Mallidis C, Agbaje I, McClure N, Kliesch S
Centrum für Reproduktionsmedizin und Andrologie, Universität Münster, Domagkstraße 11, 48149 Münster, Deutschland.
Urologe A. 2011 Jan;50(1):33-7. doi: 10.1007/s00120-010-2440-3.
Whilst diabetes mellitus is known to have many systemic complications, male infertility, beyond impotence, retrograde ejaculation and hypogonadism, has not been widely recognised to be one of them. Due to the paucity of studies and inconsistencies regarding the condition's impact on semen quality, few fertility specialists consider the condition noteworthy. As a consequence little information exists as to its prevalence amongst infertile men. Recently the prevailing view has been challenged by findings showing that diabetes induces subtle molecular changes that are important for sperm quality and function. Diabetic men have been found to have a significantly higher percentage of sperm with nuclear DNA damage, a factor known to be associated with compromised fertility and increased miscarriage rates. The mechanism by which this diabetes-related sperm nDNA damage occurs remains unknown. The identification of high levels of advanced glycation end products (AGEs) and their receptor (RAGE) throughout the male reproductive tract coupled to changes in testicular metabolite levels and spermatogenic gene expression suggest that glycation may play an integral role in oxidative stress which in turn causes sperm nDNA damage. As glycation is a normal consequence of life and has been implicated in DNA fragmentation in a variety of seemingly unconnected conditions, it may constitute a common mechanism for the damage seen in sperm DNA.
虽然糖尿病已知会引发许多全身性并发症，但除了阳痿、逆行射精和性腺功能减退外，男性不育尚未被广泛认为是其中之一。由于关于该病症对精液质量影响的研究匮乏且结果不一致，很少有生育专家认为该病症值得关注。因此，关于其在不育男性中的患病率几乎没有相关信息。最近，这一普遍观点受到了一些研究结果的挑战，这些研究表明糖尿病会引发一些细微的分子变化，而这些变化对精子质量和功能至关重要。研究发现，糖尿病男性中具有核DNA损伤的精子比例显著更高，而这一因素已知与生育能力受损和流产率增加有关。糖尿病相关精子核DNA损伤发生的机制仍然未知。在整个男性生殖道中发现高水平的晚期糖基化终产物（AGEs）及其受体（RAGE），再加上睾丸代谢物水平和生精基因表达的变化，表明糖基化可能在氧化应激中起重要作用，进而导致精子核DNA损伤。由于糖基化是生命的正常结果，并且在各种看似不相关的情况下都与DNA片段化有关，它可能是精子DNA损伤的一种常见机制。
