过去二十年精子数量和浓度变化趋势：系统评价和荟萃回归分析。
Trend of change of sperm count and concentration over the last two decades: A systematic review and meta-regression analysis.
机构信息
Gynaecology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
出版信息
Andrology. 2023 Sep;11(6):997-1008. doi: 10.1111/andr.13396. Epub 2023 Feb 7.
BACKGROUND
Since the 1970s, several studies found that sperm concentration (SC) and total sperm count (TSC) constantly worsened over time, mainly in high-income countries.
OBJECTIVES
To evaluate whether the decreasing trend in sperm count is continuing in Western European countries and USA, we performed a systematic review and meta-regression analysis.
MATERIALS AND METHODS
Embase and Pubmed/Medline were searched papers published in English in the 2000-2020 period limiting the search to data collected in the USA and Western European countries.
RESULTS
We identified 62 articles and pooled information on 24,196 men (range 10-2,523), collected from 1993 to 2018. Considering all the studies, random-effects meta-regression analyses showed no significant trend for SC (slope per year -0.07 mil/mL, p-value = 0.86). Negative trends of SC were detected in Scandinavian countries (slope per year -1.11 mil/mL, 95% CI: -2.40 to +0.19; p-value = 0.09), but the findings were statistically not significant. No significant trends of SC were detected in Central Europe (slope per year +0.23, 95% CI -2.51 to +2.96; p-value = 0.87), the USA (slope per year +1.08, 95% CI -0.42 to +2.57; p-value = 0.16), and Southern Europe (slope per year +0.19, 95% CI -0.99 to +1.37; p-value = 0.75). We have analyzed separately findings from studies including sperm donors, fertile men, young unselected men (unselected men, study mean age < 25 years) and unselected men (unselected men, study mean age ≥ 25 years). No significant trends of SC were observed among sperm donors (slope per year -2.80, 95% CI -6.76 to +1.17; p-value 0.16), unselected men (slope per year -0.23, 95% CI -1.58 to +1.12; p-value 0.73), young unselected men (slope per year -0.49, 95% CI -1.76 to +0.79; p-value 0.45), fertile men (slope per year +0.29, 95% CI -1.09 to +1.67; p-value 0.68).
DISCUSSION AND CONCLUSION
The results of this analysis show no significant trends in SC, in USA, and selected Western European countries.
背景
自 20 世纪 70 年代以来，多项研究发现，精子浓度（SC）和总精子数（TSC）随着时间的推移持续恶化，主要发生在高收入国家。
目的
为了评估精子计数的下降趋势是否仍在继续，我们对来自美国和西欧国家的研究进行了系统回顾和荟萃回归分析。
材料与方法
检索 2000 年至 2020 年期间以英语发表的论文，限定在仅收集美国和西欧国家数据的研究。
结果
我们共确定了 62 篇文章，纳入了 24196 名男性（范围 10-2523 名）的数据，这些数据收集自 1993 年至 2018 年。考虑到所有研究，随机效应荟萃回归分析显示 SC 无显著趋势（每年斜率为-0.07 毫升/毫升，p 值=0.86）。在斯堪的纳维亚国家（每年斜率-1.11 毫升/毫升，95%置信区间：-2.40 至+0.19；p 值=0.09）检测到 SC 的负趋势，但统计学上无显著意义。在中欧（每年斜率+0.23 毫升/毫升，95%置信区间：-2.51 至+2.96；p 值=0.87）、美国（每年斜率+1.08 毫升/毫升，95%置信区间：-0.42 至+2.57；p 值=0.16）和南欧（每年斜率+0.19 毫升/毫升，95%置信区间：-0.99 至+1.37；p 值=0.75），SC 也没有明显的趋势。我们还分别分析了精子供者、生育男性、年轻未选择的男性（未选择的男性，研究平均年龄<25 岁）和未选择的男性（未选择的男性，研究平均年龄≥25 岁）的数据。在精子供者（每年斜率-2.80 毫升/毫升，95%置信区间：-6.76 至+1.17；p 值 0.16）、未选择的男性（每年斜率-0.23 毫升/毫升，95%置信区间：-1.58 至+1.12；p 值 0.73）、年轻未选择的男性（每年斜率-0.49 毫升/毫升，95%置信区间：-1.76 至+0.79；p 值 0.45）和生育男性（每年斜率+0.29 毫升/毫升，95%置信区间：-1.09 至+1.67；p 值 0.68）中，SC 也没有明显的趋势。
讨论与结论
该分析结果显示，在美国和部分选定的西欧国家，SC 没有明显的变化趋势。
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