血清 17-羟孕酮能否预测显微镜精索静脉结扎术后精液参数的改善？一项前瞻性研究。

Can serum 17-hydroxy progesterone predict an improvement in semen parameters following micro-varicocelectomy? A prospective study.

机构信息

Department of Andrology & STDs, Kasr Alainy Faculty of Medicine, Cairo University.

Department of Chemical Pathology, Kasr Alainy Faculty of Medicine, Cairo University.

出版信息

Arch Ital Urol Androl. 2024 Oct 2;96(3):12545. doi: 10.4081/aiua.2024.12545.

DOI:10.4081/aiua.2024.12545

PMID:39356026

Abstract

BACKGROUND & OBJECTIVES: Notably, 17-hydroxy progesterone (17-OHP) (17-OHP) is a precursor for testosterone (T) synthesis, and intratesticular testosterone (ITT) is essential for spermatogenesis. Varicocele (Vx) has an estimated prevalence of 15% in the general population and 35% in those with primary infertility. We aimed to evaluate the correlation between changes of serum 17-OHP after sub-inguinal micro-varicocelectomy and improvement of semen parameters.

PATIENTS AND METHODS

The current prospective study included 45 infertile men attending the andrology clinic form February 2021 to August 2021. Two semen analyses and hormonal profile were evaluated. Colored duplex ultasonography (CDUS) was done in standing and supine position for accurate measurements of testicular volumes and confirmation of Vx. Patients underwent sub-inguinal micro-varicocelectomy using a surgical microscope HB surgitech. We followed them prospectively up for three months following micro-varicocelectomy with serum TT and 17-OHP.

RESULTS

Sperm concentration improved significantly from 8.36 ± 5.04 million/ml to 12.52 ± 8.42 million/ml after 3 months following sub-inguinal micro-varicocelectomy (p= 0.001), with normalization of concentration in 15/45 (33%) patients. Total motility did not improve significantly but progressive motility improved significantly from 8.62 ± 8.74% to 16.24 ± 14.45% (p=0.001). Abnormal forms significantly declined from 96.67 ± 2.03% to 95.75 ± 2.47% (p=0.009). Serum 17 OHP and 17 OHP/total testosterone (TT) improved significantly from 1.21 ± 0.45 ng/ml and 0.26 ± 0.09 to 1.42 ± 0.76 ng/ml and 0.3 ± 0.16 (p= 0.013, p= 0.004), respectively, while serum TT did not improve significantly. A significant correlation was found between improvement in sperm concentration and both serum 17 OHP and 17 OHP/TT ratio (p=0.001, p=004). Furthermore, change in abnormal sperm forms showed significant correlations with changes in both 17-OHP and 17-OHP/TT.

CONCLUSION

17 OHP and 17OHP/ TT ratio can be used as biomarkers to detect improvement in semen parameters following sub-inguinal micro-varicocelectomy.

摘要

背景与目的

众所周知，17-羟孕酮（17-OHP）是睾酮（T）合成的前体，而睾丸内睾酮（ITT）对于精子发生至关重要。精索静脉曲张（Vx）在普通人群中的估计患病率为 15%，在原发性不育人群中的患病率为 35%。我们旨在评估精索内静脉显微结扎术后血清 17-OHP 变化与精液参数改善之间的相关性。

患者与方法

本前瞻性研究纳入了 2021 年 2 月至 2021 年 8 月期间在男科诊所就诊的 45 名不育男性。评估了两次精液分析和激素谱。采用彩色双功能超声（CDUS）在站立和仰卧位进行检查，以准确测量睾丸体积并确认 Vx。患者采用 HB surgitech 手术显微镜进行精索内静脉显微结扎术。我们对他们进行了前瞻性随访，在精索内静脉显微结扎术后 3 个月内检测血清 TT 和 17-OHP。

结果

精子浓度从 8.36±5.04 百万/ml 显著改善至 12.52±8.42 百万/ml（p=0.001），45 例患者中有 15 例（33%）恢复正常。总活力虽无显著改善，但前向运动精子活力从 8.62±8.74%显著改善至 16.24±14.45%（p=0.001）。异常形态显著下降，从 96.67±2.03%降至 95.75±2.47%（p=0.009）。血清 17-OHP 和 17-OHP/总睾酮（TT）分别从 1.21±0.45ng/ml 和 0.26±0.09 显著改善至 1.42±0.76ng/ml 和 0.3±0.16（p=0.013，p=0.004），而血清 TT 无显著改善。精子浓度的改善与血清 17-OHP 和 17-OHP/TT 比值均呈显著相关性（p=0.001，p=0.004）。此外，异常精子形态的变化与 17-OHP 和 17-OHP/TT 的变化均呈显著相关性。