摘要
目的分析阴囊冷敷贴联合敏感抗生素对存在精道感染因素的死精子症患者的疗效。方法回顾性分析2021年1月至2022年9月来我中心男科就诊,精液常规检查2次以上确诊为死精子症、且行精液细菌培养为阳性的患者。选择药敏结果中敏感的抗生素进行抗感染治疗,同时联合阴囊冷敷贴及左卡尼汀口服液的患者作为实验组,实验组根据每日冷敷贴使用次数不同分为实验A组(1次/d)和实验B组(2次/d)。选择单纯抗生素抗感染治疗加用左卡尼汀口服液。作为对照组的患者分别统计治疗4周、8周及12周不同组患者的精液细菌培养转阴数和精子参数改变情况。结果共纳入患者145例,按随机化原则分实验A组49例,实验B组49例,另有47例患者作为对照组。治疗第4周,实验组在禁欲时间、细菌培养转阴、精液pH、前向运动精子比率及精子存活率方面与对照组无统计学差异(P均>0.05);而在精子存活率方面,实验B组(53.1±14.1)优于实验A组(46.2±16.4,P<0.05)。治疗第8周,细菌培养转阴数实验组(74/98)高于对照组(26/47),存在统计学差异(χ^(2)=5.14,P<0.05);前向运动精子比率实验组(26.5±11.9)高于对照组(22.8±12.6),精子存活率实验组(53.1±14.6)同样高于对照组(47.6±13.4),均存在统计学差异(P均<0.05);而细菌转阴数、前向运动精子比率和精子存活率,实验A组(35/49、25.5±10.3、51.1±15.0)均低于实验B组(39/49、27.5±13.2、55.1±14.2),但组间无统计学差异(P均>0.05)。治疗第12周细菌培养转阴数实验组(67/98)高于对照组(21/47),存在统计学差异(χ^(2)=6.11,P<0.05);前向运动精子比率实验组(30.9±11.2)高于对照组(24.7±13.4,P<0.05);精子存活率实验组(56.3±13.0)高于对照组(46.7±12.0),二者间差异有统计学意义(P<0.01);而细菌转阴数、前向运动精子比率和精子存活率,实验A组(31/49、28.8±10.0、55.9±12.7)与实验B组(36/49、32.8±12.1、56.7±13.4)间无统计学差异(P均>0.05)。结论阴囊冷敷联合抗生素对存在精道感染因素的死精子症患者治疗效果优于单纯抗生素的治疗,尤其是在前向运动精子比率和精子存活率方面,但与每日冷敷次数关系不大。因此,在此类患者的诊疗中,建议推广阴囊冷敷联合治疗。
Objective To analyze the efficacy of scrotum cold compress combined with antibiotics on necrospermia patients with seminal tract infection.Methods We made a retrospective analysis of the patients who were confirmed as necrospermia by more than 2 times of semen examination and positive by sperm bacteria culture at the Andrology Department of our center from January 2019 to September 2022.The experiment group patients who were cured by scrotum cold compress combined with sensitive antibiotics and L-carnitine were divided into experiment group A(1 time/day)and experiment group B(2 times/day)according to the daily times of scrotum cold compress.Meanwhile,only sensitive antibiotics and L-carnitine were administered in the control group patients.We recorded the improvement of sperm parameters and the number of negative sperm bacterial cultures in different groups at 4 weeks,8 weeks,and 12 weeks of treatment.Results A total of 145 patients were enrolled in the study.According to the principle of randomization,49 patients in group A,49 patients in group B,and 47 patients in the control group were enrolled.After 4 weeks of treatment,there was no significant difference between the experiment group and the control group in terms of abstinence time,the number of negative sperm bacterial cultures,semen pH,sperm ratio of forward motility,or the sperm survival rate(all P>0.05).In terms of the sperm survival rate,group B(53.1±14.1)was superior to group A(46.2±16.4)(P<0.05).In the results of the treatment at 8 weeks,the number of negative sperm bacterial cultures was significantly higher in the experiment group(74/98)than in the control group(26/47)(χ^(2)=5.14,P<0.05).Sperm ratio of forward motility was higher in the experiment group(26.5±11.9)than in the control group(22.8±12.6).The experimental group(53.1±14.6)also had a significantly higher sperm survival rate than the control group(47.6±13.4)(P<0.05).However,the number of negative sperm bacterial cultures,sperm ratio of forward motility,and the sperm survival rate were lower in experiment group A(35/49,25.5±10.3,51.1±15.0)than in experiment group B(39/49,27.5±13.2,55.1±14.2),but there was no statistical difference between the two groups(all P>0.05).After 12 weeks of treatment,the number of negative sperm bacterial cultures in the experimental group(67/98)was significantly higher than that in the control group(21/47)(χ^(2)=6.11,P<0.05).Sperm ratio of forward motility in the experiment group(30.9±11.2)was higher than that in the control group(24.7±13.4)(P<0.05).The experiment group(56.3±13.0)had a significantly higher sperm survival rate than the control group(46.7±12.0,P<0.01).However,in terms of the number of negative sperm bacterial cultures,sperm ratio of forward motility,and the sperm survival rate,there were no statistical differences between group A(31/49,28.8±10.0,55.9±12.7)and group B(36/49,32.8±12.1,56.7±13.4)(all P>0.05).Conclusion Scrotum cold compress combined with antibiotics is superior to only antibiotic treatment on necrospermia patients with seminal tract infection,especially in the sperm ratio of forward motility and sperm survival rate,but it has little relationship with the times of cold compressions per day.Therefore,the method deserves application in this type of patients’diagnosis and treatment.
作者
李建波
闵保华
马旭辉
杨涛
兰辉
王晓红
LI Jianbo;MIN Baohua;MA Xuhui;YANG Tao;LAN Hui;WANG Xiaohong(Medicine Center of Obstetrics and Gynecology,the Second Affiliated Hospital of Air Force Military Medical University,Xi’an 710038,China)
出处
《西安交通大学学报（医学版）》
CAS
CSCD
北大核心
2023年第5期779-783,共5页
Journal of Xi’an Jiaotong University（Medical Sciences）
基金
国家自然科学基金资助(No.82071717)。
关键词
死精子症
精道感染
阴囊冷敷
不育症
抗生素
necrospermia
infection of seminal tract
scrotum cold compress
infertility
antibiotic
