精液异常患者人口学因素调查

摘要

目的 研究中重度少弱精子症、梗阻性无精子症与患者年龄、不育时间、文化程度、职业、体重指数、民族的相关性. 方法 回顾性收集2005年1月至2015年12月在昆明医科大学第二附属医院生殖医学科接受体外受精-胚胎移植的5 411例临床资料,根据男方精液分析异常类型,发现中重度少弱精子症有534例,无精子症有174例,精液分析正常有4 703例,比较这三组人群在不同的年龄组、文化程度、职业及民族等方面的患病率,采用Logistic回归分析上述因素与精液异常发生的相关性. 结果 (1)年龄＜30岁组的无精子症患病率(5.5％)高于其他年龄组,差异有统计学意义;不育时间≥15年组的少弱精子症(15.6％)及无精子症(7.1％)患病率高于其他不育时间组,差异有统计学意义;文化程度为小学组的少弱精子症患病率(6.6％)低于初中组和大学及以上组,差异有统计学意义;高中组(3.1％)、大学及以上组(1.7％)的无精子症患病率均低于其他文化程度组,差异有统计学意义;职业为工农组的无精子症患病率(4.2％)明显高于其他职业组,差异有统计学意义;民族为纳西族的少弱精子症患病率(16.9％)高于汉族(9.4％),傣族的无精子症患病率(7.5％)高于汉族(2.9％),差异均有统计学意义.(2)随年龄增加,患无精子症可能性下降,即年龄是无精子症的保护因素(P＜0.05,OR =0.78);随不育时间增加,患少弱精子症及无精子症的可能性增加,即不育时间是少弱精子症的危险因素[(P＜0.05,OR=1.23),(P=0.03,OR=1.05)];随文化程度升高,患无精子症可能性下降,即文化程度是无精子症的保护因素(P ＜0.05,OR=0.62);纳西族相对于汉族是少弱精子症的危险因素(P=0.03,OR=1.98). 结论 年龄是无精子症的保护因素,年龄越大,患无精子症的可能性越小,而青年人群中无精子症患病率最高;不育时间是少弱精子症及无精子症的危险因素,随不育时间延长,患少弱精子症及无精子症的可能性增加;少弱精子症在文化程度较高人群有高发倾向,而无精子症在文化程度不高的人群存在高发倾向,文化程度是无精子症的保护因素,随文化程度升高,患无精子症的可能性越小;工农职业人群的无精子症患病率最高;少数民族的精液异常患病率与汉族人群存在差异,纳西族的少弱精子症患病率明显高于汉族,傣族的无精子症患病率高于汉族,且纳西族患中重度少弱精子症的危险系数是汉族的1.98倍.%Objective To study the correlation between demographic characteristics,and moderate or severe oligoasthenospermia and obstructive azoospermia.Methods Clinical data of 5 411 cases,who received IVF-ET or ICSI treatment in the Second Affiliated Hospital of Kunming Medical University of reproductive medicine,were retrospectively collected from January 2005 to December 2015.Three groups were divided based on the type of abnormal semen.534 cases were in severe oligoasthenospermia group,174 cases were in azoospermia group,4 703 cases were in normal group.Demographic characteristics were compared between the three groups,which including age,duration of infertility,education,occupation,body mass index and nationality.Logistic regression model was used to analyze the correlation between the above factors and abnormal semen.Results (1) The prevalence of azoospermia in age younger than 30 years old was 5.5％ which was statistically higher than other age groups;prevalence of oligoasthenospermia and azoospermia was 15.6％ and 7.1％ among people with ≥ 15 years of duration of infertility,which were statistically higher than other groups.Prevalence of oligoasthenospermia among people with primary school was 6.6％,which was significantly lower than other group.Prevalence of azoospermia among people high school and University and above group was 3.1％ and 1.7％ respectively which was significantly lower than other groups.Prevalence of azoospermia among workers and peasants was 4.2％ which was significantly higher than other occupation group.The prevalence of oligoasthenospermia in Naxi nationality was 16.9％,prevalence of azoospermia in Dai nationality was 7.5％,which was higher than that of Han nationality.(2) With age increasing,the possibility of azoospermia was decreasing,that is,age was a protective factor for azoospermia (P ＜ 0.05,OR =0.78).The possibility of oligoasthenospermia and azoospermia was increased with duration of infertility prolonging,that is,it was a risk factor for oligoasthenospermia and azoospermia (P ＜ 0.05,OR =1.23;P =0.03,OR =1.05).The possibility of azoospermia was decreased with education elevating,that is,education was a protective factor for azoospermia (P＜0.05,OR =0.62).Naxi nationality was a risk factor for oligospermia and asthenospermia in comparison with Han nationality (P =0.03,OR =1.98).Conclusion Age was a protective factor for azoospermia.The possibility of azoospermia was decreased with age increasing,and the highest prevalence was among young people.Duration of infertility was a risk factor for oligoasthenospermia and azoospermia.The possibility of oligoasthenospermia and azoospermia was increased with duration of infertility prolonging.Prevalence of oligoasthenozoospermia was higher among people with higher education,and prevalence of azoospermia was higher among less educated people.The prevalence of azoospermia was the highest among workers and peasants.Education was a protective factor for azoospermia.The possibility of azoospermia was decreased with education elevating.There was significant difference of abnormal semen among minority and Han population,with higher prevalence of oligoasthenospermia in Naxi nationality and higher prevalence of azoospermia in Dai nationality,and the risk of moderate to severe oligoasthenospermia among Naxi nationality was 1.98 times than that of the Han nationality.