男性生育力与精液参数的变化趋势

近年来,男性生育力与精液参数的变化趋势不仅是学术界争论的焦点,也是公众舆论关注的热点。尽管评价男性生育力的"金标准"是配偶妊娠,但是临床与科研工作中常常使用精液参数检测作为男性生育力评估的替代指标和间接证据。目前,国内所使用的正常人群精液参数参考值范围均是WHO从国外人群获得的数据,缺乏中国正常人群的精液参数参考值。国内外对于精液参数变化趋势的研究结果表明,世界范围内精液质量总的变化趋势没有明确结论,但部分地区的精液质量下降已经被许多学者所接受。需要进行长期连续性前瞻性研究对精液质量变化趋势作出评估与预测。     

广东某市农村地区正常生育力男性精液参数的研究

目的探索现阶段正常生育力的健康男性精液的各项参数及其相互关系。方法采用WHO最新推荐的方法,对广东某市农村312例具有生育力的健康志愿者进行精液检测分析。结果(1)具有(a+b)级活动力精子率(60.63±11.76)%;(2)精子存活率(80.89±10.49)%;(3)精子密度(60.09±30.25)×106/ml;(4)不同年龄组间(a+b)级活动力精子、精子存活率及精子密度的参数比较,无显著差异(P>0.05);(5)禁欲时间与(a+b)级活动力精子、精子存活率间的关系呈负相关(P<0.05),与精子密度间的关系呈正相关(P<0.01),但不同禁欲时间组间与(a+b)级活动力精子、精子存活率及精子密度的比较,无显著差异(P>0.05);(6)精子密度与(a+b)级活动力精子和精子存活率无明显的相关关系(P>0.05),且(a+b)级活动力精子和精子存活率始终保持着平衡状态,并在50%以上。结论(1)(a+b)级活动力精子>50%、精子存活率>50%,即使精子密度偏低或<20×106/ml仍不影响正常男性的生育能力;(2)(a+b)级活动力精子、精子存活率以及精子密度与年龄(20~45岁)无关;(3)精子密度的高低对(a+b)级活动力精子和精子存活率无明显影响。     

吸烟对男性精液质量的影响

目的 探讨吸烟对男性精液质量的影响.方法 应用伟力彩色精子质量分析系统对180例不育男性(96例不育吸烟组和84例不育非吸烟者)和112例正常生育男性精液从精液量、液化时间、精子总数、精子密度、精子活力、精子活率等参数方面进行分析.结果 (1)不育吸烟组、不育非吸烟组与正常对照组比较,精子活力、精子活率等参数显著降低(P＜0.05或P＜0.01),液化时间延长(P＜0.05),而精液量、精子密度和精子总数之间无显著性差异(P＞0.05);(2)不育吸烟组与不育非吸烟组相比,精子活力、精子活率显著降低(P＜0.05或P＜O.01);(3)小烟量组和短烟龄组与不育非吸烟组相比,精液各参数之间差异无显著性(P＞O.05).大烟量组和长烟龄组与不育非吸烟组相比,精子总数、精子密度、精子活力和精子活率都显著降低(P＜O.05或P＜0.01),液化时间显著延长(P＜0.01);(4)小烟量组和短烟龄组分别与大烟量组和长烟龄组相比,精子密度、液化时间、精子活力和精子活率等均有显著性差异(P＜0.0 1).结论 (1)吸烟对男性精液质量的不良影响存在量效和时效关系.(2)大量吸烟(日吸烟量＞20支)和长期吸烟者(烟龄＞10年)可能是引起男性不育的重要原因之一.     

射精频率对精液参数的影响

射精频率对精液参数的影响王信心吴周亚作者对１０名健康生育力男子和１０例少弱精症不育男子连续一周采集精液标本进行观察，以探讨射精频率对精液参数的影响。一、材料与方法１０名健康生育力男子，年龄２４～３０岁，均已生育有正常子女，性功能和精液常规检查正常（Ａ...     

上海地区正常生育力男性精液参考值初探

目的:回顾分析上海地区志愿捐精者与正常生育力男性精液分析各项主要参数的分布特征,比较两组男性精液质量的差别,探讨上海地区男性精液参数的正常参考值下限。方法:2010年10月至2011年7月上海市人类精子库招募正常生育力男性41例,健康捐精者100例,按《世界卫生组织人类精液检查与处理实验室手册》(第5版)进行精液常规检测,评估精液体积、精子浓度、前向运动(PR)精子百分率、精子总数和PR精子总数的均值,标准差,并进行t检验。同时统计正常生育力组上述各参数的分布,得出精液特征参数的正常参考值下限。结果:健康捐精组与正常生育力组精液常规各项主要参数(精液体积、精子浓度、PR精子百分率、精子总数、PR精子总数)间差异无统计学意义(P<0.05)。上海地区正常生育力男性精液参考值下限(P<0.05)为:浓度≥27.3×106/ml、PR≥8.1%、体积≥0.82 ml、精子总数≥44.73×106/1次射精、PR精子总数≥24.68×106/1次射精。结论:在评估男性生育力时,精子总数和PR精子总数可能是比精子浓度、精液体积和PR精子百分数更具参考价值的评价指标。     

吸烟对男性精液质量的影响及相关性研究

目的 :探讨吸烟对男性精液质量的影响及相关性。　方法 :30 1例不育男性 (110例非吸烟者和 191例吸烟者 ) ,对照组为 6 1例已生育 1个或 1个以上子女的健康男性 (无吸烟史 )。根据吸烟量和烟龄分为不同吸烟量组和不同烟龄组。检测了精液各参数 (精液量、精液pH、精子计数、精子存活率及前向运动级别等 )和精浆Zn、Cu、超氧化物歧化酶 (SOD)含量。　结果 :中、大量或长时间吸烟组精液量 ,精子计数 ,精子存活率及前向运动级别 ,精浆Zn、Cu和SOD含量较非吸烟组显著降低 ,精液pH显著升高 (P均 <0 .0 1)。精子计数 ,精子存活率及前向运动级别 ,精浆Zn、Cu、SOD含量与吸烟量和烟龄之间呈高度负相关 (P <0 .0 1)。　结论 :吸烟对精液各参数的影响存在着量 效和时 效关系 ,中、大量吸烟或烟龄长者可能对男性生育有不良影响     

生育力男性精液检测与计算机辅助分析参数的主成分分析

目的 对生育力男性进行精子形态学分析和精子存活率检测以及计算机辅助精液分析系统(CASA)分析的检测结果进行主成分分析,探讨能综合反映生育力男性精液质量的指标,并对其影响因素进行评估.方法 招募有近期怀孕史夫妇的丈夫,进行问卷调查、体格检查和精液分析.精液分析包括精子形态学分析、存活率检测和CASA分析,资料分析方法采用描述性分析、相关分析和主成分分析等.结果 288名生育力男性精液检测指标数值如下:总精子数(X1)为(186±2)×106/ml,活动率(X2)为(65±15)%,正常形态精子百分比(X3)为(294±13)%,存活率(X4)为(764±1)%,畸形精子指数(TZI,X5)为1.154±1.10,精子畸形指数(SDI,X6)为(1.04±0.11),曲线速度(VCL,X7)为(48.624±15.50),直线速度(VSL,X8)为(24.544±9.16),平均路径速度(VAP,X9)为(32.544±11.05),精子头侧摆幅度(ALH,X10)为(49.904±7.93),鞭打频率(BCF,X11)为(7.324±2.01)和圆细胞浓度(X12)为(6.58±5.64).主成分分析第一主成分函数Z1=-0.067 ×1+0.477 X2+0.161 X3+0.788 X4+0.621 X5+0.482 X6+0.602 X7+0.576 X8+0.604 X9+0.673 X10+0.736 X11-0.071 X12+5.581,与其关系密切的是活动率、存活率、VCL、VSL、VAP、ALH和BCF;主成分分析第二主成分函数Z2=0.414 X1+0.901 X2+0.332 X3+0.363 X4-0.403 X5-0.539 X6-0.003 X7-0.316 X8.0.130 X9-0.088 X10-0.900 X11+0.537 X12+0.170,与其关系密切的是总精子数、活动率、正常形态精子百分比和圆细胞浓度;主成分分析第三主成分函数Z3=-0.066 X1-0.095 X2-0.042X3-0.017 X4+6.210 X5+5.143 X6+0.097 X7+0.094 X8+0.106 X9+0.038 X10+0.197 X11+0.020 X12+11.684,与其关系密切的是TZI和SDI.结论 在本研究中,12个精液分析检测指标经过主成分分析提取为3个主成分综合指标,分别反映了精子运动能力、有效精子总数和精子畸形状况.睾丸总体积与第一主成分得分正相关,显示体积越大,精子运动能力较强.禁欲时间和睾丸总体积与第二主成分得分正相关,显示有效精子总数较多.年龄影响第三主成分得分,年龄越大,精子畸形程度越高.     

男性阴囊冷敷贴对精液参数影响的研究

目的 探索男性阴囊冷敷贴对男性不育患者精液参数和自然怀孕率的影响.方法 回顾总结自2018年11月至2020年8月期间,使用药物和(或)男性阴囊冷敷贴对患有精索静脉曲张(varicocele,VC)不愿意接受手术治疗、职业司机、肥胖(BMI＞ 28Kg/m2)、长期久坐合并少弱精子症和(或)畸形精子症患者203例的治疗...     

司机职业不育男性的精液分析

目的 :探讨司机职业与男性精液质量有无相关性。　方法 :对 12 2 3例不育男性 (司机 78例、非司机 114 5例 )和 10 0例生育男性精液从液化、精子密度、精子活力、精子活率、精子形态等方面进行全面分析。　结果 :从事司机职业的不育男性精液质量异常率显著高于非司机职业不育男性 (P <0 .0 5 )和生育男性 (P <0 .0 1) ,且开车 8年以上组精液质量异常率显著高于开车 8年以下组 (P <0 .0 5 )。　结论 :司机职业可引起男性精液质量异常。     

Impact of body mass index on seminal oxidative stress

Male obesity has been linked with a reduction in sperm concentration and motility, an increase in sperm DNA damage and changes in reproductive hormones. Recent large observational studies have linked male obesity with a reduced chance of becoming a father. One of the potential underlying pathological mechanisms behind diminished reproductive performance in obese men is sperm oxidative stress. The primary aim of this study was to determine if sperm oxidative stress was more common in obese/overweight men. A total of 81 men had their body mass index (BMI) correlated with seminal reactive oxygen species (ROS) production (Nitro Blue Tetrazolium assay), sperm DNA damage (TUNEL), markers of semen inflammation (CD45, seminal plasma PMN elastase and neopterin concentration) and routine sperm parameters, together with reproductive hormones. The principal finding from this study was that oxidative stress did increase with an increase in BMI, primarily due to an increase in seminal macrophage activation. However, the magnitude of this increase was small and only of minor clinical significance as there was no associated decline in sperm DNA integrity or sperm motility with increasing ROS production. Increased BMI was also found to be significantly linked with a fall in sperm concentration and serum testosterone, and an increase in serum oestradiol.     

Impact of MRI on treatment plan and fracture classification of tibial plateau fractures

OBJECTIVE: To evaluate the interobserver agreement for both treatment plan and fracture classification of tibial plateau fractures using plain radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). DESIGN: Prospective study to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures among three orthopaedic surgeons. SETTING/PARTICIPANTS: Patients presenting with tibial plateau fractures to a level I trauma center were evaluated with plain knee radiographs (anteroposterior, lateral, two oblique views), CT scan, and MRI. Three experienced attending orthopaedic trauma surgeons were randomly presented three sets of studies for each injury: radiographs alone, radiographs with CT, and radiographs with MRI (including soft tissue injuries documented by an experienced MRI radiologist). The surgeons were asked to render fracture classification and treatment plan based upon the blind reading of each individual radiographic set. MAIN OUTCOME MEASURES: Agreement among the three surgeons was measured using kappa coefficients. RESULTS: For fracture classification, radiographs alone yielded a mean kappa coefficient of 0.68, which increased to 0.73 for radiographs with CT scan and 0.85 for radiographs with MRI. Fracture classification (Schatzker) was changed an average of 6% with the addition of the CT scan and 21% based on radiographs with MRI. For the fracture management plan, the mean interobserver kappa coefficient for radiographs alone was 0.72, which increased to 0.77 for radiographs with CT scan and 0.86 for radiographs with MRI. MRI changed treatment plan in 23% of the cases. CONCLUSION: Magnetic resonance imaging increases the interobserver agreement on fracture classification and operative management of tibial plateau fractures.     

Predictors of improved seminal characteristics by varicocele repair

The aim of this study was to investigate predictors of the improvement of semen characteristics after low ligation for patients with varicoceles. The records of 97 oligozoospermic patients who underwent microsurgical left or bilateral inguinal varicocele repair were retrospectively evaluated. We assessed factors that could be predictors of the improvement of semen characteristics using logistic regression analysis. We evaluated age, testicular volume, varicocele grade, serum follicle-stimulating hormone (FSH), luteinising hormone, testosterone, sperm concentration and motility before low ligation. Among the 97 patients, sperm concentration improved from 6.4 ± 5.8 to 24.2 ± 35.1 million ml⁻¹ and sperm motility increased from 32.8 ± 24.9% to 41.0 ± 14.6% in 55 patients (57%). In logistic regression analysis, pre-operative serum FSH and testosterone concentration were predictors of sperm concentration improvement. Varicocele repair improved sperm concentration and motility. Low serum FSH and high testosterone are significant factors predicting the improvement of semen characteristics before low ligation.     

Ultrasonographic characteristics of the seminal vesicles after ejaculation

A total of 12 men from a sperm donor bank underwent transrectal ultrasonography before and after ejaculation to investigate possible changes that could influence interpretation of seminal vesicle ultrasonography. The mean length of the seminal vesicles was 2.98 cm. before and 2.95 cm. after ejaculation. The anteroposterior diameter decreased only from 0.59 to 0.52 cm. Minimal differences were noted between the right and left seminal vesicles, and the greatest variation in size in an individual was only 3 mm. These results indicate that interpretation of seminal vesicle anatomy as seen by ultrasonography does not depend upon the temporal relationship to ejaculation.     

吸烟对育前男性精浆活性氧含量及精子质量的影响

目的:了解重庆市育前男性吸烟现状及吸烟对育前男性精浆活性氧(ROS)含量及精子质量的影响,为育前夫妇优生优育指导提供参考。方法:根据吸烟情况,将368例育前男性分为不吸烟组,轻度吸烟组(每天吸烟≤9支及吸烟年限≤5年),中、重度吸烟组(每天吸烟≥10支及吸烟年限≥5年;或每天吸烟量≤9支及吸烟年限≥10年)。全部对象进行体格检查和病史询问,填写健康调查表,并进行精液参数、精浆ROS含量、精子DNA碎片指数(DFI)检测。结果:368例育前男性中,有吸烟史者为53. 26%,中、重度吸烟者为29. 35%;仅55. 44%和52. 59%的育前男性的正常形态精子百分率和前向运动精子百分率(PR%)在正常参考值范围内。中、重度吸烟组与不吸烟组相比,精液量[(2. 78±1. 08) ml vs (3. 33±1. 20) ml]、精子浓度[(75. 16±60. 13)×106/ml vs (88. 19±70. 33)×106/ml]、PR%[(32. 18±15. 24)%vs (36. 58±13. 90)%]、正常形态精子百分率[(3. 52±1. 58)%vs(3. 85±1. 93)%]显著下降(P均0. 05);精子DFI[(14. 53±12. 85)%vs (10. 45±8. 53)%]和精浆ROS[(24. 10±18. 50) nmol/mg prot vs (12. 20±8. 10) nmol/mg prot]含量均显著增高(P 0. 05)。吸烟与育前男性精浆ROS含量显著正相关(r=0. 235,P 0. 05);吸烟者精浆ROS含量与PR%(r=-0. 381,P 0. 01)、精子总数(r=-0. 136,P 0. 05)、正常形态精子百分率(r=-0. 218,P 0. 01)显著负相关;与精子DFI显著正相关(r=0. 387,P 0. 01)。结论:吸烟会导致育前男性精浆ROS含量升高,精子总数和PR%下降,诱导精子畸形和DNA损伤。     

Growth of porcine kidneys in their native and xenograft environment

Abstract: The increased survival of hDAF pig-to-primate renal xenografts for up to two months has afforded the opportunity to study physiological aspects such as organ growth. Experimental evidence exists of species restriction of the activity of growth hormone, although growth itself is also controlled by a number of other endocrine, paracrine and autocrine substances.
This study consisted of four parts: (1) measurement of pig kidney size according to pig body weight; (2) measurement of pig kidney size according to pig age; (3) serial length measurement of pig-to-primate renal xenografts; (4) correlation of terminal weight of renal xenograft with age and histology.
The xenografted pig kidneys in a primate recipient grow as they would in the pig for the first two weeks after transplantation. After this time there is a reduction in the rate of increase in the length of the xenograft. Over the same period, changes in weight are greatly increased by the presence of rejection. This observational study supports the notion that regulation of growth of a xenotransplanted porcine kidney occurs.     

精索静脉曲张对精液质量和血清、精浆中抑制素B水平的影响

目的:探讨精索静脉曲张(VC)患者精索静脉曲张程度对精液参数和血清、精浆中抑制素B(inhibin B)水平的影响。方法:收集95例不育伴VC患者,55例有正常生育力的男性作为对照组,均通过CASA进行精液常规检查,改良巴氏染色进行精子形态检查;通过ELISA法检测外周血、精浆中抑制素B的水平。结果:VC患者正常形态精子百分率[Ⅰ度:(6.3±6.5)%,Ⅱ度:(2.6±3.0)%,Ⅲ度:(1.0±0.7)%]和前向运动精子百分率[Ⅰ度:(33.3±20.8)%,Ⅱ度:(28.9±19.8)%,Ⅲ度:(13.5±8.4)%]明显低于对照组[(7.5±5.2)%,(43.9±22.7)%](P0.05),精子畸形以头部畸形为主;VC患者外周血和精浆中抑制素B水平[Ⅰ度:(160.9±48.9)pg/ml,(208.3±28.1)pg/ml;Ⅱ度:(150.6±44.7)pg/ml,(201.5±83.5)pg/ml;Ⅲ度:(132.6±41.5)pg/ml,(150.2±51.6)pg/ml]均低于对照组[(201.0±38.1)pg/ml,(225.3±82.5)pg/ml]。结论:VC可导致精子活力降低,畸形率升高,外周血和精浆抑制素B水平下降,从而导致男性生育力受损。     

胫骨平台骨折非解剖复位对膝关节功能影响的研究

目的分析随访病例关节移位的类型、部位、程度对膝关节功能的影响,探讨影响胫骨平台骨折治疗效果的关键因素。方法对1991年6月～2004年6月间在我院治疗的不同类型胫骨平台骨折进行回顾性分析,对有良好随访的29例未达解剖复位或术后出现复位丢失的病例的X线片进行分析,并进行膝关节功能评分。结果随访6个月～13年,平均3.5年,膝关节功能参照Rasmussen评分法,优11例,良13例,可4例,差1例,优良率达82.75%。结论胫骨平台骨折获得良好治疗效果首先要恢复膝关节的稳定性,其次要恢复膝关节良好的力线,再者要在保护膝关节周围软组织情况下恢复关节面的解剖复位,并要有完善、合理的康复计划。     

Impact of biological and artificial seminal fluids on sperm parameters and DNA status in asthenozoospermic ejaculates

The chemical composition and physiological properties of seminal fluid (SF) affect sperm quality. The objective was to investigate the effects of in vitro exposure of artificial seminal fluid (ASF) and biological seminal fluid (SF) on sperm quality. Asthenozoospermic ejaculates (n = 20) were divided into two aliquots. The first aliquot was centrifuged for obtaining asthenozoospermic SF. The second aliquot was processed with density gradient centrifugation (DGC), and the pellet was diluted separately with following media: (a) ASF; (b) Ham's F10; (c) normozoospermic SF; and (d) asthenozoospermic SF. Sperm parameters and DNA status were assessed after DGC, as well as 2 and 24 hr after incubation. The data showed that sperm progressive motility, viability and DNA integrity were significantly higher in ASF than Ham's F10 medium immediately after DGC. At 2 and 24 hr, the progressive motility was significantly decreased in biological SF compared with ASF and Ham's F10. DNA fragmentation index (DFI) was significantly lower in normozoospermic SF than asthenozoospermic SF and Ham's F10 at time 2 hr. In conclusion, normal SF showed the protective role on sperm DNA structure. Moreover, ASF preserved sperm motility better than biological SF during 24 hr, despite being similar to normal SF regarding DNA integrity preservation in short time.     

胫骨后外侧平台骨折的CT形态学研究

 目的 探讨胫骨后外侧平台关节面骨折在胫骨平台骨折中的发生率及其形态学特点。方法 回顾性分析2008年 5月至 2013年 1月 309例胫骨平台骨折患者的 CT图像及临床资料,其中 45例 CT图像缺失或不兼容医学影像存储和传输（PACS）系统予排除,共纳入 264 例患者资料。确定胫骨平台后外侧象限关节面骨折块在胫骨平台骨折中的发生率并测量其骨折线的轴向角度、受累面积、矢状位角度、骨折块高度及移位程度等形态学参数。结果 在 264例胫骨平台骨折中,共检测到 39例胫骨平台骨折存在后外侧象限关节面骨折块,在胫骨平台骨折中的发生率为 14.8%（39/264）。其中男 18例,女 21例;年龄 31~70岁,平均 52岁;左侧 17例,右侧 22例。致伤原因：交通伤 22例,重物砸伤 2例,摔伤 11例,受伤原因不明 4例。后外侧象限关节面骨折块的骨折线偏于冠状位,骨折线轴向角度为-43°~62°,平均 22°;受累的后外侧骨折块面积占整个胫骨平台面积的 8%~32%,平均 14.1%;后外侧平台骨折块的矢状位角度为 58°~97°,平均 76°,提示该骨折块在垂直剪切应力下易发生移位;后外侧骨折块的高度为 18~42 mm,平均 28 mm;后外侧髁骨折块平均移位 2~19 mm,平均 10.48 mm。结论 胫骨平台骨折累及后外侧平台关节面的发生率为 14.8%;胫骨后外侧平台关节面的骨折线偏于冠状位且矢状位角度较大,骨折块所累及的关节面面积较小。