Sigman M, Lopes L
Division of Urology, Brown University, Providence, Rhode Island.
J Urol. 1993 May;149(5 Pt 2):1338-40. doi: 10.1016/s0022-5347(17)36386-3.
It is generally recognized that white blood cells in semen are detrimental to sperm function and fertility. Traditionally, pyospermia has been suspected if greater than 10 round cells per high power field or more than 1 million round cells per ml. were identified in the semen. Since immature germ cells and white blood cells appear as round cells under wet mount light microscopy, the relationship between increased numbers of round cells in semen and true pyospermia was examined. Semen analyses were performed on specimens from 627 infertility patients. The numbers of round cells per high power field and the number of round cells per ml. of semen were recorded. Specimens from 57 patients (9%) persistently demonstrated greater than 10 round cells per high power field or more than 1 million round cells per ml. and they were subjected to immunohistochemical staining against white blood cell surface antigens. Greater than 1 million white blood cells per ml. were identified in only 20 patients (35%) and only 8 samples demonstrated more than 3 million white blood cells per ml. Of the patients with greater than 1 million white blood cells per ml. 65% had motilities of less than 60% compared to 49% of the patients with less than this amount of pyospermia. This difference was not statistically significant. Round cells counted on a per milliliter basis correlated better with results of immunohistochemical staining than did round cells counted on a per high power field basis. These data demonstrate that the majority of patients with excess round cells in the semen do not have pyospermia and, therefore, empiric antibiotic therapy without further testing will likely be unproductive.
人们普遍认为，精液中的白细胞会损害精子功能和生育能力。传统上，如果在精液中每高倍视野发现超过10个圆形细胞或每毫升超过100万个圆形细胞，就会怀疑患有脓精症。由于未成熟生殖细胞和白细胞在湿片光学显微镜下均表现为圆形细胞，因此对精液中圆形细胞数量增加与真正脓精症之间的关系进行了研究。对627例不育患者的标本进行了精液分析。记录了每高倍视野的圆形细胞数量和每毫升精液中的圆形细胞数量。57例患者（9%）的标本持续显示每高倍视野超过10个圆形细胞或每毫升超过100万个圆形细胞，对这些标本进行了针对白细胞表面抗原的免疫组织化学染色。每毫升超过100万个白细胞的情况仅在20例患者（35%）中发现，只有8个样本显示每毫升超过300万个白细胞。每毫升白细胞超过100万个的患者中，65%的精子活力低于60%，而脓精症数量低于此水平的患者中这一比例为49%。这种差异无统计学意义。以每毫升计数的圆形细胞与免疫组织化学染色结果的相关性优于以每高倍视野计数的圆形细胞。这些数据表明，精液中圆形细胞过多的大多数患者并非患有脓精症，因此，未经进一步检测就进行经验性抗生素治疗可能不会有效果。
