was found between the correlation of MMP and total normal motile sperm count after preparation in the OAT group. The level of ROS was associated with the amount of white blood cells in the LC group. The MMP can be used as an objective index to evaluate the sperm quality of OAT patients, and the combination of MMP and ROS can be used to assess the efficiency of sperm preparation in LC patients. These findings can guide selection of the ideal sperm separation technique for different sperm samples.     

无症状性前列腺炎对精液参数的影响

目的:探讨无症状性前列腺炎对精液参数的影响。方法:对已诊断无症状前列腺炎的152例患者按EPS中的WBC水平进行分组:A组(WBC+～++)和B组(WBC+++～++++);并设立健康正常的个体作为对照组(C组)。检测指标包括:精液量、pH值、液化时间、精子浓度、精子存活率、a级精子百分率、正常形态精子百分率、WBC计数与相关的炎症细胞因子等。结果:精液参数中液化时间、a级精子百分率(%)和正常形态精子百分率(%):A组(24.5±5.2)min、(20.0±4.1)、(10.5±4.8)和B组(30.4±5.0)min、(10.0±3.8)、(7.5±4.2)与C组(18.5±5.3)min、(32.3±4.5)、(17.8±3.6)相比,以及B组与A组相比,差异均有显著性(P<0.001),而pH值、精液量、精子存活率、精子浓度:A组(7.6±0.3)、(3.0±1.1)ml、(56.0±6.0)%、(65.9±11.3)×106/ml,B组(7.7±0.3)、(2.8±1.2)ml、(52.3±6.3)%、(62.5±10.3)×106/ml和C组(7.5±0.2)、(2.9±1.2)ml、(62.1±5.3)%、(87.7±10.1)×106/ml差异均无显著性(P>0.05)。B组精液中IL-1β(58.64±30.82)pg/ml、TNF-α(50.57±27.48)pg/ml与C组IL-1β(17.68±5.65)pg/ml、TNF-α(23.50±4.80)pg/ml比较,显著上升(P<0.001)。结论:无症状性前列腺炎对精液主要参数有明显影响。     

精液中白细胞含量不同的少弱精子症患者分类治疗观察

目的观察精液中白细胞含量不同的少、弱精子症患者的分类治疗效果。方法60例正常白细胞含量的少、弱精子症患者双盲分成治疗1组与治疗2组;68例白细胞精液症的少、弱精子症患者双盲分成对照1组和对照2组。分别比较4组治疗前后精液白细胞含量、精液常规及临床妊娠率。结果正常白细胞含量的少、弱精子症患者分别采用助育1号和五子衍宗丸治疗,治疗前后两组患者精液密度、活力、临床妊娠率均有提高,助育1号提高更显著。白细胞精液症的少、弱精子症患者分别采用助育2号和五子衍宗丸治疗,治疗前、后对照1组精液白细胞含量显著下降,对照2组治疗前、后精液白细胞含量无显著改变,对照1组治疗后精液常规有显著提高,与治疗前比较均有显著性差异(P<0．01);与对照2组比较,有显著性意义(P<0．01);配偶妊娠率对照1组与对照2组比较,有显著性意义(P<0．01)。结论少、弱精子症患者治疗前检测精液白细胞含量,根据不同精液白细胞含量分类、结合中医辨证治疗可收到显著疗效。     

Reduced semen quality in chronic prostatitis patients that induce the release of apoptotic protein Omi/HtrA2 from spermatozoa

The relationship between chronic prostatitis and fertility has been disputed for many years. Several groups have shown infection and autoimmune response against prostate antigens could have a deleterious effect on semen quality and fertility. This study was conducted to test the hypothesis that Omi/HtrA2-induced apoptosis in chronic prostatitis could be a mechanism underlying the observed clinical benefit. The Omi/HtrA2 serine protease is a nuclear-encoded mitochondrial protein, which can be released from mitochondria into the cytosol after apoptosis stimuli, inducing apoptosis in caspase-dependent and independent manners. Forty-one patients diagnosed as suffering from chronic prostatitis were included. Healthy normal individuals were included as controls. Human spermatozoa in the semen were purified by Percoll-gradient technique to separate the seminal plasma and other round cells. Measurements for sperm concentration, motility, morphology, proinflammatory cytokines, Omi/HtrA2 mRNA and protein levels in spermatozoa of chronic protatitis patients, were performed accordingly. Significantly increased levels of proinflammatory cytokines were detected in seminal plasma from these prostatitis patients. Omi/HtrA2 mRNA and protein levels were significantly higher in prostatitis men than in normal men. This study shows that chronic prostatitis patients present important alterations in their semen quality parameters, Omi/HtrA2 mRNA and protein levels of spermatozoa. We speculate that the inflammatory process involved may affect male fertility by release of proapoptotic protein Omi/HtrA2.     

慢性非细菌性前列腺炎患者精液质量改变和抗生素治疗效果

目的 :观察慢性非细菌性前列腺炎 (CAP)对精液质量的影响和抗生素对CAP的治疗效果。　方法 :对诊断为CAP的 86例患者进行精液分析 ,同时测定血清和精浆的抗精子抗体 (AsAb) ,并和 2 0例正常男性进行比较。然后把 86例CAP患者随机分成用抗生素组和未用抗生素组共 2组 ,每组 4 3例 ,用抗生素组除选用 3种抗生素序贯治疗外 ,其余治疗 2组相同。连续治疗 3个月 ,每个月随访 1次。　结果 :CAP患者精子活动率、前向运动精子百分率和正常形态精子均明显低于正常对照组 (P <0 .0 0 5 ) ;精浆和血清AsAb阳性率均明显高于正常对照组 (P <0 .0 1 )。应用抗生素组精子活动率、前向运动精子百分率和正常形态精子等提高均明显大于未用抗生素组 (P <0 .0 5 ) ,临床治疗效果也明显优于未用抗生素组 (P <0 .0 5 )。　结论 :CAP使精液质量和男性生育力下降。抗生素治疗可明显改善CAP患者的精液质量 ,并提高CAP的治疗效果     

Leukocytospermia in male infertility patients in China

Summary. Recent studies have revealed a high prevalence of leukocytospermia (> 1 × 10⁶ white blood cells ml⁻¹ semen) in male infertility patients in the USA and certain European countries, and have implicated white blood cells as a cause of infertility. Since leukocytospermia may often be attributed to male genital-tract infections, its prevalence could vary widely in different populations depending on factors such as sexual practices and the prevalence of sexually transmitted pathogens. In the study described here the incidence of leukocytospermia was determined in a group of 101 male infertility patients and a small reference group of normal fertile men in Beijing, China. Seminal white blood cells (WBC) and WBC sub-populations were enumerated by peroxidase staining and immunohistological assay. Eight out of 101 (7.9%) samples from infertility patients and 0/10 samples from fertile donors were leukocytospermic. The incidence of leukocytospermia in the Chinese infertility patients was considerably lower than the 23% incidence observed in a recent study of infertility patients in the USA using a similar technique. All but one of the patients with leukocytospermia had a poor sperm count and/or poor sperm motility. However, due to the low incidence of leukocytospermia and the small number of patients in this group, a statistically significant association between leukocytospermia and poor semen quality was not attained. The simple peroxidase test correlated well with the more expensive and technically demanding immunohistological assay for detection of white blood cells in semen.     

The limit of leucocytospermia from the microbiological viewpoint

The aim of the study was to find out the correlation between white blood cell (WBC) counts in semen and quantitative composition of seminal microflora, and to establish the minimum WBC count associated with significant bacteriospermia. The research included 159 men with different WBC counts in their semen, 84 of them with chronic prostatitis/chronic pelvic pain syndrome. Semen samples were cultivated quantitatively for detecting anaerobic, microaerophilic and aerobic bacteria. Bryan-Leishman stained slides were used for detecting WBC in semen. Seminal fluid was colonized by eight different microorganisms, and the total count of microorganisms in semen ranged from 102 to 107 CFU ml-1. A high frequency of anaerobic microorganisms was found. A positive correlation was observed between the WBC count and the number of different microorganisms, and also between the WBC count and the total count of microorganisms in semen sample. The receiver operating characteristic curve analysis demonstrated that the WHO-defined WBC cut-off point (1 x 106 WBC ml-1) has very low sensitivity for discriminating between patients with and without significant bacteriospermia, as a more optimal sensitivity/specificity ratio appears at 0.2 x 106 WBC ml-1 of semen. The quantitative microbiological finding of semen in the patients of National Institute of Health (NIH) categories IIIa and IV was very similar, i.e. a high number of different microorganisms and a high total count of microorganisms. In the control group (without leucocytospermia and prostatitis symptoms) both parameters were significantly lower.     

精索静脉曲张患者精液质量及其不育患者手术前后精液变化的观察

目的观察精索静脉曲张（VC）患者的精液质量和精子形态学改变，以及VC不育患者手术前后精液的变化。方法121例VC患者精液按WHO标准常规分析并对精子形态学进行评价，23例健康男性精液检查结果作为对照。并对21例VC不育患者术前及术后的精液进行检测分析。结果121例VC患者的精子密度、（A＋B）级活动力精子（％）、活率、有效精子数、活动精子数、活力指数以及正常形态精子比例较对照组明显降低（P〈0．01）；畸形精子中小头、锥形头和无定形头精子数较对照组增多（P〈0．01）。21例VC不育患者手术后精子质量和精子形态学较术前明显改善。结论VC可以引起精液质量下降导致不育，精子形态学分析是判定VC患者精子受损的一个敏感指标，手术能有效地改善精液质量。     

Effects of microsurgical varicocelectomy on semen analysis and sperm function tests in patients with different grades of varicocele: Role of sperm functional tests in evaluation of treatments outcome

It seems that varicocele play a role in male infertility, as such, their prevalence increases from 15% in the normal population to 80% in secondary infertility subjects. Varicoceles may have negative effects on semen quality. Our goal was to assess the effects of microsurgical varicocelectomy on semen analysis and sperm functional tests in men with different grades of varicoceles. Thirty infertile men with different grades of varicoceles (grades 1 to 3) were enrolled in our study. Semen quality was assessed by semen analysis according to the WHO guideline (WHO, 1999) and four different sperm functional tests (aniline blue, toluidine blue, chromomycin A3 and TUNEL test) were carried out before and 3 months after microsurgical varicocelectomy (M‐varicocelectomy). When considered all three grades together, we showed that M‐varicocelectomy had statistically significant effects on all four types of sperm functional tests (p value<0.05). It also had positive effects on conventional semen parameters, although the effects were not statistically significant for some parameters (for example sperm count). When analysed separately (based on varicocele grades) the surgery, although caused improvements in semen quality, but may have more statistically significant effects on patients with varicocele of higher grade. In addition, in varicocele of lower grade (for example grade 2), sperm function test may be a better predictor of surgical success than the conventional semen analysis. Thus, we show that not only M‐varicocelectomy has significant positive effect on semen quality but also if sperm functional tests become more affordable in the future, because they yield more precise results, their use in daily practice may increase significantly in patients with varicoceles.     

Ⅲ型前列腺炎患者精液参数、锌浓度及抗菌活性的变化

目的:探讨Ⅲ型前列腺炎(CP/CPPS)患者精液常规参数、锌浓度及抗菌活性的关系。方法:对60例CP/CPPS患者和20例健康男性进行精液常规参数、锌浓度及抗菌活性的检测。结果:CP/CPPS患者精液液化时间、精子活力、精浆抗菌活性及精浆锌离子浓度与对照组相比,差异有显著性(P均<0.01)。CP/CPPS患者精子活力与精浆锌离子浓度间有显著相关性(r=0.272,P=0.015)。精浆抗菌活性与精浆锌离子浓度间有显著相关性(r=0.449,P<0.01)。结论:CP/CPPS患者精液液化时间延长,精子活力下降,精浆锌浓度和抗菌活性降低。精浆抗菌活性与精浆锌浓度、精子活力间有显著相关性。     

Secular and seasonal changes in semen quality among young Danish men: a statistical analysis of semen samples from 1927 donor candidates during 1977-1995

The objective of this study was to investigate whether semen quality has changed during the years 1977-1995 in a group of unselected semen donor candidates, and to determine whether semen quality is subject to seasonal variation, by analysis of time- and season-related changes in semen quality using multiple regression and ANOVA. The study was based on analysis of the first semen sample delivered by 1927 semen donor candidates in Copenhagen during the period 1977-1995, with determination of semen volume, sperm concentration, total sperm count, percentage motile spermatozoa, and a semiquantitative sperm motility score. Multiple linear regression analysis with year, sexual abstinence and season as covariates showed a significant increase in mean sperm concentration from 53.0 x 10(6)/mL in 1977 to 72.7 x 10(6)/mL in 1995 (p < 0.0001) and in mean total sperm count from 166.0 x 10(6) to 227.6 x 10(6) (p < 0.0001). Mean semen volume and percentage motile spermatozoa did not change. Sperm motility deteriorated, as the spermatozoa in 74.2% of the samples were of excellent motility in 1977-1980 compared to only 41.9% in 1993-1995 (chi 2 = 130.0, p < 0.0001). Analysis of variance showed significant variation between seasons regarding sperm concentration (p < 0.0001) and total sperm count (p < 0.0001). Highest sperm counts were found in spring, with a mean concentration (95% C.I.) of 77.6 x 10(6)/mL (71.9-83.7), and lowest in summer, with a mean of 57.5 x 10(6)/mL (50.1-65.4). No other semen parameter varied with season. It is concluded that sperm counts increased, whereas sperm motility decreased, in a group of Danish semen donor candidates, from 1977 to 1995. Due to the retrospective design and the anonymity of the donors, we were unable to control for variation in donor age, and we cannot exclude the possibility that some donor candidates were selected by being accepted as donors by other semen donor services in Copenhagen. With these limitations in mind, we suggest our results should be interpreted cautiously and regarded as a contribution to the ongoing dispute on whether or not there is a continuous decrease in sperm quality. The seasonal variations found in sperm concentration and total sperm count were pronounced and were not attributable to seasonal differences in the length of sexual abstinence. Additionally, the same seasonal pattern was observed in five successive year-intervals. These findings strongly indicate that human testicular function is influenced by season, a phenomenon well known in many lower mammals.