男性附属性腺感染(MAGIs)在继发性无精子症中的作用探讨

<正>无精子症占男性不育症的19%~30%[1],欧洲泌尿外科学会(The European Association of Urology,EAU)2012年发表的《EAU男性不育症(Male Infertility,MI)指南(2012年版)》(以下简称《指南》)认为,没有数据表明男性附属性腺感染(male accessory gland infections,MAGIs)[2-4]包括尿道炎、前列腺炎、睾丸炎、附睾炎对精液质量和男性生育有消极影响,最近发表的2013年版EAU仍然持此观点,强调尿道炎和前列腺炎与男性不育的关系并不明确,为了了解男性附属性腺感染在男性无精子症及特别是     

ESRD患者C反应蛋白水平与炎症

C反应蛋白是炎症的敏感指标，而炎症在终末期肾病患者中非常普遍。本文就终末期肾病患者C反应蛋白水平与营养不良、心血管并发症以及与EPO低反应性贫血的关系进行了综述。     

ESRD患者C反应蛋白水平与炎症

C反应蛋白是炎症的敏感指标 ,而炎症在终末期肾病患者中非常普遍。本文就终末期肾病患者C反应蛋白水平与营养不良、心血管并发症以及与EPO低反应性贫血的关系进行了综述。     

精浆蛋白电泳分析的临床意义

目的为了初步了解男性精浆中的蛋白电泳谱以及蛋白谱与男性生育能力的相关关系。方法通过应用SPIFE3000全自动电泳分析仪对20例对照组(生育组)与140例观察组(不育组)的精浆进行蛋白分离(琼脂糖区带电泳法),建立其精浆蛋白质的特征电泳图谱,并进行对比分析。结果精浆蛋白经酸蓝染色后,区带清晰,从阳极到阴极分为A、B、C、D、E 5条带,电泳各区带百分比含量结果经方差分析,发现不育组与生育组A、C、D、E百分比含量变化有统计学意义(P<0.01),且无精子症患者精浆的蛋白谱有特异的"双峰"特点。结论精浆蛋白区带电泳分析可作为不育症的辅助诊断指标,且将是对男性不育诊断手段的有力补充。     

C反应蛋白在EST术后胰腺炎早期诊断中的意义

目的 探讨C反应蛋白(C-reactive protein,CRP)对内镜下乳头括约肌切开术(EST)术后胰腺炎的早期诊断.方法 选择经B超、CT或MRI(MRCP)证实为胆管结石的病人42例.①所有病人将拟施行ERCP、EST及经内镜取石,分别于术前1h及术后6h、24 h、48h抽取空腹静脉血,同时测定这4个时间点的淀粉酶、脂肪酶及CRP.②将EST术后病人分为EST术后胰腺炎组((post-EST pancreatits,PEP组)和EST术后非胰腺炎组(非PEP组),对两组的淀粉酶、脂肪酶及CRP进行比较.结果 在入选EST术后病人中,PEP组有5例,非PEP组有37例.两组病人术前淀粉酶、脂肪酶和CRP经比较,差异均无统计学意义(P＞0.05).在PEP组,与术前比较,淀粉酶从6h开始差异有统计学意义,脂肪酶从24 h开始差异有统计学意义,CRP在6h时差异有统计学意义.在非PEP组,脂肪酶和CRP在6h、24 h、48 h这3个时间点与术前比较,差异均无统计学意义(P＞0.05);淀粉酶在术后24 h开始与术前比较,差异有统计学意义(P＜0.05).结论 CRP可与血清淀粉酶、脂肪酶联合测定,作为EST术后急性胰腺炎早期诊断的指标之一.     

Clusterin蛋白在男性不育症睾丸组织中的表达及意义

目的 探讨Clusterin蛋白在男性不育症患者睾丸组织中的表达及意义.方法 采用免疫组化染色法和Western blot法检测了10例正常睾丸组织,8例梗阻性不育患者睾丸组织,13例非梗阻性不育患者睾丸组织标本中Clusterin蛋白的表达水平.结果 免疫组化染色结果表明,3组睾丸组织中Clusterin蛋白都有表达,.正常睾丸组织、梗阻性不育患者睾丸组织、非梗阻性不育患者睾丸组织中阳性或强阳性表达率分别为100%(10/10),87.5%(7/8),46%(6/13),非梗阻性不育睾丸组织中Clusterin蛋白表达水平显著低于正常睾丸组织(P<0.05).Western blot法检测结果也表明,该蛋白在非梗阻性不育睾丸组织中的表达较正常睾丸组织显著降低,而在梗阻性不育睾丸组织中的表达无显著性降低.结论 Clusterin蛋白的表达降低与非梗阻性不育症的发生密切相关.     

血清降钙素原与C反应蛋白在反流性胆管炎中的临床诊疗价值

目的:探讨血清降钙素原(PCT)与C反应蛋(CRP)水平在反流性胆管炎的临床诊疗价值。方法:回顾性分析2010年1月—2014年6月收治的40例反流性胆管炎的患者资料,患者治疗前均行血培养、胆汁细菌培养检查,并检测治疗前及治疗后4 d血清PCT、CRP及血白细胞(WBC)值;比较各项指标治疗前的检测阳性率的差异以及PCT、CRP和WBC值治疗前后的变化,根据患者感染是否控制分组,用受试者工作特征曲线(ROC)分析PCT、CRP和WBC治疗后/治疗前比值与感染是否控制的关系。结果:治疗前PCT、CRP、WBC、血培养、胆汁培养阳性检测率分别为92.5%、87.5%、57.5%、25.0%、100.0%,PCT与CRP的阳性率差异无统计学意义(P=0.709),但均明显高于WBC和血培养(均P0.05);与治疗前比较,治疗后血清PCT、CPR值均明显降低(均P0.05),但血WBC水平变化不明显(P0.05);PCT比值对感染控制的判断ROC曲线下面积为0.827(95%CI=0.724~0.929,P0.001),灵敏度为87.5%,特异度为77.5%,CPR为0.764(95%CI=0.644~0.883,P0.001),灵敏度为92.5%,特异度为60.5%,而WBC比值差异无统计学意义(P0.05)。结论:血清PCT、CRP水平是诊断反流性胆管炎的敏感指标,两者的变化对判断反流性胆管炎患者感染是否得到有效控制起到重要的参考价值。     

超敏C反应蛋白在冠心病患者中的意义

目的:研究超敏C反应蛋白(hs-CRP)的检测在冠心病患者中的意义.方法:随机选择我院心血管内科住院病房确诊冠心病(CAD)的患者100例,将其划分为急性心肌梗死组(AMI),不稳定型心绞痛组(UAP),稳定型心绞痛组(SAP).随机选择门诊100例健康人群作为对照.分别测定其hs-CRP水平.结果:冠心病患者的hs-CRP水平明显高于健康人群,AMI组的hs-CRP水平高于UAP组,UAP组的hs-CRP水平高于SAP组,且差异具有统计学意义.结论:hs-CRP的检测对于冠心病患者的病情分级及预后有重要意义.     

慢性前列腺炎合并男性不育患者精浆生化指标的变化

目的探讨慢性前列腺炎(CP)所致男性不育患者精液生化指标以及电解质的变化。方法自门诊选择无CP正常生育健康志愿者对照组(A组)17例;以及慢性前列腺炎患者54例,按精液液化时间分为B组(液化时间正常组)和C组(延迟液化组),分别测定精浆中前列腺特异性抗原、酸性磷酸酶、唾液酸以及果糖的浓度,并测定钾、钠、钙、氯等浓度。结果正常生育组、CP液化正常组及CP液化异常组精浆PSA浓度有显著性差异(P<0.001)。K 浓度有差异性(P<0.05)。Ca2 浓度有差异性(P<0.05)。PAP浓度无统计学意义(P>0.05)。唾液酸以及果糖浓度无差异性(P>0.05)。Na 浓度无差异性(P>0.05)。Cl-浓度无差异性(P>0.05)。结论CP所致男性不育患者与健康正常组相比,精浆PSA以及K 、Ca2 存在差异。     

Ultrasonographic evaluation of patients with male accessory gland infection

MAGI is the inflammation of the accessory male glands that notoriously exerts a negative influence on male fertility. The diagnosis is integrated by clinical, laboratory and ultrasound evaluation. In particular, the ultrasound criteria were published in 1999. The aim of this study was to analyse the sensitivity and specificity of additional diagnostic ultrasound criteria as well as of conventional criteria in a selected category of infertile patients with MAGI. To accomplish this, 100 patients with MAGI were evaluated by scrotal and transrectal ultrasound by three different operators. The control group consisted of 100 age-matched healthy men. Statistical analysis was performed to evaluate sensitivity, specificity, positive and negative predictive values, and ROC curve analysis. The results showed that additional ultrasound criteria had a diagnostic accuracy similar to traditional criteria. The threshold value of two criteria for each diagnostic category (traditional and additional criteria) obtained high values of sensitivity and specificity. In conclusion, this study confirms the validity of the ultrasound criteria of MAGI previously published; in addition, it suggests the clinical utility of other indicators in clinical practice with good diagnostic accuracy and finally it establishes a clear threshold ultrasonographic value for the diagnosis of MAGI.     

Cellular and biochemical markers in semen indicating male accessory gland inflammation

Leucocytospermia is considered to be a sign of male accessory gland inflammation. The leucocytes in semen are mainly polymorphonuclear neutrophilic granulocytes. Leucocytospermia is not associated with the presence of bacteria and antibiotic treatment does not significantly lower the extent of leucocytospermia. A higher frequency of elevated herpes simplex antibodies titres were found in men with leucocytospermia. The concentration of inflammatory cytokines, interleukin-6 and -8, is closely correlated with the number of leucocytes. Their determination does not provide additional information. Reactive oxygen species (ROS) are generated at least in part by seminal leucocytes in response to stimulating factors. Purified leucocytes produce high levels of ROS. The determination of ROS appears to represent a parameter of functional activity of leucocytes. The role of chlamydiae in male accessory gland infection is unclear. Their determination in semen by DNA amplification and by immunological tests does not provide reliable results.     

Fertility, fecundity, sex ratio and the accessory sex glands in male golden hamsters

The ventral prostates, dorsolateral prostates, coagulating glands (anterior prostates), ampullary glands and/or seminal vesicles of male golden hamsters were excised bilaterally. The effects of these treatments on fertility, fecundity and sex ratio of offspring were studied. Total removal of the glands or ablation of the ventral prostates alone reduced fertility. The lack of secretions from the coagulating glands and seminal vesicles in the seminal fluid all favoured a higher proportion of male pups born in a litter. Absence of all or any of these glands did not appear to affect litter size.     

The effect of doxycycline in infertile couples with male accessory gland infection: a double blind prospective study

Male accessory gland infection (MAGI, epididymo-prostato-vesiculitis) with abnormal semen quality was rarely the only abnormality in infertile couples since it occurred in no more than 1.6% of 2871 couples evaluated in 7 centres during a 3-year period. Both partners of 33 infertile couples with no other demonstrable abnormality than abnormal semen and MAGI consented to participate in a double blind trial and were treated with either doxycycline, 100 mg/day for 1 month (20 couples) or placebo (13 couples). Follow-up during a total of 175 couple-months included semen analysis and the recording of pregnancy. Pregnancy occurred in 2 of the doxycycline-treated couples (10%) and in 1 of the placebo treated couples (8%), corresponding with conception rates per month of 1.9% and 1.5%, respectively. Sperm motility and, to a lesser extent, morphology showed improvement in both groups. Evidence of infection, namely increased numbers of white blood cells and positive sperm culture, disappeared in both the doxycycline-treated and placebo group. It is concluded that features of MAGI in semen may regress spontaneously and are not influenced by the doxycycline treatment. The concomitant improvement of sperm motility and morphology still does not seem to enhance the probability of conception.     

Persistence of ultrasound alterations after antibiotic treatment with levofloxacin in patients with male accessory gland infection

No studies have evaluated the ultrasound features of the male sex accessory glands in infertile patients with bacterial male accessory gland infection (MAGI) according to the microbiological outcomes of bacterial cultures (absent, partial or complete) following antibiotic therapy administration. Therefore, the aim of this study was to evaluate the ultrasound characteristics of the prostate, seminal vesicles, and epididymal tracts after treatment with levofloxacin (a common quinolone antibiotic), in patients with infections caused by Escherichia coli (a Gram-negative bacterium) according to the Naber''s classification, which includes the following categories: eradication, eradication with superinfection, persistence and persistence with superinfection. The study was conducted in 100 patients aged 25±8 years (range: 20–40 years) with bacterial MAGI and bacterial cultures positive only for E. coli (colony forming units ≥10⁶ per ml). Retrospective analysis was conducted only on patients treated with oral levofloxacin (500 mg) administered once daily for 28 days who were recruited over the last 5 years. Following antibiotic treatment, patients with microbiological persistence or persistence with superinfection had a significantly higher percentage of ultrasound abnormalities suggestive of prostato-vesiculitis (PV) (30.2% and 36.0%, respectively) or prostato-vesiculo-epididymitis (PVE) (60.2% and 70.0%, respectively) compared with patients with microbiological eradication (PV=10.2% and PVE=8.2%, respectively) or eradication with superinfection (PV=18.8% and PVE=21.2%, respectively). In conclusion, patients with microbiological persistence or persistence plus superinfection showed the highest prevalence of complicated forms of MAGI (PV and PVE), compared with patients with microbiological eradication or eradication with superinfection.     

C-反应蛋白和血清降钙素原对危重患者感染的监测价值研究

目的探讨C-反应蛋白（CRP）和血清降钙素原（PCT）对危重患者感染的监测价值。方法收集2012年10月至2013年10月本院ICU病房收治的98例危重患者,根据辅助检查结果将其分为细菌感染组（68例）和病毒感染组（30例）两组,对其PCT和CRP含量进行测定。并将细菌感染组患者随机分为观察组和对照组,每组各34例;动态监测其治疗前后PCT和CRP含量的变化情况。结果细菌感染组和病毒感染组患者的PCT平均含量分别为（3.64±0.58）μg/L和（0.37±0.35）μg/L,差异具有统计学意义（t=2.437,P〈0.05）。细菌感染组和病毒感染组患者的CRP平均含量分别为（38.27±20.55）mg/L和（37.91±20.63 mg/L）相比,差异无统计学意义（t=0.694,P〉0.05）。观察组治疗后PCT的平均含量由治疗前的（3.68±0.62）μg/L下降为（0.53±0.21）μg/L,相比于对照组由治疗前的（3.59±0.51）μg/L下降为（2.67±0.43）μg/L,下降幅度更大;观察组治疗后CRP的平均含量为（13.81±5.64）mg/L,显著低于对照组的（21.53±5.38）mg/L,差异具有统计学意义（t=5.724,P〈0.05）。结论 PCT和CRP含量的动态监测在临床应用时各有优势,二者联合应用,在对危重患者感染的诊断和治疗中具有极高的临床价值。     

伴随自主神经病变的二型糖尿病人中雄附腺炎症的发病率

雄附腺炎（MAGI）在二型糖尿病人（DM2）当中可能被漏诊。近期文献报道TDM2中MAGI的发病率是43％。以往的研究证明糖尿病患者的自主神经病变与精子囊泡的特有超声波有关。本项研究意在评估二类DM2患者（是否具有自主神经病变）的MAGI发病率并测定各自的超声特征。共60例DM2患者（平均年龄42．0±6．0岁）根据是否具有自主神经病变分为二组（A组具有可能的神经病变症状共28人,B组无神经病变症状共32人）。结果发现A组较B组有更高的MAGI发病率及精囊炎的超声频率。此外,A组患者精液中的淋巴细胞聚焦浓度显著高于B组。     

Male accessory gland infection: standardization of inflammatory parameters including cytokines

Assessment of infection of the male accessory glands is usually based on the search for white blood cells in different specimens to document an inflammatory reaction. This widely used practice allows to establish the diagnosis of inflammation in many cases. However, clinical symptoms do not always correlate with the presence or absence of white blood cells. This is particularly true for chronic prostatitis/chronic pelvic pain syndrome. In the last few years different research efforts have been made to look for markers of inflammation other than elements of the white blood cell line. Several studies suggest that humoral rather than cellular parameters are involved in male accessory gland infections. Substances such as reactive oxygen species, nerve growth factor and cytokines seem to be important not only in the pathogenesis of the inflammatory reaction but may also serve as diagnostic markers to indicate the presence of inflammation.     

精浆蛋白电泳带谱分析对梗阻性无精子症的定位诊断价值

目的：评估精浆蛋白电泳带谱对梗阻性无精子症的定位诊断价值。方法：对28例正常生育男子和21例梗阻性无精子症患者(包括14例双侧输精管结扎和7例双侧附睾尾梗阻)，采用不连续SDS-PAGE分析精浆蛋白带谱变化，并分别测定精浆总蛋白质含量。结果：正常生育男子与梗阻性无精子症者比较，虽然总蛋白质含量有差异(P＜0．05)，但精浆蛋白带谱分析基本相同。结论：精浆蛋白电泳带谱分析对梗阻性无精症的诊断及定位无临床意义。     

Leucocyte populations in semen and male accessory gland function: relationship with antisperm antibodies and seminal quality

Semen samples from 279 infertility patients attending an Immunological Centre were analysed to evaluate the relationship between the populations of leucocytes, seminal quality, antisperm antibodies, and seminal vesicle function. The most frequent finding between leucocytospermic samples was asthenozoospermia (57%), whereas in non-leucocytospermic samples normozoospermia was the most frequent finding (47%). In the samples with asthenozoospermia, granulocytes predominated, whereas in those with oligozoospermia and azoospermia a reduction in the number of macrophages and lymphocytes was observed, suggesting an obstructive process at the level of epididymis and/or vas deferens where these leucocytes are mostly produced. In the case of hypofunction of the seminal vesicles there was a predominance in granulocytes. The increased levels of each type of leucocytes affected seminal quality only when seminal vesicles were affected. Only the elevated granulocytes count was related to a decrease in sperm motility. In those samples with leucocytospermia, positive antisperm antibodies (ASA) were associated with low sperm motility, low sperm normal morphology, and low value of seminal corrected fructose, whereas, in the absence of leucocytospermia, ASA, were more related to low sperm counts. These data suggest that granulocytes were more related to seminal vesicles dysfunction and sperm motility changes, and that ASA may be observed in the presence or absence of leucocytospermia.