Effects of metabolic syndrome on semen parameters and reproductive hormones in male infertility patients
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摘要: 目的 探讨代谢综合征(metabolic syndrome，MS)对男性不育患者精液参数及生殖激素的影响。方法 筛选2019年1月—2022年1月于上海交通大学医学院附属仁济医院诊断为原发性不育的1500例患者作为研究对象，分为MS组和非MS组，另纳入300名健康体检者作为对照组，收集其一般信息、血脂、生殖激素和精液参数等指标，应用Mann-Whitney U检验、协方差分析(ANCOVA)、logistic回归分析探讨各组人群不同指标之间的关系。结果 1500例原发性不育患者中，MS患者共有160例，患病率为10.7%。与非MS不育患者比较，MS患者尿促卵泡素(FSH)升高，睾酮(T)、性激素结合球蛋白(SHBG)、抑制素B(Inh B)降低(P < 0.05)，精子正常形态率降低(P < 0.05)，而精子密度和活力无明显差异(P>0.05)。协方差多因素分析表明腰围、高密度脂蛋白(HDL)、甘油三酯(TG)对精子形态有影响(P < 0.05)。logistic回归未能证明MS是影响精子形态的独立危险因素，却发现FSH、Inh B、BMI是精子密度的独立预测因子(P < 0.05)，FSH、BMI升高及Inh B降低的患者其精子密度更低。结论 MS与男性不育存在相关性，可影响患者生殖激素的正常水平，同时对精子正常形态率产生影响，此可能是MS导致男性不育的机制之一。Abstract: Objective To investigate the effect of metabolic syndrome (MS) on semen parameters and reproductive hormones in male infertility patients.Methods From January 2019 to January 2022, 1500 cases who were diagnosed as primary infertility in Renji Hospital were enrolled in this study, and they were divided into MS group and non-MS group. Other 300 healthy men were enrolled as the control group. We collected the general information, blood lipids, reproductive hormones and sperm parameters, and used the Mann-Whitney U test, the analysis of covariance(ANCOVA) and logistic regression analysis to analyze the relationship among the different parameters.Results There were 160 patients with MS in 1500 primary infertility patients, with a prevalence rate of 10.7%. Compared with non-MS infertility patients, the patients in MS group had elevated FSH, decreased T, SHBG, Inh B and sperm normal morphology rate (P < 0.05). There was no significant difference in the sperm density or activity (P > 0.05). Multivariate analysis of covariance showed that waist circumference, HDL and TG had influence on sperm morphology (P < 0.05). Logistic regression failed to prove that MS is an independent risk factor of sperm morphology, but showed that FSH, Inh B and BMI are independent predictors of sperm density (P < 0.05). Patients with increased FSH and BMI or decreased Inh B had lower sperm density.Conclusion MS is associated with male infertility, which could affect the normal level of reproductive hormone and the sperm normal morphology rate. This may be the mechanism of male infertility induced by MS.
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Key words:
- infertility /
- metabolic syndrome /
- semen parameters /
- reproductive hormones
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表 1 MS组和对照组一般资料及血液、精液比较结果
X±S 项目 MS组(160例) 非MS组(1340例) 对照组(300例) P值a P值b 年龄/岁 30.17±3.89 27.46±2.62 25.33±2.98 < 0.001 < 0.001 BMI/(kg·m-2) 31.28±1.93 21.99±4.66 20.87±5.43 < 0.001 < 0.001 睾丸体积/mL 14.45±2.90 14.53±2.35 15.12±3.79 0.692 0.052 收缩压/mmHg 129.10±5.41 117.11±6.74 112.21±5.23 < 0.001 < 0.001 舒张压/mmHg 82.05±5.20 81.99±5.45 80.23±3.43 0.183 0.546 腰围/cm 130.70±6.43 99.80±16.47 98.45±15.34 < 0.001 < 0.001 HDL/(mmol·L-1) 1.36±0.34 2.43±0.80 2.54±0.78 < 0.001 < 0.001 TG/(mmol·L-1) 3.02±1.12 1.14±0.18 1.01±0.32 < 0.001 < 0.001 FBG/(mmol·L-1) 5.50±0.56 4.75±0.56 4.89±0.21 < 0.001 < 0.001 FSH/(mUI·mL-1) 7.29±3.50 4.91±2.20 4.21±3.10 0.001 < 0.001 LH/(mUI·mL-1) 4.08±2.37 3.95±1.73 3.98±2.31 0.390 0.661 PRL/(ng·mL-1) 12.08±4.07 12.78±5.56 12.12±3.89 0.123 0.918 E2/(pg·mL-1) 36.86±16.85 38.57±15.56 38.23±11.23 0.150 0.299 T/(ng·mL-1) 4.41±1.78 4.64±1.33 5.12±1.89 0.047 < 0.001 ft/(ng·mL-1) 7.53±3.92 7.75±5.43 8.38±4.23 0.619 0.036 SHBG/(nmol·L-1) 29.12±4.34 30.32±5.07 32.11±4.56 0.004 < 0.001 Inh B/(pg·mL-1) 138.62±43.20 150.11±56.48 148.56±47.72 < 0.001 < 0.001 精液量/mL 3.34±1.20 3.19±1.48 3.42±1.12 0.217 0.477 精子密度/(×106·mL-1) 21.35±13.20 22.50±18.89 29.89±15.45 0.454 < 0.001 前向运动率/% 26.82±17.20 28.49±24.72 60.12±9.33 0.406 < 0.001 正常形态率/% 11.76±1.99 12.26±2.42 12.12±1.47 0.012 0.028 注：aMS组和非MS组比较结果；bMS组和对照组比较结果。 
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表 2 ANCOVA多变量分析结果
P值 项目 精子密度 精子前向活力 精子形态 MS 0.876 0.977 0.104 高血压 0.931 0.390 0.309 腰围 0.823 0.865 0.026 FBG 0.380 0.078 0.128 HDL 0.111 0.164 0.015 TG 0.933 0.684 0.047
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表 3 logistic回归分析结果
P值 项目 精子密度 精子前向活力 精子形态 单因素分析 多因素分析 单因素分析 多因素分析 单因素分析 多因素分析 年龄 0.041 0.018 0.252 0.135 0.184 0.236 BMI 0.708 0.033 0.194 0.461 0.692 0.120 睾丸体积 0.240 0.314 0.882 0.929 0.059 0.068 FSH 0.019 0.007 0.630 0.220 0.214 0.071 Inh B 0.002 0.005 0.071 0.065 0.722 0.793 MS 0.483 0.076 0.214 0.949 0.977 0.651
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