Effects of microsurgical subinguinal varicocelectomy on sperm quality, oxidative stress and anti-sperm antibody levels in patients with varicocele
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摘要: 目的 探讨显微镜下外环下精索静脉结扎术(MSV)对精索静脉曲张患者精子质量、氧化应激水平及抗精子抗体水平的影响。方法 选取2018年2月—2020年3月诊治的144例精索静脉曲张患者作为研究对象，按照随机数字表法分为A组(予以MSV)、B组(予以腹腔镜下精索静脉高位结扎术)、C组(予以腹膜后精索高位结扎术)，各48例。对比精子密度、A+B级精子、精子活率、ASA阳性率、SOD、TAC; 分析TAC、SOD与精子密度、A+B级精子、精子活率的相关性; 观察并发症发生率及复发率。结果 重复测量方差分析显示，三组精子密度、精子活率、TAC的时点、组间、交互比较，差异有统计学意义(P< 0.05);三组A+B级精子、SOD的时点、交互比较，差异有统计学意义(P< 0.05);三组A+B级精子、SOD的组间比较差异无统计学意义(P>0.05)。单因素方差比较，三组术前精子密度、A+B级精子、精子活率、SOD、TAC比较，差异无统计学意义(P>0.05);两两比较显示，术后3个月，A组和B组的精子密度、A+B级精子、精子活率、SOD、TAC高于C组(P< 0.05)。A组和B组的ASA阳性率低于C组(P< 0.05)。Pearson相关性分析显示，TAC、SOD与精子密度、A+B级精子、精子活率呈正相关(P< 0.05)。A组的并发症发生率、复发率低于B组和C组(P< 0.05)。结论 MSV治疗精索静脉曲张效果显著，能改善精子质量和降低氧化应激、抗精子抗体水平。
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关键词:
- 显微镜下外环下精索静脉结扎术 /
- 精索静脉曲张 /
- 精子质量 /
- 氧化应激 /
- 抗精子抗体
Abstract: Objective To investigate the effect of microsurgical subinguinal varicocelectomy (MSV) on sperm quality, oxidative stress level and anti-sperm antibody level in patients with varicocele.Methods A total of 144 patients with varicocele who were diagnosed and treated from February 2018 to March 2020 were selected as the research objects, and were divided into group A (MSV) and group B (laparoscopic high ligation of spermatic vein), group C (retroperitoneal high ligation of spermatic cord), 48 cases in each according to the random number table method. Sperm density, A+B grade sperm, sperm motility rate, ASA positive rate, SOD, TAC were compared. The correlation between TAC, SOD and sperm density, A+B grade sperm, sperm motility rate was analyzed. The complication rate and recurrence rate were observed.Results Repeated measures analysis of variance showed that there were statistically significant differences in sperm density, sperm motility rate, time point of TAC, between groups, and interaction among the three groups (P< 0.05). Interaction comparison, the difference was statistically significant in A+B grade sperm and SOD (P< 0.05). There was no significant difference among the three groups in A+B grade sperm or SOD (P> 0.05). One-way comparison of variance, before surgery, there was no significant difference in sperm density, A+B grade sperm, sperm motility rate, SOD or TAC among the three groups (P> 0.05);Pairwise comparison showed that the sperm density, A+B grade sperm, sperm motility rate, SOD and TAC of group A and group B were higher than those of group C 3 months after operation (P< 0.05). The positive rate of ASA in group A or group B was lower than that in group C (P< 0.05). Pearson correlation analysis showed that TAC and SOD were positively correlated with sperm density, A+B grade sperm and sperm motility rate (P< 0.05). The complication rate and recurrence rate of group A was lower than that of group B or group C (P< 0.05).Conclusion MSV has a significant effect on treatment of varicocele, for it can improve sperm quality and reduce oxidative stress and anti-sperm antibody levels. -
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表 1 三组一般资料比较
例(%)，X ± S 组别 年龄/岁 BMI/(kg·m-2) VC程度 VC分布部位 Ⅱ级 Ⅲ级 左侧 右侧 A组(n=48) 27.56±3.52 23.25±2.12 23(47.92) 25(52.08) 45(93.75) 3(6.25) B组(n=48) 27.62±3.48 23.30±2.18 24(50.00) 24(50.00) 46(95.83) 2(4.17) C组(n=48) 27.59±3.55 23.28±2.15 26(54.17) 22(45.83) 44(91.67) 4(8.33) F值 0.002 0.004 0.389 0.711 P值 0.998 0.996 0.873 0.701 
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表 2 三组精子密度、A+B级精子、精子活率比较
X ± S 指标 例数 术前 术后3个月 t P值 精子密度/(×106·mL-1) A组 48 57.85±8.32 110.25±19.65 17.013 < 0.001 B组 48 57.90±8.28 108.96±19.251) 16.881 < 0.001 C组 48 57.88±8.36 85.02±12.051)2) 12.821 < 0.001 F值 F时点=1256.379，F组间=18.537，F交互=44.639 - - P值 P时点 < 0.001，P组间 < 0.001，P交互 < 0.001 - - A+B级精子/% A组 48 38.52±6.25 61.36±15.21 9.623 < 0.001 B组 48 38.59±6.18 60.26±15.051) 10.919 < 0.001 C组 48 38.55±6.23 55.35±8.651)2) 10.919 < 0.001 F值 F时点=454.970，F组间=1.634，F交互=3.726 - - P值 P时点 < 0.001，P组间=0.199，P交互=0.026 - - 精子活率/% A组 48 43.25±8.02 70.52±13.05 12.334 < 0.001 B组 48 43.30±7.95 70.45±12.851) 12.448 < 0.001 C组 48 43.28±8.06 62.35±10.251)2) 10.132 < 0.001 F值 F时点=1016.568，F组间=3.138，F交互=12.471 - - P值 P时点 < 0.001，P组间=0.046，P交互 < 0.001 - - 与A组比较，1)P < 0.05;与B组比较，2)P < 0.05。
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表 3 三组ASA阳性率比较
例(%) 组别 例数 ASA阳性率 术前 术后3个月 A组 48 44(91.67) 9(18.75) B组 48 42(87.50) 11(22.92)1) C组 48 40(83.33) 23(47.92)1)2) χ2 1.524 11.406 P值 0.467 0.003 与A组比较，1)P < 0.05;与B组比较，2)P < 0.05。
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表 4 三组氧化应激水平比较
X ± S 指标 例数 术前 术后3个月 t P值 SOD/(U·mL-1) A组 48 8.52±2.32 12.36±4.02 17.013 < 0.001 B组 48 8.47±2.36 12.27±3.961) 16.881 < 0.001 C组 48 8.55±2.30 10.05±3.211)2) 12.821 < 0.001 F值 F时点=109.259，F组间=2.937，F交互=2.937 - - P值 P时点 < 0.001，P组间=0.056，P交互=0.056 - - TAC/(U·L-1) A组 48 24.32±6.85 36.85±8.21 9.623 < 0.001 B组 48 24.35±6.79 36.75±8.251) 10.919 < 0.001 C组 48 24.38±6.75 31.02±7.521)2) 4.552 < 0.001 F值 F时点=249.319，F组间=3.361，F交互=8.510 - - P值 P时点 < 0.001，P组间=0.038，P交互 < 0.001 - - 与A组比较，1)P < 0.05;与B组比较，2)P < 0.05。
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表 5 TAC、SOD与精子密度、A+B级精子、精子活率的相关性分析
指标 精子密度 A+B级精子 精子活率 TAC r 0.358 0.465 0.433 P值 < 0.001 < 0.001 < 0.001 SOD r 1.000 0.490 0.476 P值 < 0.001 < 0.001 < 0.001
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表 6 三组并发症和复发率比较
例(%) 组别 并发症 复发率 阴囊水肿 皮下气肿 附睾炎 总发生率 A组(n=48) 1(2.08) 0 0 1(2.08) 1(2.08) B组(n=48) 3(6.25) 4(8.33) 1(2.08) 8(16.67)1) 7(14.58)1) C组(n=48) 2(4.16) 3(6.25) 7(14.58) 12(25.00)1) 13(27.08)1) χ2值 - - - 10.369 12.042 P值 - - - 0.006 0.002 与A组比较，1)P < 0.05。
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