精索静脉曲张不育症患者精浆生化标志物与精子顶体酶的测定与分 析简

目的探讨精索静脉曲张（VC）不育症与精浆生化标志物及精子顶体酶的关系，为精索静脉曲张不育症的发病机制提供实验依据。方法患者来源于2012年5月～2013年5月广东省中医院珠海医院男科门诊就诊的不育症患者，随机选取VC不育症精液参数异常者（A组）136例，生殖系统感染性不育症但无VC且精液参数异常者（B组）32例，有VC精液参数正常者（C组）35例，另取无VC且精液参数正常并已生育的体检健康者（D组）35例设为正常对照。其中A组根据VC的程度分为A1组（Ⅰ度）34例、A2组（Ⅱ度）35例、A3组（Ⅲ度）35例、A4组（亚临床型）32例，分别对其精浆中性α-葡萄糖苷酶、锌、弹性硬蛋白酶、酸性磷酸酶、精子顶体酶含量进行定量检测。结果A组与B组中性α-糖苷酶含量分别为（28．44±17．02）、（25．27±10．17）mu／一次射精．精子顶体酶含量分别为（70．20±49．02）、（50．93±38．64）μIU／10^6精子，两组相比，差异无统计学意义（P〉0．05）；锌含量分别为（2．57±1．19）、（1．85±1．11）μmol／mL，弹性硬蛋白酶含量分别为（178．14±79．36）、（601．84±553．97）μg／L，酸性磷酸酶含量分别为（239．71±35．21）、（147．96±28．44）U／一次射精，两组相比，差异有高度统计学意义（P〈0．01）；C组中性α-糖苷酶含量为（48．02±21．10）mU／一次射精，精子顶体酶含量为（138．46±99．14）μIU／10^6精子，与A组相比．差异有高度统计学意义（P〈0．01）；锌含量分别为（3．87±1．85）μmol／mL，与A组相比，差异有统计学意义（P〈0．05）：弹性硬蛋白酶含量为（182．01±108．64）μg／L，酸性磷酸酶含量为（270．11±31．03）U／一次射精，与A组相比．差异无统计学意义（P〉0．05）。D组中性α-糖苷酶含量为（50．82±20．85）mU／一次射精，锌含量为（3．90±1．62）μmol／mL，精子顶体酶含量为（146．78±90．59）μIU／10^6精子，与A组相比，差异有高度统计学意义（P〈0．01）；酸性磷酸酶含量为（269．64±28．91）U／一次射精，与A组相比，差异有统计学意义（P〈0．05）；弹性硬蛋白酶含量为（177．77±86．55）μg/L，与D组相比，差异无统计学意义（P〉0．05）；精索静脉曲张不育症各亚组A4组、A1组、A2组、A3组曲张程度逐渐加重．各组进行多组问方差分析比较，其中A1、A3组、A4组中性α-糖苷酶含量分别为（31．87±20．45）、（21．57±7．15）、（34．12±19．34）mU／一次射精，A1与A3、A3与A4两组相比，差异有统计学意义（P〈0．05）。A2、A3、A4组顶体酶含量分别为（53．11±19．34）、（45．50±28．76）、（974．73±42．41）μIU／10^6精子，A2与A4两组相比，差异有统计学意义（P〈0．05），A3与A4两组相比，差异有高度统计学意义（P〈0．01）。结论VC可导致仅一糖苷酶活性、锌、酸性磷酸酶、精子顶体酶含量下降，随曲张程度加重，α-糖苷酶、精子顶体酶活性下降越明显，影响精子的活动力和受精能力。

The analysis and determination of biochemical marker of seminal plasma and spermatozoa acrosin in infertile patients with varicocele

Objective To investigate the relationship among the biochemical marker of seminal plasma, spermatozoa acrosin and infertility with varicocele and provide experimental basis for the pathogenesis of infertility with varicocele.Methods Infertility patients were provided by Andrology Clinic in Zhuhai Branch of Guangdong Provincial ＇Hospi- tal of TCM, received from May 2012 to May 2013. 136 samples of abnormal seminal parameters of varicocele （group A）, 32 samples of non-VC, abnormal seminal pa-rameters, reproductive system infective infertility （group B）, 35 samples of normal parameters of VC semen （group C） were randomly selected. Additional 35 samples of non-VC, normal seminal parameters and normal fertility （group D） were served as normal control. Based on the severe degree of varicocele, samples in group A were further divided into group A1 （lst degree） with 34 samples, group A2 （2nd degree） with 35 samples, Group A3 （3rd degree） with 35 samples and group A4 （Subclinical） with 32 samples. The quantitive determination was processed on neutral α-glycosidase （NAG）, Zine, PMN-elastase, acid phosphatase and spermatozoa acrosin in seminal plasma in all groups. Results The contents of NAG in group A and group B respectively were （28.44±17.02）, （25.27±10.17） mU/ejaculation. The contents of spermatozoa aerosin in group A and group B respectively were （70.20±49.02）, （50.93±38.64） μIU/10^6 sperms, no sig- nificant difference was found in the content of NAG and spermatozoa acrosin between group A and group B （P 〉 0.05）; the contents of Zinc in group A and group B respectively were （2.57±1.19）, （1.85±1.11） μmol/mL. The contents of PMN-elas- tase in group A and group B respectively were （178.14±79.36）, （601.84±553.97） μg/L. The contents of acid phosphatase in group A and group B respectively were （239.71±35.21）, （147.96±28.44） U/ejaculation. Huge differences （P 〈 0.01） were found in the contents of acid phosphatase, Zinc and PMN-elastase between Group A and Group B; the content of NAG in group C was （178.14±79.36） mU/ejaculation. The content of spermatozoa acrosin in Group C was （138.46±99.14） μIU/106 sperms. Huge significant differences （P 〈 0.01） were found in the content of NAG and spermatozoa acrosin be- tween Group A and Group C; the content of Zine in Group C was （3.87±1.85） μmol/mL and significant difference （P 〈 0.05） was found in the content of Zinc by comparing with Group A; the content of PMN-elastase in Group C was （182.01±108.64） μg/L. The content of acid phosphatase in Group C was （270.11±31.03） U/ejaculation. No significant dif- ference was found in the contents of PMN-elastase and acid phosphatase between group A and group C （P 〉 0.05）; the content of NAG in Group D was （50.82±20.85） mU/ejaculation. The content of Zinc in group D was （3.90±1.62） μmol/ mL. The content of spermatozoa acrosin in group D was （146.78±90.59） μIU/10^6 sperms. Huge differences were found in the contents of spermatozoa acrosin, Zinc and NAG between group A and group D （P 〈 0.01）; the content of acid phos- phatase in group D was （269.64±28.91） U/ejaculation and significant difference was found by comparing with group A; the contents of PMN-elastase in group D was （177.77±86.55） μg/L and no significant difference was found by comparing with normal control group （P 〉 0.05）; in group A, sub-groups A4, A1, A2, A3 were ranked in sequence based on incre- mental severity of varicose. Variance analysis comparison of multi-groups was processed among each sub-group. The content of NAG in sub-groups A1, A3, A4 respectively were （31.87±20.45）, （21.57±7.15）, （34.12±19.34） mU/ejacula- tion. Significant differences were found in the content of NAG between A1 and A3, between A3 and A4 （P 〈 0.05）. The content of spermatozoa acrosin in sub-groups A2, A3, A4 respectively were （53.11±19.34）, （45.50±28.76）, （74.73±42.41） μIU/106 sperms. Significant differences were found between A2 and A4 （P 〈 0.05）. Huge differences were found between A3 and A4 （P 〈 0.01）. Conclusion VC can lead to the reduction of NAG activity, Zinc, acid phosphatase and sperma- tozoa acrosin content. The increased severity of varicocele causes the more obvious reduction of NAG and spermatozoa acrosin, which affects the quality of semen and fertility.