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目的:探讨精浆左旋肉碱测定在男性不育症诊疗中的临床意义。方法:按照第5版《世界卫生组织人类精液检查与处理实验室手册》的参考值,将不育男性按照精液常规分析结果分为精子活力正常组(前向运动精子百分率≥32%)(n=283)和弱精子症组(前向运动精子百分率<32%)(n=892)。通过比色法检测精浆中的游离左旋肉碱含量,分析左旋肉碱浓度与精子活力、精液浓度的相关性。通过受试者操作特征分析曲线(receiver operating characteristic curve,ROC curve)确定左旋肉碱浓度的阈值,以阈值为分界点,将弱精子症组患者分为高于左旋肉碱阈值组和低于左旋肉碱阈值组,分析左旋肉碱与精子活力和精子浓度的相关性。结果:弱精子症组的精浆左旋肉碱浓度(384.14±188.81μmol/L)显著低于精子活力正常组(434.04±171.77μmol/L,P<0.05)。精子活力正常组和弱精子症组精浆中的左旋肉碱含量与前向运动精子百分率和精子浓度的相关性极低或不相关(r<0.2)。肉毒碱检测的ROC曲线下面积(AUC)为0.592,阈值为380.9,低于左旋肉碱阈值弱精子症组与前向运动精子百分率有较弱的正相关关系(r=0.329,P=0.000)。结论:对于拟行辅助生育的不育男性患者,精浆中左旋肉碱浓度作为精浆生化的指标之一,可能对弱精子症患者有一定的临床参考意义。
Objective: To investigate the clinical significance of seminal plasma L-carnitine in the diagnosis and treatment of male infertility. METHODS: Male infertile men were divided into normal sperm motility group (% of forward spermatozoa ≥32%) according to the reference manual of the 5th edition of WHO Handbook of Human Semen Inspection and Treatment (n = 283) and asthenospermia group (% of forward motile sperm <32%) (n = 892). The content of free L-carnitine in seminal plasma was detected by colorimetric method, and the correlation between L-carnitine concentration and sperm motility and seminal fluid concentration was analyzed. The receiver operating characteristic curve (ROC curve) was used to determine the threshold value of L-carnitine concentration, and the threshold value was used as the cut-off point to divide the patients with asthenospermia group into higher than L-carnitine threshold group and lower than L- Carnitine threshold group, analysis of the correlation between L-carnitine and sperm motility and sperm concentration. Results: The concentration of L-carnitine (384.14 ± 188.81μmol / L) in asthenospermia group was significantly lower than that in normal sperm motility group (434.04 ± 171.77μmol / L, P <0.05). The correlation between L-carnitine content in seminal plasma of sperm motility normal and asthenospermia group and motility sperm percentage and sperm concentration was very low or not (r <0.2). The area under the curve of carnitine (AUC) was 0.592 and the threshold value was 380.9. There was a weak positive correlation between carnitine and motile spermatozoa (r = 0.329, P = 0.000 ). CONCLUSIONS: L-carnitine concentration in seminal plasma is one of the biochemical markers of seminal plasma in infertile male patients who wish to give birth. It may have certain clinical significance in patients with asthenospermia.