精索静脉曲张不育患者各项精液分析指标的特征及其临床价值

目的通过比较精索静脉曲张不育患者与健康婚育检查人士各项精液分析指标水平,探讨精索静脉曲张不育患者各项精液分析指标的特征,并分析精子DNA碎片指数(DFI)与其他精液分析指标的相关性,以及各项指标联合检测在精索静脉曲张不育中的诊断效能。方法将该院2019年经B超确诊为精索静脉曲张,并同时进行精子DNA完整性检查、精液常规参数分析和精子形态分析的107例不育患者纳入精索静脉曲张组,选择同期60例健康婚育检查人士纳入健康对照组。检测并比较两组研究对象精子DFI、高DNA可染性(HDS)、精子浓度、前向运动精子(PR)、正常形态精子百分比(PNS)、畸形精子指数(TZI)、精子畸形指数(SDI),分析精子DFI与其他精液分析指标的相关性,绘制受试者工作特征(ROC)曲线,判断联合检测在精索静脉曲张不育患者中的诊断效能。结果两组精子DFI、HDS、精子浓度、PR、PNS、TZI、SDI比较,差异均有统计学意义(P<0.05)。精子DFI与HDS、TZI、SDI呈正相关(r=0.530、0.454、0.306,P<0.05),与PR、PNS呈负相关(r=—0.559、—0.245,P<0.05),与精子浓度无明显相关性(r=—0.112,P>0.05)。多因素Logistic回归分析显示,精子DFI与HDS是精索静脉曲张不育的独立危险因素精子DFI(OR=1.179,95%CI:1.094~1.271,P<0.05)、HDS(OR=1.150,95%CI:1.029~1.286,P<0.05)]。ROC曲线分析显示,各项指标联合检测ROC曲线下面积(AUC)为0.871(95%CI:0.819~0.924,P<0.05),灵敏度为71.0%,特异度为95.0%,阳性预测值为95.0%,阴性预测值为65.5%,约登指数为0.660,诊断效能均优于单独检测。结论精索静脉曲张不育患者精子DNA完整性、常规精液分析结果与健康人有差异,精子DFI与部分精液分析指标存在相关性,精子DFI与其他精液常规分析参数联合检测能为临床筛查和治疗精索静脉曲张不育提供更好的依据。

Features and clinical value of routine semen analysis indicators in study of varicocele infertility patients

Objective By comparing the semen analysis index levels of varicocele infertility patients and health examination person,to analyze characteristics of these indicators of varicocele infertility patients,and analyze the correlations between sperm DNA fragmentation index(DFI)and other indicators,as well as the value of joint detection of these indicators in patients with varicocele infertility.Methods In 2019,107 cases of infertility patients with B-ultrasound diagnosed as varicocele in Luohu District People′s Hospital were retrospectively collected into varicocele infertility group.Meanwhile,107 cases of infertility patients were examined for sperm DNA integrity,semen routine analysis and sperm morphological analysis.A total of 60 healthy marriage and childbirth examinees in the same period were collected into healthy control group.The results of sperm DFI,high DNA staining cells(HDS),sperm concentration,sperm forward movement(PR),percentage of normal sperm(PNS),malformed sperm index(TZI),defective sperm index(SDI)between the two groups were compared,the correlation between the parameters of sperm DFI and routine semen analysis was analyzed,and the receiver operating characteristic curve(ROC)was established to determine the diagnostic efficacy of combined detection in patients with varicocele infertility.Results The sperm DFI,HDS,sperm concentration,PR,PNS,TZI,SDI in varicocele infertility group had statistically significant differences compared with those in healthy control group(P<0.05).Sperm DFI positively correlated with HDS,TZI and SDI(r=0.530,0.454,0.306,P<0.05),negatively correlated with PR and PNS(r=—0.559,—0.245,P<0.05),and not significantly correlated with sperm concentration(r=—0.112,P>0.05).Multivariate Logistic regression analysis showed that sperm DFI and HDS were independent risk factors for varicocele infertility,sperm DFI with OR=1.179,95%CI:1.094—1.271,P<0.05 and HDS with OR=1.150,95%CI:1.029-1.286,P<0.05.ROC curve analysis showed that the area under the curve of combined multi-parameter was 0.871(95%CI:0.819-0.924,P<0.05),the sensitivity was 71.0%,the specificity was 95.0%,the positive predictive value was 95.0%,the negative predictive value was 65.5%,and the Yoden index was 0.660,all of which were better than the single-parameter diagnosis.Conclusion Sperm DNA integrity and routine semen analysis results of patients with varicocele infertility are different from those of healthy patients.Sperm DFI correlates with some items of routine semen analysis,and joint detection could provide better basis and help for clinical diagnosis and treatment of varicocele infertility.