| Abnormal sperm morphology, which is a common male clinic reproductive dysfunction, refers to the normal morphology sperm less than4%, mean while, the sperm deformity sperm is more than96%. Abnormal sperm morphology is one of a common cause of male infertility of reproductive age, however, the understanding of sperm morphology is still at the stage of a stranger status, and there are already study abroad points out the significance of sperm morphology for male infertility diagnosis, and sperm morphological effects on sperm motility, acrosome reaction, etc have got the academic reports, so abnormal sperm morphology, as a independent disease,must reach importance on it. Now international and domestic have not unified on sperm morphology inspection system specification, the epidemiology, pathogenesis of abnormal sperm morphology research still have greatly improve the space, also failed to achieve a unified understanding on clinical treatment. In the treatment of traditional Chinese medicine also has many difficult to solve the problems and contradictions.Research purposes:based on the current Chinese and western medicine to the diagnosis and treatment of abnormal sperm morphology of the insufficiency of the understanding, in order to study the epidemiology of abnormal sperm morphology data and the law of TCM syndrome study, himself under the guidance of tutor,we design the study, in order to explore the influence facters of abnormal sperm morphology, affect sperm morphology and reproductive hormones, as well as the learning rule of syndromes.Methods:design outpatient medical records, collect all the standard patients in nearly a year in the second affiliated hospital of Beijing university of Chinese medicine, perfect the investigation form of writing,125cases were collected at last. Outpatient cases include:(1) general situation:name, age, culture level, occupation, etc.;(2) the chief complaint and the history of diagnosis and treatment;(3) medical history;(4) physical examination;(5) auxiliary examination;(6) the doctor of traditional Chinese medicine dialectical treatment,(7) treatment.125patients were divided into abnormal sperm morphology group and normal sperm morphology group, after statistics, abnormal sperm morphology group is65cases, normal sperm morphology group is60cases. Record two groups of patients with baseline information, sex hormone six and BMI, body mass index, the abnormal sperm morphology group and the comparison between sperm morphology of normal baseline data, sex hormone six and BMI, body mass index (BMI), statistical analysis of abnormal sperm morphology group of epidemiology, etiology and TCM syndrome patterns. Exploratory comparison abnormal sperm morphology infertility group and normal sperm forms infertility patients with sex hormone and six primary secondary infertility, and according to the statistical results continue to study the serum testosterone reference range and testosterone replacement therapy.The results of the study:1. Age composition:In this study of125cases, include65cases abnormal sperm morphology, whose average age is32.74+4.88(smallest23years old, largest47years of age);Normal sperm morphology group has60cases, average age is32.05±4.56years old (minimum of23years old, biggest45years of age), two groups have no difference, there have no age difference.2. Career:In this study of125cases, the case of abnormal sperm morphology is65, which include36cases of knowledge workers,29cases of manual workers; Normal sperm morphology group of60cases, of which the knowledge workers is42, the case of manual workers is18,x’=5.967, P=0.039<0.05, there are differences between two groups, manual workers abnormal sperm morphology is higher than the proportion of knowledge workers.3. The sex hormones control study:In this study of125cases, the case of abnormal sperm morphology is65,the case of normal sperm morphology is60, two groups of sex hormone and test analysis, the results of the numerical rank Z=2.435, abnormal sperm morphology group with normal sperm morphology group between follicle-stimulating hormone (FSH) leels were also associated with significant difference (P=0.011<0.05), follicle stimulating hormone levels in patients with abnormal sperm morphology group was higher than patients with normal sperm morphology group; Two groups of total testosterone, estradiol, luteinizing hormone, prolactin levels, the difference was not statistically significant (P value were greater than0.05), is not this a few results in the difference between the two groups. Preliminary judgment this topic into the group of patients, follicle stimulating hormone levels have an effect on sperm morphology, and the total testosterone, estradiol, luteinizing hormone, prolactin may had no obvious effect on sperm morphology.4. Weight index control study:according to the patients for the height and weight to calculate the BMI of body mass index (BMI=weight (Kg) present height (m)2), abnormal sperm morphology group with an average of25.16±3.43Kg/m2(note:Asian reference range18.5-22.9Kg/m2), at full-figured levels, normal sperm morphology group with an average of24.82±3.68Kg/m2, also at full-figured levels, both sets of data obey the normal distribution, comparing differences between two groups of body mass index (BMI) results P=0.673>0.05, no statistical significance, body mass index (BMI) no difference, two groups of body mass index.5. Abnormal sperm morphology merger other abnormal semen quality:in65patients with abnormal sperm morphology, idiopathic abnormal sperm morphology (not less with less weak sperm and semen) accounted for21.5%(14/65), and combined the weak sperm ratio reached78.5%(51/65), merging sperm and semen quantity is little less also reached21.5%(14/65), respectively,21.5%(10/65) of the proportion, the abnormal sperm morphology,as a less disease occur alone, merger other abnormal semen quality diseases in normal.6. Research of the regular of doctor of traditional Chinese medicine syndrome types:In this study,damp invasion of lower energizer, stagnation of blood stasis, deficiency of the kidney yin, stagnation of QI due to depression of the liver, decline of kidney-YANG and qi-blood deficiency are included,Χ2=74.413, P=0.000, showed that patients with abnormal sperm morphology has a significant difference between different syndrome. Damp invasion of lower energizer is significantly more than any other type (P=0.000), but with the stagnation of QI due to depression of the liver and qi-blood deficiency, there was no statistically significant difference between the two virtual. There is only7cases in65patients with abnormal sperm morphology is single card type, and there is only4case in40cases of damp invasion of lower energizer is single card type, the rest are composite card type, mostly combined with stagnation of QI due to depression of the liver and qi-blood deficiency.7. Organic factors of abnormal sperm morphology:local factors of accessory sex gland infection, the most common is varicocele. Systemic factors occupy9.4%, which is3cases (3/32),may be because of systemic sex disease affecting the normal function of the reproductive target organs, leading to the result of the indirect affect sperm quality. Local organs factors in22cases (22/32), occupy68.8%of the total organic causes, including accessory sex gland infection with varicocele almost half and half. Endocrine factors which is7cases (7/32,21.9%) might be caused by influencing the reproductive endocrine and sperm production function and sperm maturation. 8. The way of work and lifestyle factors of abnormal sperm morphology:including work way, life style, with reference to the foreign similar literature group, the way of work is divided into (1) working pressure:pressure, pressure, pressure is small;(2) the cumulative working hours every week:>50hours,50or less and>40hours,40hours or less.(3) the time of exposure to computer every day:>4hours,4or less, and>2hours,2hours or less, no computer contact;(4) contact computer number:10years or more,<10and5or more years,<5years exposure history, no computer. Lifestyle in (1) the number of dai ly smoking:p20,<20and10or more,<10, there is no his tory of smoking;(2) years smoking:20,<20and10or higher, or<10, there is no his tory of smoking.(3) drinking:of ten drinking, the occasional drink, there is no history of alcohol;(4) the daily food preferences, habits:bland diet, meat, Fried food, the more the more spicy food is, the more the diet preferences;(5) the daily drink drink: often drink coffee, often drinking cola, without frequent coffee drink coke;(6) always phone placed trouser pocket:10years or more, but><10five years, five years or less, usually without mobi le phone placed trouser habi t;(7) whether to stay up late at ordinary times:yes, no;(8) evapotranspiration, bubble bath, yes, no;(9) every seat clamp leg length:4h>,<4h, no. Will be abnormal sperm morphology group with normal sperm morphology group of variables into the relevant data processing, the school teaching and research section of statistics under the guidance of relevant personnel adopted qualitative dependent variable can be used to deal with the multi-factor Logistic regression analysis through statistical analysis, statistical results show that abnormal sperm morphology group with normal sperm morphology group work lifestyle factors had no statistical significance, variables are rejecting equation, it is not the conclusion of the above factors have an effect on sperm morphology.9. The iatrogenic factors of abnormal sperm morphology:composi t ion than data statistics results show that the history of surgery in patients with history of food and medicine taking equally5cases, it is difficult to give conclusions.10. The etiology of the abnormal sperm morphology classification:this clinical research results show that there are only a few cases may be caused by iatrogenic factors (10/65=15.4%); While most of the work is1ifestyle factors, physical factors (40/65=61.5%,32/65=49.2%), while the number of cases is less, but the proportion has certain persuasive, combined with clinical analysis of actual lifestyle factors may also be caused the organic causes, thus reproductive target organ damage and cause the abnormal sperm morphology, suggesting we substantive organs damage in abnormal spermmorphology cause may be the important position. At the same time the clinical research results show that the composite factor and the proportion of patients with abnormal spermmorphology, the highest for42cases (42/65=64.6%), the independent factors accounted for only a few (4/65=6.2%). Although the number of cases is few, but the proportion has certain persuasive, on the basis of the results may prompt in clinic,we should attach great importance to the overlapping influence of many factors on sperm morphology. In addition, unknown origin also accounts for a considerable proportion,19(19/65=29.2%), it may indicate that actively explore the causes of abnormal sperm morphology has an important clinical significance.11. Exploratory research on A:this clinical study will be abnormal sperm morphology infertility group of40patients and normal sperm forms infertility group of35cases of serum sex hormone data processing variables, tha school teaching and research section of statistics under the guidance of relevant personnel have adopted qualitative dependent variable can be used to deal with related data statistical analysis, Logistic regression analysis results suggest that abnormal spermmorphology, infertility group of sex hormones in serum total testosterone (T) only have significant difference, equations for In (P)/(1-P) T=0.7770.777, P=0.016<0.05, with statistical significance; Sex hormone variables and sperm morphological normal fertility group were not statistically significant, variables are rejecting equation. Based on the above results, analysis of serum testosterone may has protection significance to infertile patients with abnormal sperm morphology. Accordingly, this clinical study was further studied:(1) the reference range of statistical methods, statistical analysis was carried out on the serum testosterone, statistic analysis of MD+SD:453.68±177.11, preliminary judgment:serum total testosterone (T) the reference range of276.57to630.79ng/ml, namely the into the sperm deformity of group95%proportion of the total serum testosterone value distribution on the interval;(2) on the current international and domestic recognized testosterone supplementation limit is350ng/ml, abnormal sperm morphology in patients with infertility group serum testosterone<350ng/ml has26patients, the serum testosterone>14cases of350ng/ml, sperm morphology in the normal fertility group serum testosterone<13cases of350ng/ml, serum testosterone >22cases of350ng/ml, chi-square,Χ2=5.804, P=0.014<0.05, there was a significant difference between two groups, abnormal sperm morphology infertility patients’ serum total testosterone<350ng/ml (upper limit of testosterone supplementation) is much higher than the proportion of normal sperm morphology infertility patients, the clinical serum testosterone (T)<350ng/ml sperm deformity, discuss whether there is a need to line of testosterone replacement therapy has a certain research significance, but whether it is feasible to testosterone replacement therapy still needs further clinical research.12.Exploratory study on B:40cases of abnormal sperm morphology in this clinical study infertility patients,28cases of primary infertility,12cases of secondary infertility,35cases of normal sperm morphology infertility patients,15cases of primary infertility,20cases of secondary infertility. By chi-square test,Χ2=6.917, P=0.008<0.05, there was a significant difference between two groups, sperm morphological abnormalities in patients with infertility idiopathic infertility proportion is far higher than that of normal sperm morphology infertility patients, and this topic sperm morphological abnormali t ies in patients with infertility, proport ion of secondary infertility is less, while the number of cases is less, but the proportion has certain powers of persuasion.In conclusion, actively explore the sperm morphology in primary infertility etiology of abnormal status, may have a certain clinical significance.Conclusion:1. The small sample data statistics show that follicle-stimulating hormone levels in pat ients wi th abnormal sperm morphology group was higher than patients with normal sperm morphology group, with significant difference statistically significant, follicle stimulating hormone levels of the male sperm shape abnormality rate may have important influence. Large sample statistical needs further research.2. The small sample data statistics show that TCM syndrome type distribution of patients with abnormal sperm morphology, significant differences were found between different syndrome, two more hot and humid betting type of syndrome is significantly more than any other, the highest proportion of treating syndrome patients, and abnormal sperm morphology in patients with more for compound TCM syndrome types, multiple combined liver depression and qi stagnation, qi deficiency syndrome type.3. The small sample data statistics show that the serum testosterone may of abnormal sperm morphology infertility, sperm deformity patient protection significance, total serum testosterone (T) reference value in the range of276.57to630.79ng/ml, abnormal sperm morphology infertility, sperm deformity patients serum total testosterone<350ng/ml (upper limit of testosterone replacement therapy) is much higher than the proportion of normal sperm morphology infertility patients, the clinical serum testosterone(T)<350ng/ml sperm deformity, discuss whether there is a need to row testosterone replacement therapy has a certain research significance. |
