精索静脉曲张不育者的精索静脉血气分析及其意义

本文对２０例精索静脉曲张致不育症患者和１０例已生育的精索静脉曲张患者在行左精索静脉高位结扎术中，同时取左精索静脉及周围静脉血气作血气分析比较，并与患者术前精液分析对照。发现两组的术中精索静脉血与周围静脉血ＰＯ２，ＳａＯ２，ＰＣＯ２，ｐＨ及其它指标没有显著性差异。     

精索静脉曲张不育症患者精索静脉血气分析

目的 探讨精索静脉曲张（varicocele,VC）导致男性不育的具体发病机制.方法 选择50例VC不育症患者及40例对照组作为研究对象,分别取其左侧精索内静脉以及周围静脉血进行血气分析,然后比较.结果 （1）VC不育症患者左侧精索静脉血中的PH、PO2、SO2及HCO3-低于外周静脉血（P＜0.05）,PCO2及K＋高于外周静脉血（P＜0.05）,而其他指标差异无统计学意义（P＞0.05）.（2）VC不育症患者左侧精索静脉血中的PH、PO2、SO2及HCO3-低于对照组（P＜0.05）,40例对照组PCO2及K＋高于对照组（P＜0.05）,而其他指标差异无统计学意义（P＞0.05）.（3）VC不育症患者精液密度及活率低于对照组（P＜0.05）,畸形率高于对照组（P＜0.05）.结论 VC不育症患者精索静脉中的PH、PO2、SO2、HCO3-降低和PCO2、K＋升高是导致精液密度及活率降低同时畸形率升高进而引起男性不育的原因.     

精索静脉曲张不育患者精子核蛋白、精子膜麦芽凝集素受体的检测和意义

用苯胺蓝细胞化学染色法和精子膜麦芽凝集素（ＷＧＡ）从细胞和分子水平分别检测精索静脉曲张不育患者精子核蛋白以及精子膜与ＷＧＡ结合的糖复合物的变化。结果正常对照组（１２例）核蓝染精子数为２７．８２％±９．７３％，不育组（２１例）为４０．６２％±１１．７３％，Ｐ＜０．０１；ＯＤ变化值对照组（９例）为０．０８３±０．０７３，不育组（１７例）为０．０２８±０．０２５，Ｐ＜０．０１；ＯＤ变化值与附睾功能的特异性标记酶α－糖苷酶活性的相关系数ｒ＝０．５６，Ｐ＜０．０５。结果表明，精索静脉曲张不育与精子核蛋白转型异常以及与ＷＧＡ受体数目下降有密切的关系。ＷＧＡ受体数目的降低可能与附睾功能异常进而引起与ＷＧＡ结合的糖复合物合成受阻有关。     

精索静脉曲张不育患者精子形态学分析及其治疗后的初步观察

应用改良巴氏染色法对５４例精索静脉曲张不育患者的精子形态学进行了分析并初步观察治疗后的效果。结果表明，精索静脉曲张Ⅰ度组、Ⅱ度组和Ⅲ度组的精子畸形率均显著高于正常生育力组（Ｐ＜０．０１），而且尖头精子、顶体异常、老化精子和不定形精子数都有较高的比率。经手术治疗后，初步观察到Ⅱ度组的精子畸形率显著减少（Ｐ＜０．０１），但是Ⅲ度组却无显著变化（Ｐ＞０．０５）。提示①精索静脉曲张导致不育的原因之一是正常     

与精索静脉曲张相关不育的机理研究

精索静脉曲张(varicocele．VC)是精索内蔓状静脉丛因各种原因引起回流不畅或因静脉瓣膜损坏引起血液倒流．而形成局部静脉扩张、迂曲、伸长的病理现象。VC的发病以左侧为主，占70％以上。VC在10岁以前较少发病，10～15岁间发病率明显增加．可高达15％，与成人水平一致且基本保持稳定。根据发病年龄可将VC分为两类：一类是从青春期     

精索静脉曲张不育患者手术前后血浆性激素变化

将６４例单纯精索静脉曲张源性不育患者随机分为手术组３３例与非手术组３１例，分别于术前及术后６个月测血浆卵泡刺激素（ＦＳＨ）、黄体生成素（ＬＨ）、睾酮（Ｔ），同时测４６名正常生育力男性性激素作为正常值对照，对两组不育患者还进行了睾丸体积测定和精液分析。手术组采用经髂窝腹膜外单纯精索内静脉高位结扎术。结果：６４例精索静脉曲张源性不育患者精子密度、精子存活率、睾丸体积低于正常组，ＦＳＨ、ＬＨ、Ｔ均在正常值范围，与正常组对照无明显差异。两组手术前后对照分析，手术组与非手术组手术前后血浆性激素虽无统计学差异，但手术组患者术后精液质量、睾丸体积明显改善，随访一年手术组妊娠率（２７％）显著高于非手术组（１３％）。术前ＦＳＨ较高的患者术后精液质量、睾丸体积无明显改善，而术前ＦＳＨ正常者有显著差异。认为，精索静脉曲张不育患者通过手术治疗确能提高其生育能力，而术前根据血浆ＦＳＨ、ＬＨ、Ｔ测定结合睾丸检查、精液分析可以初步估计睾丸受损程度，对手术预后的判断有一定参考价值。     

精索静脉曲张不育症精索内静脉的病理组织学观察

应用显微镜对２８例精索静脉曲张不育症患者的精索内静脉（ＩＳＶ）进行病理组织学观察。结果ＩＳＶ内膜、内皮细胞变性，平滑肌细胞严重空泡变性，中膜明显增生肥厚，血管增殖并形成多腔血管结构以及瓣膜严重机化，其中多腔血管结构、瓣膜机化更具有特征性。认为ＩＳＶ瓣膜功能不全、中膜肥厚以及瓣膜严重机化等病理性损害是引起精索静脉曲张的重要原因，如不及时治疗，精索静脉曲张会愈加严重，其影响生育的结果亦将更加突出。     

精索静脉曲张不育患者精囊内静脉血中活性氧和抗氧化剂的关系(英文)

目的:以外周静脉血作为比较对象,评估精囊内静脉血中活性氧(ROS)和抗氧化剂的关系。方法:观察对象为68名患有精索静脉曲张的少弱精患者。在腹股沟的曲张精索静脉切除术中,提取精囊内血液样本和中央尺骨静脉血样本。分别测定这些血液样本中的三种 ROS(丙二醛[MDA]、双氧水[H_2O_2]、一氧化氮[NO])和四种抗氧化剂(过氧化岐化酶[SOD]、过氧化氢酶[Cat]、谷胱甘肽过氧化酶[GPx]、维生素 C)。结果:精囊内静脉血样内的 ROS 因素的平均值明显高于外周血中的值(MDA 18.7±1.4 nm/mL vs.15.4±1.4 nm/mL,H_2O_2 43.6±8.0 Um/mL vs.30.8±8.1 Um/mL,NO 2.3±0.5 nm/L vs.1.6±0.4nm/L,P<0.01)。而精囊内静脉血的抗氧化剂的平均值明显低于外周血中的值(SOD 1690.7±130.0 U/mL vs.1818.5±143.0 U/mL,Cat 38.9±6.1 mm/mL vs.47.9±10.2 mm/mL,GPx 20.4±8.1 U/mL vs.23.0±8.4 U/mL,维生素 C 0.3±0.1 vs.0.4±0.1 mg/dL,P<0.05)。结论:患有精索静脉曲张不育男性的精囊内静脉血相对于外周静脉循环,具有更高的 ROS 和更低的抗氧化剂。     

Glutathione‐S‐transferase‐oxidative stress relationship in the internal spermatic vein blood of infertile men with varicocele

This study aimed to assess glutathione‐S–transferase (GST) enzyme‐ oxidative stress (OS) relationship in the internal spermatic vein (ISV) of infertile men associated with varicocele (Vx). Ninety five infertile oligoasthenoteratozoospemic (OAT) men associated with Vx were subjected to history taking, clinical examination and semen analysis. During inguinal varicocelectomy, GST, malondialdehyde (MDA) and glutathione peroxidase (GPx) were estimated in the blood samples drawn from ISV and median cubital veins. The mean levels of GST, GPx were significantly decreased and the mean level of GPx was significantly increased in the ISV compared with the peripheral blood. The mean level of GST and GPx in the ISV was significantly decreased, and the mean level of MDA was significantly increased in Vx grade III compared with Vx grade II cases. There was nonsignificant difference in the mean level of GST in the ISV in unilateral Vx cases compared with bilateral Vx cases. There was significant positive correlation of GST with sperm count, sperm motility, GPx and significant negative correlation with sperm abnormal forms, MDA. It is concluded that ISV of infertile men associated with Vx has decreased levels of GST compared with peripheral venous circulation that is correlated with both OS and Vx grade.     

Nitric oxide produced in the testis is involved in dilatation of the internal spermatic vein that compromises spermatogenesis in infertile men with varicocele

OBJECTIVE: To determine the concentration of nitric oxide (NO) and the location and change in the expression of NO synthase (NOS) isoforms in the testes of subfertile men with varicocele, and to compare the NO concentration or NOS expression with clinical variables, to determine the role of NO on the pathophysiology of varicocele. PATIENTS AND METHODS: In all, 27 men who had a left varicocelectomy and five with 'normal' spermatogenesis (controls) who had scrotal surgery for other reasons were enrolled. Intratesticular fluid was taken from the men and the NO concentration determined colorimetrically. The expression and location of NOS isoforms were examined by Western blotting and immunohistochemistry, using testicular biopsy specimens, and NADPH-diaphorase (NADPH-d) staining used to identify NO-producing cells. The relationship between the NO concentration and the expression of NOS isoforms or clinicopathological variables was investigated. RESULTS: In testes with grade 2 and 3 varicoceles there were significant increases in the concentration of NO or the expression of inducible NOS. There was no change in the expressions of endothelial NOS, which is located in vascular endothelial cells, while NADPH-d activity was mainly located in these cells. The concentration of NO was significantly correlated with the maximum and total vein diameter (both P<0.01). In patients aged>35 years, the concentration of NO significantly correlated with a deterioration in total motile sperm count (P<0.05). CONCLUSIONS: Increased production of NO in the testis is involved in the enlargement of varicocele and indirectly deteriorates spermatogenesis.     

Comparison of antioxidant enzyme activity in the internal spermatic vein and brachial veins of patients with infertile varicocele

AIM: Recent studies have shown that both oxidative and reductive stresses are present within the internal spermatic vein of patients with varicocele. The aim of this study was to compare the activities of antioxidant enzymes in the internal spermatic vein and brachial vein of patients with varicocele. METHODS: Fifteen primary infertile varicocele patients and ten normal-nonvaricocele-fertile control subjects participated in this study. The patients and subjects were first given a physical and color doppler examination, and then whole blood samples were drawn from the brachial vein and a dilated internal spermatic vein during surgery. Superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) enzyme activities were assessed by enzymatic methods, and the results were compared using the Mann-Whitney U test. RESULTS: The activity of SOD in the internal spermatic veins and brachial veins of patients with varicocele was 60.17 +/- 2.15 and 42.10 +/- 1.60 U/g protein, respectively; that of GSH-Px was 5.44 +/- 0.14 and 3.92 +/- 0.14 U/g protein, respectively. The results were statistically significant (P < 0.05). In the control group, the activity of SOD in the internal spermatic veins and brachial veins was 43.12 +/- 1.80 and 40.01 +/- 2.10 U/g protein, respectively; that of GSH-Px was 3.35 +/- 0.20 and 3.7 +/- 0.10 U/g protein, respectively (P > 0.05). CONCLUSIONS: Increased antioxidant enzyme activity in the internal spermatic vein may be due to increased oxidative stress in the internal spermatic vein: the increase in antioxidant enzyme activity may be a response to offset the toxic actions of reactive oxygen species. Further studies are needed to confirm this suggestion.     

Left spermatic vein cortisol in subfertile men with varicocele

Varicocele is one of a number of well-documented causes of male subfertility. In patients undergoing varicocelectomy high success rates are achieved postoperatively, with improved women quality and subsequent pregnancies. Why varicocele causes subfertility in some men is unknown. Recently, it has been hypothesized that the left spermatic vein might be rich in by-products of adrenal metabolism, thus leading to diminished spermatogenesis. This study does not support this hypothesis, finding no significant difference in plasma cortisol in the left spermatic vein than from distant peripheral circulation. Further investigation into the etiologic factors causing subfertility with varicocele is recommended.     

Assessment of seminal granulysin in infertile men with varicocele

Varicocele has a common association with male infertility, but its exact role is still debated. Apoptosis has been suggested as one of the mechanisms of varicocele‐associated infertility. Granulysin is a molecule that plays a role in apoptosis with no previous study about its role in male infertility. This case‐controlled study aimed to assess seminal plasma granulysin level in infertile patients with varicocele. This study involved 90 men that were allocated into fertile normozoospermic men (n = 20), infertile men without varicocele (n = 30) and infertile men with varicocele (n = 40). These men were subjected to history taking, clinical examination, semen analysis and estimation of seminal granulysin. In general, seminal granulysin level was significantly elevated in infertile men compared with fertile men. Infertile men with varicocele showed significantly higher seminal granulysin compared with infertile men without varicocele, in bilateral varicocele cases and in grade III varicocele. Seminal granulysin level was negatively correlated with sperm concentration, sperm motility, sperm normal forms percentage and testicular volumes. It is concluded that increased seminal granulysin has a negative impact on spermatogenesis in infertile men in general and in infertile men associated with varicocele in particular.     

Semen cahracteristics before and after ligation of the left internal spermatic veins in men with varicocele.

The semen from 20 men with varicocele was studied before and after surgical correction of the varicocele. The effect on sperm quality was only marginal and could not explain the fairly high conception rate (20%) after operation. The recommendation that varicocele in men with long-term infertility should be eliminated by ligation of the internal spermatic veins is still justified despite the absence of positive effects on sperm quality.