男性不育患者精液质量及其影响因素分析

doi:10.13481/j.1671-587X.20220225

摘要/Abstract

摘要： 目的

分析男性不育患者的精液质量，探讨近年来男性不育患者精液质量的总体情况和变化趋势。

方法

选取就诊于中国人民解放军陆军第七十三集团军医院生殖医学中心和厦门大学附属第一医院生殖医学中心的4 190例男性不育患者，分析总体精液参数。按患者年龄、检测年份、禁欲天数和检测季节分组，分析其精液常规参数和正常形态精子百分率，进行组间比较。采用多元线性回归分析，分析患者年龄、检测年份、禁欲天数和检测季节等因素对精液参数的影响。

结果

患者平均年龄（31.81±5.55）岁，患者精液量、精液pH值、精子浓度、精子总数、精子总活动率、前向运动精子（PR）和正常形态精子百分率的中位数分别为3.0 mL、7.3、47.0×10⁶mL^－1、139.3×10⁶/每次射精、75.0%、53.0%和3.4%。年份组间精液参数差异有统计学意义（P<0.05），患者精子总活动率、PR和正常精子形态百分率在2017—2019年呈逐年下降趋势；年龄分组中，患者精子总活动率和正常形态精子百分率组间比较差异有统计学意义（P<0.05）；禁欲天数分组中，患者精子浓度、精子总数、精子总活动率和PR在各组间比较差异有统计学意义（P<0.05）；季节分组中，患者精子浓度、精子总活动率、PR和正常形态精子百分率在各组间比较差异有统计学意义（P<0.05）。多元线性回归分析，不同年龄组间精液参数比较差异无统计学意义（P>0.05）；禁欲天数与患者精子浓度、精子总数、精子总活动率和PR有关联；季节变化与患者精子总数、精子总活动率和PR有关联。

结论

4 190例男性不育患者精子总活动率、PR和正常形态精子百分率在2017—2019年呈逐年下降趋势，禁欲天数和检测季节可影响患者部分精液参数。

关键词: 男性不育, 精液质量, 禁欲时间, 年龄, 季节

Abstract: Objective

To analyze the semen quality of male infertility patients， and to discuss the general situation and trend of semen quality of the male infertility patients in recent years.

Methods

A total of 4 190 male infertility patients who were treated in Reproduction Medicine Center of 73rd Army Hospital of the People’s Liberation Army and Reproductive Medicine Center of the First Affiliated Hospital of Xiamen University were selected and their total semen parameters were analyzed. The patients were grouped according to age， testing year， abstinence days and testing season， and the routine parameters of semen and the percentage of normal sperm were analyzed and compared between groups.Multiple linear regression analysis was conducted to analyze the effects of age， testing year， abstinence days and testing season on the semen parameters.

Results

The mean age of the patients was （31.81±5.55） years old；the medians of semen volume serum， pH value semen， sperm concentration， total number of sperm，total motility rate， forward motility sperm（PR） and percentage of normal sperm of patients were 3.0 mL， 7.3， 47×10⁶mL^－1， 139.3×10⁶/each ejaculation， 75%， 53% and 3.4%，respectively.There were statistically significant differences in the semen parameters between testing year groups （P<0.05），and the total motility rate， PR and the percentage of normal sperm of patients showed a decreasing trend from 2017—2019.Among age groups， there were significant differences in the total activity rates and percentages of normal sperm of patients among various groups（P<0.05）. In abstinence groups day， there were statistically significant differences in the sperm concentrations， total number of sperm， total motility rates of sperm and PR of patients among various groups （P<0.05）. In the seasonal groups， there were statistically significant differences in the sperm concentrations， total motility rate of sperm， PR and percentages of normal sperm of patients among various groups（P<0.05）.The results of multiple linear regression analysis showed that there was no significant differences in the semen parameters between different age groups；the abstinence days was related to sperm concentration， total number of sperm， total motility rate of sperm and PR of patients， and the seasonal variation was related to the total sperm， total motility rate of sperm and PR of patients.

Conclusion

The total motility rate， PR and percentage of normal sperm in 4 190 male infertility patients show a decreasing trend from 2017—2019， and abstinence days and testing season can affect some semen parameters of the patients.

Key words: Male infertility, Semen quality, Abstinence time, Age, Season

中图分类号:

R698.2

刘巧斌,程玲,叶圆圆,孙鸣,李友筑. 男性不育患者精液质量及其影响因素分析[J]. 吉林大学学报(医学版), 2022, 48(2): 470-477.

Qiaobin LIU,Ling CHENG,Yuanyuan YE,Ming SUN,Youzhu LI. Analysis on semen quality and its influencing factors in male infertility patients[J]. Journal of Jilin University(Medicine Edition), 2022, 48(2): 470-477.

图/表 7

表1

表2

表3

表4

表5

表6

表7

参考文献 22

1	LI W N， JIA M M， PENG Y Q， et al. Semen quality pattern and age threshold： a retrospective cross-sectional study of 71，623 infertile men in China， between 2011 and 2017［J］. Reprod Biol Endocrinol， 2019， 17（1）：1-8.
2	YUAN H F， SHANGGUAN H F， ZHENG Y， et al. Decline in semen concentration of healthy Chinese adults： evidence from 9 357 participants from 2010 to 2015［J］. Asian J Androl， 2018， 20（4）：379-384.
3	MISHRA P， NEGI M P S， SRIVASTAVA M， et al. Decline in seminal quality in Indian men over the last 37 years［J］. Reprod Biol Endocrinol，2018，16（1）：103-112.
4	ROLLAND M， LE MOAL J， WAGNER V， et al. Decline in semen concentration and morphology in a sample of 26 609 men close to general population between 1989 and 2005 in France［J］. Hum Reprod， 2013， 28（2）：462-470.
5	陈涓涓，雷婷，李欣，等. 4479例不孕夫妻男性患者精液检测结果分析［J］. 标记免疫分析与临床， 2019， 26（5）：737-740，780.
6	刘琳，李发敏子，张瑞，等. 甘肃地区 1705 例不育门诊男性患者精液质量及影响因素分析［J］. 中国男科学杂志， 2019， 33（6）：17-22.
7	RAHBAN R， PRISKORN L， SENN A，et al. Semen quality of young men in Switzerland： a nationwide cross‐sectional population‐based study［J］. Andrology， 2019， 7（6）： 818-826.
8	马宝良，高轲，陈思，等. 甘肃地区6325例不育男性精液分析［J］. 中国男科学杂志， 2019， 33（1）： 36-39.
9	HUANG X， ZHANG B， WU L， et al. Association of exposure to ambient fine particulate matter constituents with semen quality among men attending a fertility center in China［J］. Environ Sci Technol， 2019， 53（10）： 5957-5965.
10	MAO H， FENG L， YANG W X. Environmental factors contributed to circannual rhythm of semen quality［J］. Chronobiol Int， 2017， 34（3）： 411-425.
11	HUANG Q， LIU L， WU Y， et al. Seminal plasma metabolites mediate the associations of multiple environmental pollutants with semen quality in Chinese men［J］. Environ Int， 2019，132： 105066.
12	PIZZOL D， FORESTA C， GAROLLA A， et al. Pollutants and sperm quality： a systematic review and meta-analysis［J］.Environ Sci Pollut Res Int，2021，28（4）： 4095-4103.
13	CHEN Q， JIANG H， ZHANG H T， et al. Ambient ozone pollution is associated with decreased semen quality： longitudinal analysis of 8945 semen samples from 2015 to 2018 and during pollution-control period in Beijing， China［J］.Asian J Androl，2019，21（5）： 501-507.
14	ZOU P， SUN L， CHEN Q， et al. Social support modifies an association between work stress and semen quality： Results from 384 Chinese male workers［J］. J Psychosom Res， 2019， 117： 65-70.
15	RODPRASERT W， VIRTANEN H E， SADOV S，et al.An update on semen quality among young Finnish men and comparison with Danish data［J］. Andrology， 2019，7（1）： 15-23.
16	YUAN H F， SHANGGUAN H F， ZHENG Y， et al. Decline in semen concentration of healthy Chinese adults： evidence from 9357 participants from 2010 to 2015［J］. Asian J Androl， 2018， 20（4）：379-384.
17	易兵，戚青林. 赣西地区1 500例男性不育患者精液质量分析［J］. 实验与检验医学， 2018， 36（1）： 105-108.
18	BORGES E， BRAGA D P A F， ZANETTI B F， et al. Revisiting the impact of ejaculatory abstinence on semen quality and intracytoplasmic sperm injection outcomes［J］. Andrology， 2019， 7（2）： 213-219.
19	贾红军，温子娜，卢奋坚，等. 同一年龄段男性禁欲时间对精液质量的影响［J］. 生殖医学杂志， 2018， 27（11）： 1146-1148.
20	HANSON B M， ASTON K I， JENKINS T G， et al. The impact of ejaculatory abstinence on semen analysis parameters： a systematic review［J］. J Assist Reprod Genet， 2018， 35（2）： 213-220.
21	LEVITAS E， LUNENFELD E， WEISZ N， et al. Seasonal variations of human sperm cells among 6455 semen samples： a plausible explanation of a seasonal birth pattern［J］. Am J Obstet Gynecol， 2013， 208（5）： 406.e1-406.e6.
22	ZHANG X Z， LIU J H， SHENG H Q， et al. Seasonal variation in semen quality in China［J］. Andrology， 2013， 1（4）： 639-643.

Semen parameter	Mean value (standard deviation)	Median	5% percentile	25% percentile	75% percentile	95% percentile
Semen volume(V/mL)	3.2(1.4)	3.0	1.2	2.2	4.0	5.6
Sperm concentration(×10⁶ mL^－1)	56.0 (41.0)	47.0	5.0	25.0	74.0	136.0
Sperm total number (×10⁶time^－1)	172.1(136.2)	139.3	17.5	72.4	233.3	445.3
(PR+NP)(η/%)	71.0（16.0）	75.0	42.0	62.0	83.0	89.0
PR(η/%)	52.0（18.0）	53.0	18.0	40.0	65.0	81.0
Percentage of normal sperm(η/%)	4.1（3.7）	3.4	0	1.0	6.3	11.2
pH value	7.3(0.2)	7.3	7.2	7.3	7.4	7.6

Group		Semen parameters
Group	n	Sperm concentration (×10⁶mL^－1)	Total number of sperm (×10⁶)	PR+NP(η/%)	PR(η/%)	Percentage of normal sperm(η/%)
Year
2017	917	59(31－83)	154.2(81.7－261.8)	81(72－86)	64(50－76)	4.9(2.7－7.7)
2018	1 317	56(30－89)	163.2(88.2－268.8)	74(58－83)	51(40－66)	3.8(1.5－6.3)
2019	1 956	41(23－63)	121.9(64.0－204.0)	71(61－79)	50(39－59)	2.6(0.9－5.6)
P		<0.01	<0.01	<0.01	<0.01	<0.01
Age(year)
≤25	346	48(30－72)	143.2(82.5－229.8)	75(64－84)	54(41－66)	2.8(1.0－5.6)
26－30	1 659	47(26－74)	144.0(79.1－236.9)	75(62－83)	54(40－66)	3.5(1.0－6.5)
31－35	1 250	50(27－76)	141.1(73.8－237.6)	75(62－83)	53(40－65)	3.5(1.0－6.3)
36－40	583	51(24－79)	133.0(69.0－230.4)	74(62－81)	51(40－61)	3.5(1.0－6.3)
≥41	352	50(28－75)	125.4(62.9－216.6)	70(54－82)	51(36－61)	3.8(1.4－6.9)
P		0.46	0.09	<0.01	0.10	0.02
Abstinence day（t/d）
2－3	1 539	43(24－69)	119.7(61.5－207.4)	75(63－83)	55(40－67)	3.5(1.0－6.5)
4－5	1 782	51(28－77)	151.2(80.6－241.8)	75(62－83)	53(40－65)	3.4(1.0－6.2)
6－7	869	53(30－83)	159.9(88.2－278.8)	73(59－81)	50(38－62)	3.4(1.0－6.4)
P		<0.01	<0.01	<0.01	<0.01	0.41
Season
Spring	997	51(25－82)	145.18(72.63－243.90)	77(66－85)	57(41－68)	3.7(1.0－6.5)
Summer	1 037	45(28－69)	132.60(76.41－225.90)	71(61－81)	52(40－63)	3.5(1.0－6.3)
Autumn	1 057	49(25－73)	140.50(68.80－229.58)	75(60－83)	52(39－64)	3.0(1.0－6.0)
Winter	1 099	51(28－74)	142.80(76.80－245.90)	74(61－82)	52(39－65)	3.5(1.2－6.6)
P		0.03	0.32	<0.01	<0.01	0.01

Group	Semen parameters
	Sperm concentration		Total number of sperm		PR+NP		PR		Percentage of normal sperm
	z	P	z	P	z	P	z	P	z	P
2019 vs 2018	10.238	<0.01	5.802	<0.01	4.229	<0.01	4.913	<0.01	6.850	<0.01
2019 vs 2017	9.655	<0.01	9.182	<0.01	17.075	<0.01	17.549	<0.01	13.063	<0.01
2018 vs 2017	0.500	0.62	－2.272	0.069	12.384	<0.01	12.258	<0.01	6.476	<0.01

Group	Semen parameter
	PR+NP		Percentage of normal sperm
	z	P	z	P
≥41 years vs 36－40 years	2.087	0.369	0.989	0.323
≥41 years vs 31－35 years ≥41 years vs 26－30 years ≥41 years vs ≤25 years 36－40 years vs 31－35 years 36－40 years vs 26－30 years	3.200	0.014	2.352	0.187
	3.778	0.002	2.974	0.029
	3.922	0.001	2.718	0.066
	1.044	0.297	1.502	0.133
	1.685	0.920	2.243	0.249
36－40 years vs ≤25 years 31－35 years vs 26－30 years 31－35 years vs ≤25 years	2.303	0.213	2.051	0.403
	0.770	0.442	0.874	0.382
	1.712	0.869	1.053	0.292
26－30 years vs ≤25 years	1.272	0.203	0.529	0.597

Group	Semen parameter
Group	Sperm concentration		Total number of sperm		PR+NP		PR
	z	P	z	P	z	P	z	P
6－7 d vs 4－5 d	－2.781	0.016	－3.204	0.004	2.399	0.049	3.451	0.002
6－7 d vs 2－3 d	－5.573	<0.001	－8.153	<0.001	3.600	0.001	4.971	<0.001
4－5 d vs 2－3 d	－3.504	<0.001	－6.157	<0.001	1.543	0.368	1.967	0.147