精索静脉曲张修复术对临床精索静脉曲张不育男性精子DNA碎片化和精液丙二醛水平的影响：一项系统评价和Meta分析

Effects of Varicocele Repair on Sperm DNA Fragmentation and Seminal Malondialdehyde Levels in Infertile Men with Clinical Varicocele: A Systematic Review and Meta-Analysis.

作者信息

Cannarella Rossella, Shah Rupin, Saleh Ramadan, Boitrelle Florence, Hamoda Taha Abo-Almagd Abdel-Meguid, Singh Rajender, Salvio Gianmaria, Toprak Tuncay, Falcone Marco, Gul Murat, Dimitriadis Fotios, Rambhatla Amarnath, Russo Giorgio I, Ko Edmund, Zini Armand, Kavoussi Parviz, Phuoc Nguyen Ho Vinh, Kandil Hussein, Ghayda Ramy Abou, Birowo Ponco, Gherabi Nazim, Ceyhan Erman, Dong Jie, Malhotra Vineet, Durairajanayagam Damayanthi, Kolbasi Bircan, Bahar Fahmi, Calik Gokhan, Çayan Selahittin, Pinggera Germar-Michael, Calogero Aldo E, Rajmil Osvaldo, Mostafa Taymour, Atmoko Widi, Harraz Ahmed M, Le Tan V, de la Rosette Jean, Hakim Lukman, Pescatori Edoardo, Sergeyev Oleg, Rashed Ayman, Saini Pallavi, Agarwal Ashok

机构信息

Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.

出版信息

World J Mens Health. 2024 Apr;42(2):321-337. doi: 10.5534/wjmh.230235. Epub 2024 Jan 2.

DOI:10.5534/wjmh.230235

PMID:38164034

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10949029/

Abstract

PURPOSE

Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could reduce these parameters. This systematic review and meta-analysis (SRMA) aims to investigate the impact of VR on SDF and seminal malondialdehyde (MDA).

MATERIALS AND METHODS

A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD).

RESULTS

Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD -1.125, 95% confidence interval [CI] -1.410, -0.840; p<0.0001) with high inter-study heterogeneity (I²=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD -1.014, 95% CI -1.263, -0.765; p<0.0001, and SMD -1.495, 95% CI -2.116, -0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD -2.197, 95% CI -3.187, -1.207; p<0.0001), sperm chromatin structure assay (SMD -0.857, 95% CI -1.156, -0.559; p<0.0001) or TUNEL (SMD -1.599, 95% CI -2.478, -0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD -2.450, 95% CI -3.903 to -0.997, p=0.001) with high inter-study heterogeneity (I²=93.7%).

CONCLUSIONS

Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.

摘要

目的

精索静脉曲张可能是导致精液氧化应激（OS）升高和精子DNA碎片率（SDF）增加的原因。然而，精索静脉曲张修复术（VR）是否能降低这些指标仍不清楚。本系统评价和荟萃分析（SRMA）旨在研究VR对SDF和精液丙二醛（MDA）的影响。

材料与方法

在Scopus、PubMed、Ovid、Embase和Cochrane数据库中进行文献检索。本SRMA纳入了随机对照试验和观察性研究，这些研究报告了接受VR的临床精索静脉曲张不育男性术前和术后的SDF和精液OS水平。亚组分析包括VR技术和SDF检测方法。效应大小以标准化均数差（SMD）表示。

结果

在评估的1632篇摘要中，有29项研究共纳入1491名不育男性。分析显示，与术前相比，VR术后SDF显著降低（SMD -1.125，95%置信区间[CI] -1.410，-0.840；p<0.0001），研究间异质性较高（I²=90.965%）。显微外科技术和非显微外科腹股沟入路术后SDF均明显降低（分别为SMD -1.014，95% CI -1.263，-0.765；p<0.0001和SMD -1.495，95% CI -2.116，-0.873；p<0.0001）。无论采用精子染色质扩散试验（SMD -2.197，95% CI -3.187，-1.207；p<0.0001）、精子染色质结构分析（SMD -0.857，95% CI -1.156，-0.559；p<0.0001）还是TUNEL法（SMD -1.599，95% CI -2.478，-0.719；p<0.0001）进行检测，VR术后SDF均显著降低。VR术后精液MDA水平显著降低（SMD -2.450，95% CI -3.903至-0.997，p=0.001），研究间异质性较高（I²=93.7%）。