赖智润

[摘要] 目的 探讨在男性不育诊疗中进行精液常规检验的临床价值。方法 方便选取1 593例该所接收的男性不育患者，时间为2013年8月—2018年8月期间，患者禁欲2～7 d，手淫法取精，收集完整精液于清洁盖的小杯内，采用北京伟力WLJY-9000彩色精子质量检测系统，检测精子活力、精子密度等。 结果 1 593份不育患者精液检查所有参数均正常的占29.8%（475/1 593），有一项或多项参数异常的占70.2%（1 118/1 593）。异常组与正常组PH值和精液量比较，差异无统计学意义（t=0.742、-1.171，P>0.05）;异常组与正常组精液液化时间、精子数、精子总活力、前向运动力比较，差异有统计学意义（t=-34.527、38.432、28.699、17.234，P<0.05）;1 118例异常精液标本中，异常率最高的指标为精子总活力，占22.9%;除去无精子患者，共1 098例患者分为4個年龄段，在这4组间，其中>40岁年龄组前向运动百分率、精液浓度及精子总活力均较其他3个年龄组要低，且呈相对下降趋势（F=10.471、24.547、11.895，P<0.05）;经单因素方差分析显示，PH值和精液量、精子正常形态率比较，差异无统计学意义（F=1.341、1.524、2.956，P>0.05）;>40岁年龄组患者精液异常率最高，明显高于其他年龄组（χ2=11.391、19.321、16.781，P<0.05）。结论  男性不育患者中精子活力异常比例较高，此外年龄与男性精液质量有一定影响。

[关键词] 男性不育;精液常规检验;精子活力

[中图分类号] R271.14          [文献标识码] A          [文章编号] 1674-0742（2020）03（a）-0192-03

Evaluation of Routine Semen Testing in Diagnosis and Treatment of Male Infertility

LAI Zhi-run

Fujian Institute of Family Planning Science and Technology， Fuzhou， Fujian Province， 350011 China

[Abstract] Objective To investigate the clinical value of routine semen testing in the diagnosis and treatment of male infertility. Methods A total of 1 593 male infertile patients received were conrenient selected from August 2013 to August 2018. The patients were abstained for 2～7 d， masturbation was used to extract sperm， and the complete semen was collected in a small cup with a clean lid. Beijing Weili WLJY-9000 color sperm quality detection system was used to detect sperm motility and sperm density. Results The parameters of semen examination of 1 593 infertile patients were normal （29.8% （475/1593））， and one or more parameters were abnormal 70.2% （1 118/1 593）. There was no statistically significant difference in PH value and semen volume between the abnormal group and the normal group （t=0.742，-1.171 P>0.05）; the semen liquefaction time， sperm count， total sperm motility， and forward motility were compared between the abnormal group and the normal group. The differences were statistically significant （t=-34.527， 38.432， 28.699， 17.234， P<0.05）; among the 1 118 abnormal semen specimens， the highest abnormality index was the total sperm motility， which accounted for 22.9%; except for patients with sperm， a total of 1 098 patients were divided into 4 age groups. Among these 4 groups， the percentage of forward exercise， semen concentration， and total sperm motility of the> 40-year-old group were lower than those of the other three age groups， and they showed a relative downward trend（F=10.471， 24.547， 11.895， P<0.05）; analysis of univariate analysis of variance showed that there was no statistically significant difference between PH value and semen volume and normal sperm morphology rate （F=1.341， 1.524， 2.956， P>0.05 ）; the semen abnormality rate was highest in the> 40-year-old group， which was significantly higher than in other age groups（χ2=11.391， 19.321， 16.781， P<0.05）. Conclusion The abnormal proportion of sperm motility is higher in male infertile patients， and age and male semen quality have a certain effect.

[Key words] Male infertility; Routine semen testing; Sperm motility

精液是男性生殖器官所分泌的液体，为男性生育能力的评价和男性生殖系统疾病的诊断提供重要依据。据数据显示[1-2]，因男性因素导致育龄夫妇患有不育症的比例约为40%～50%，其中最主要的原因为精液质量异常。近年来男性不育症的发病率逐年增长，原因在于不良的生活习惯、全球性环境的恶化污染及男性生殖系统疾病增加有密切关系。精液常规检查是临床对男性不育进行诊断的最重要的检查手段。该研究中对2013年8月—2018年8月期间该所男科门诊接收的1593例男性不育患者资料进行回顾性分析，探讨在男性不育诊疗中进行精液常规检验的应用价值，现报道如下。