精索静脉曲张与氧化应激的研究

目的 :研究精索静脉曲张 (VC)时氧化应激的损害机制。　方法 :2 8例VC不育男性 ,行精索内静脉结扎术 ,采精索内静脉血和外周静脉血 ;建立大鼠左侧VC模型 (n =12 ) ,以假手术大鼠为对照组 (n =8) ,术后 3个月取睾丸组织。采用分光光度法检测VC男性血浆及大鼠睾丸组织中一氧化氮 (NO)、一氧化氮合酶 (NOS)、黄嘌呤氧化酶(XO)、乳酸 (Lac)和乳酸脱氢酶 (LDH)含量。　结果 :VC患者精索内静脉血浆中NO、NOS、XO、Lac含量明显高于外周静脉血浆 (P <0 .0 1,P <0 .0 5 ) ,LDH明显降低 (P <0 .0 1)。实验性VC大鼠左侧睾丸组织NO、XO高于对照组 (P <0 .0 1) ,Lac明显降低 (P <0 .0 1)。　结论 :VC时 ,可由于曲张精索静脉血浆中NO、NOS和XO及睾丸组织中NO和XO产生增加 ,以及Lac和LDH含量的变化 ,而导致精子生成障碍或 /和精子活力下降 ,引起男性不育。     

一氧化氮、一氧化氮合酶与伴精索静脉曲张不育患者精液参数的关系

目的:探讨一氧化氮(NO)、一氧化氮合酶(NOS)与伴精索静脉曲张(VC)不育患者精液参数之间的关系。方法:根据体格检查和彩色多普勒超声检查选择伴VC的不育患者(组1,n=53),其中临床型和亚临床型分别为21例和32例;同时选择非VC少弱精子症患者(组2,n=29)和正常生育者(组3,n=28)作对照组。采用硝酸还原法分别测定外周血和精浆中NO含量和NOS活性。用计算机辅助精液分析仪测定VC组患者精子密度、活动精子(a+b级精子)和快速前向运动精子百分率。结果:①组1外周血清NO含量和NOS活性与组2及组3相比差异无显著性(P>0.05),但精浆中NO含量和NOS活性组1明显高于其他两组,差异有显著性(P<0.01和P<0.05)。②组1中,随着曲张的精索静脉内径的增加,外周血清和精浆中NO含量和NOS活性均有所上升,但只有精浆中临床型和亚临床型之间相比差异有显著性(P<0.05)。③组1中,随着精子密度和精子活力的下降,外周血清和精浆中NO含量和NOS活性均有上升趋势,且精子密度≥20×106/ml和≤10×106/ml之间,精子活力≥50%和≤25%之间差异有显著性(P均<0.05)。结论:在VC诊断中精浆中NO含量和NOS活性测定较外周血清中更有意义。早期测定精浆NO含量和NOS活性对VC的诊断和治疗具有重要的临床价值。     

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.     

梗阻性黄疸患者并发肾功能损害时血清一氧化氮的保护作用

目的 探讨梗阻性黄疸患者并发肾功能损害时血清一氧化氮（NO）的变化及其意义。方法 检测梗阻性黄疸并发肾功能损害患者25例，并选取26例健康人作对照。分别测定血清NO，一氧化氮合成酶（NOS）活性，血尿素氮（BUN），肌酐（Cr）值。结果 梗阻性黄疸组BUN和Cr均高于健康对照组（P＜0．01），NO和NOS则低于健康对照组（P＜0．01）。相关分析显示NO与BUN，Cr呈负相关（P均＜0．01）。结论 梗阻性黄疸患者并发肾功能损害时血清NO和NOS下降，提示NO在梗阻性黄疸时对肾功能有一定的保护作用。     

亚临床型精索静脉曲张患者精浆NO浓度与精子活力关系

目的 探讨亚临床型精索静脉曲张(SVC)精浆一氧化氮(NO)浓度与精子活力的关系.方法 选择亚临床型精索静脉曲张患者35例为实验组,同时选择正常健康男性35例作对照组.采用计算机辅助精液分析技术测定各组精子活力,采用硝酸还原酶法测定精浆中NO浓度.结果 ①实验组精浆中NO浓度为52.19±17.12μmol/L,对照组精浆中NO浓度为38.06±6.43 μmol/L,实验组明显高于对照组,两者比较差异具有统计学意义(P＜0.05).②实验组精浆中NO水平与精子活力水平呈负相关性,具有统计学意义(P＜0.05).结论 亚临床型精索静脉曲张患者精浆中NO浓度增高,并在一定范围内与精子活力呈负相关.     

一氧化氮合酶在膀胱癌中的表达及临床意义

目的：探讨一氧化氮（NO）在膀胱肿瘤中的作用及临床意义。方法：采用免疫组织化学方法对58例膀胱移行细胞癌标本（实验组）及14例良性膀胱组织标本（对照组）进行一氧化氮合酶（NOS）抗体染色，观察表达结果与肿瘤生物学特性之间的相关性。结果：诱导型NOS（iNOS)在实验组中的阳性表达率明显高于对照组（P＜0．01），其表达程度与肿瘤分级、分期无关（P＞0．05）；内皮型NOS（eNOS）在实验组和对照组血管内皮细胞都有表达，但前者表达较强；而在对照组中多呈不连续的表达。结论：NO在膀胱移行细胞癌的发生、发展中起重要的作用。     

一氧化氮对精索静脉曲张患者精子功能的影响

精索静脉曲张（ＶＣ）是男性泌尿生殖系统中最常见的疾病之一,其对男性生育能力的影响越来越受到重视。为了探讨一氧化氮（ＮＯ）对精索静脉曲张患者精子功能的影响。我们测定了１５例ＶＣ不育患者及１２例有生育能力的正常人的精索静脉血清、外周静脉血清和精浆中ＮＯ含量及ＮＯＳ活性,现报道如下。一、材料和方法１．一般资料　（１）实验组：１５例精索静脉曲张不育患者,年龄２２～３６岁（平均２６岁）,婚后２～１０年内不育,查体１２例左侧精索静脉曲张（Ⅰ～Ⅲ度）,３例双侧精索静脉曲张（Ⅰ～Ⅱ度）,连续３次精液分析提示弱精…     

精索静脉曲张不育与微量元素锌和镉关系的研究

本研究应用原子吸收光谱法 (AAS)测定 18例精索静脉曲张 (VC)不育患者和 14例正常生育的斜疝和或鞘膜积液患者外周静脉血、精索静脉血、精浆中的锌 (Zn)和镉 (Cd)的含量。结果表明 :精索静脉曲张不育患者精静脉血和精浆中Cd含量较对照组明显增高 (P <0 .0 1)、而精浆中的Zn含量较对照组明显减低 (P <0 .0 1)。此外 ,其精索静脉血和精浆中Cd/Zn比值与对照组也有显著性差异 (P <0 .0 1)。提示Cd的增高可能是导致精索静脉曲张不育的原因之一     

川芎嗪联合氨胍对糖尿病大鼠肾脏一氧化氮的影响

目的：探讨川芎嗪联合氨胍对糖尿病肾脏病变的保护作用及其机制。方法：用链脲佐菌素制作糖尿病大鼠模型，分为正常对照组、糖尿病模型组、川芎嗪治疗组、氨胍治疗组和川芎嗪联合氨胍治疗组，于第12周测定各组大鼠肾组织一氧化氮合酶的活性和一氧化氮含量。结果：川芎嗪联合氨胍治疗纪、川芎嗪治疗组、氨胍治疗组大鼠肾组织NOS活性显高于模型组(P＜0．01)，NO的含量增加(P＜0．01)。川芎嗪治疗组、氨胍治疗组NOS活性低于正常对照组(P＜0．01)，NO的合量降低(P＜0．01)；川芎嗪合氨基胍治疗组与正常组相比无差异。结论：川芎嗪联合氨基胍能够增强糖尿病大鼠肾组织NOS活性，增加NO的含量，从而对糖尿病性肾病起一定治疗作用。     

总抗氧化能力和一氧化氮合酶对大鼠隐睾生殖细胞凋亡的影响

目的：探讨总抗氧化能力（T－AOC）和一氧化氮（NO）合物（NOS）对隐睾生殖细胞凋亡的影响。方法：SD雄性大鼠日龄22d时复制单侧隐睾模型。用生物素－dUTP/酶标亲和素测定法检测睾丸生殖细胞凋亡；用硝酸还原酶法测定睾丸组织中NO含量；用化学比色法测定睾丸组织中T－AOC、NOS活性。结果：术后第7天，与对侧睾丸相比，隐睾发生凋亡的生殖细胞数显著增加，NO含量及NOS活性显著上升（P＜0．01），在隐睾组织中两者呈正相关（γ3=0.890,P＜0．01）；T－AOC显著降低（P＜0．01）。结论：隐睾组织中NO和NOS升高、T－AOC下降是隐睾生殖细胞凋亡增加的生化机制之一。     

Nitric Oxide Synthase and Xanthine Oxidase Activities in the Spermatic Vein of Patients with Varicocele: A Potential Role for Nitric Oxide and Peroxynitrite in Sperm Dysfunction

Purpose

The oxidative and reductive stresses within the varicocele veins were estimated. Nitric oxide synthase and xanthine oxidase activities, as well as nitric oxide, S-nitrosothiols and superoxide release within the spermatic vein in patients with varicocele, and the role of the noxious oxidant peroxynitrite formed from nitric oxide and superoxide in sperm dysfunction were determined.

Materials and Methods

Whole blood samples were drawn from a peripheral vein and a dilated varicocele vein before ligation. Nitric oxide synthase, xanthine oxidase, nitric oxide and peroxynitrite were measured by novel spectro-fluorophotometric methods. S-nitrosothiols were estimated by a luminol-chemiluminescence method. Serum and red blood cell antioxidant capacity was determined by a chemiluminescence reaction.

Results

Serum nitric oxide synthase and xanthine oxidase activities, as well as nitric oxide, peroxynitrite and S-nitrosothiol levels were greater in the spermatic vein compared to the peripheral vein. Serum antioxidant capacity was greater in varicocele veins compared to peripheral veins. In contrast, the antioxidant capacity of red blood cells was less in the varicocele veins, which was consistent with an increased rate of peroxynitrite production.

Conclusions

Our data suggest a high oxidative stress due to the release of nitric oxide synthase and xanthine oxidase within the dilated spermatic vein. This reaction resulted in dramatic formation of nitric oxide, peroxynitrite and S-nitrosothiols, which are biologically active. Formation of peroxynitrite from the reaction of nitric oxide with superoxide could be a causative factor for impaired sperm function in patients with varicocele.     

Ligation of the left spermatic vein in the treatment of male infertility

During a 5 year period 26 selected infertile men underwent surgical correction of varicocele. They were followed up for at least 1 year after surgery. Significant improvement was detected in sperm count and motility (%) of semen analysis after ligation of the internal spermatic vein. Eight of the wives became pregnant after operation. The correction of varicocele by ligation of the internal spermatic vein is an accepted treatment for male infertility.     

不同术式治疗胡桃夹综合征所致左侧精索静脉曲张的疗效分析

目的探讨不同术式治疗胡桃夹综合征所致左侧精索静脉曲张的临床疗效。方法回顾性分析郑州大学第一附属医院在2015年7月至2018年9月期间诊治的胡桃夹综合征所致左侧精索静脉中重度曲张患者的临床资料。56例患者共分为3组,24例患者行显微镜下左侧精索静脉低位结扎术+精索外静脉剥离切除术为低位结扎组;19例患者行开放性左侧精索静脉高位结扎术为高位结扎组;13例患者左侧精索静脉中重度曲张并有血尿和/或蛋白尿,行腹腔镜下左肾静脉外支架固定术+生殖静脉结扎术,为血蛋白尿组。术后随访6~30个月,平均(11.5±6.5)月,患者于术前及术后6个月复查阴囊彩超及精液分析,对比精索静脉直径和精液恢复情况。结果①3组患者组内比较:精索静脉直径术后显著小于术前,精子浓度、精子活率术后显著高于术前,差异均有统计学意义(P均<0.01);组间比较:精子浓度3组间术前术后差异均无显著性统计学意义(P均>0.05);而精索静脉直径低位结扎组优于其他2组,精子活率的提高低位结扎组优于其他2组,差异均有统计学意义(P均<0.05)。②血蛋白尿组患者术后随访血尿、蛋白尿症状消失,左肾静脉受压状况明显改善,低位结扎组、高位结扎组左肾静脉受压状况无明显改善。结论显微镜下左侧精索静脉低位结扎术是治疗胡桃夹综合征所致左侧精索静脉中重度曲张的一种姑息、有效的手术方式。     

The relationship between varicocele and semen nitric oxide concentrations

We investigated the relationship between seminal plasma nitric oxide (NO) concentrations and conventional semen parameters in patients with varicocele. Semen samples were obtained from infertile patients with varicocele (n=55) and from normal controls (n=48). The mean NO concentration in the seminal plasma of patients with varicocele was significantly higher than that of the controls (P < 0.01). A significant negative correlation was noted between NO and sperm motility (r=−0.29, P=0.003), NO and sperm concentration (r=−0.26, P=0.008) and NO and normal morphology (normal %) (r=−0.25, P=0.01). It was concluded that increased NO production may influence sperm production, motility and morphology in patients with varicocele. Received: 21 February 2000 / Accepted: 20 June 2000     

双侧精索内动静脉结扎术后睾丸体积、精液质量变化的初步观察

目的初步评价双侧精索内动静脉结扎术后睾丸体积及精液质量的变化。方法对34例双侧精索静脉曲张患者中的16例行双侧精索内动静脉结扎术,于术前及术后随访时彩超测量睾丸体积,并行精液常规检查。结果睾丸体积无明显变化(P>0.05);精液量、精子数、精子活率明显提高(P<0.01),精子畸形率明显下降(P<0.01)。结论双侧精索内动静脉结扎术后睾丸无萎缩,精液质量明显改善。     

Sperm binding and ultrasound changes after operative repair of varicocele: correlation with fecundity

Summary. The study was conducted to evaluate the changes in sperm binding capacity and ultrasound measurements of the internal spermatic vein, after operative repair of a varicocele. In order to clarify the effect of a varicocele on fertility, these changes were correlated to pregnancy achievement. Twelve infertile males with subnormal semen parameters and varicocele, underwent operative repair. Pre- and post-operatively, all had semen analysis, hemizona assay and ultrasound of the internal spermatic veins. The patients were divided into three subgroups according to pregnancy outcome, and the changes in the different evaluation tests after the operation were compared. Sperm concentration and motility improved post-operatively in all three subgroups, whereas the hemizona index and ultrasonographic measurements improved significantly only in the subgroup that achieved early pregnancies (the mean post-operative percentage of normal morphology was significantly higher), compared to the subgroup without pregnancies. Unlike sperm parameters which improve after operative repair of the varicocele, but have no correlation to conception, sperm binding and ultrasound measurements of the internal spermatic veins improve significantly in cases that achieve early pregnancies. The use of these tests, as well as measuring the percentage of normal morphology, are recommended in all cases of infertility-related varicocele.     

Pattern of varicocele vein blood gases in patients undergoing microsurgical Varicocelectomy

Background

Varicocele is known to be associated with infertility and sperm disorders. The exact cause of this ailment is not fully understood. There are limited numbers of studies where venous blood gases (VBGs) of varicocele veins were determined with conflicting results. Therefore, we have investigated the pattern of VBGs in both internal spermatic and external spermatic varicocele veins and correlation with semen quality parameters in infertile individuals who underwent left microsurgical varicocelectomy.

Methods

Patients (n?=?27) undergoing left microsurgical varicocelectomy at a tertiary care hospital, were included in the study. Before surgery, semen parameters and scrotal color Doppler ultrasonography was performed. During surgery, blood sample was drawn from varicocele veins (internal spermatic and external spermatic veins) and a peripheral arm vein of the same patient as a control. The VBGs of all veins under study were estimated and compared with each other. The VBGs were also correlated with various semen quality parameters. Data, expressed as Mean?±?SD, regarding VBGs in three veins were analyzed using one-way ANOVA. The correlation between VBGs and semen quality parameters was determined using Pearson’s correlation. Differences were considered significant at p?<?0.05.

Results

The pH was found to be higher (p?<?0.01) in the internal spermatic vein compared with the external spermatic and the peripheral veins. Partial pressure of oxygen (pO₂) and oxygen saturation (sO₂) were higher (p?<?0.01) in the internal spermatic vein compared with the peripheral vein. However, concentration of bicarbonate (HCO₃₎ was lower (p?<?0.01) in both veins compared with the peripheral vein. Partial pressure of carbon dioxide (pCO₂) was also lower (p?<?0.01) in the varicocele veins compared with the control vein.

Conclusion

The internal spermatic veins had higher pH and oxygen tension, but lower HCO₃ and pCO₂ levels compared with the control peripheral veins. External spermatic veins had lower pCO₂ and HCO₃ but other VBGs were similar to the peripheral veins. The shift of VBGs of internal spermatic vein toward arterial blood pattern may be a missing link to understand the pathophysiology of varicocele.