青年精索静脉曲张对精液质量影响的meta分析

发布时间：2018-04-28 09:04

本文选题：青年 + 精索静脉曲张　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的:通过meta分析研究青年人群精索静脉曲张以及精索静脉曲张治疗后的精液质量变化。方法:计算机检索Pub Med、Cochrane、Medline,查找所有比较青年人群精索静脉曲张精液变化及精索静脉曲张术后精液变化的随机对照试验,检索时限为1995年1月1日到2015年1月1日,纳入所有比较青年精索静脉曲张及其治疗对精液影响的随机对照试验。无论是否提及盲法,要求数据详细准确。排除重复发表的论文;综述、评论或讲座;未报告精子浓度或精子活力的研究;不能提取统计学内容的研究。将筛选文献分类入两个假设组中。假设1(精索静脉曲张可降低精液质量):研究必须包括临床可诊断的青年男性精索静脉曲张并有相应对照组。假设2:(精索静脉曲张治疗可提高精液质量):纳入的研究可以是参与者的自身对照或与未治疗的青年精索静脉曲张患者对照。据不同的假设纳入排除标准略有差异。按纳入排除标准由2人独立进行随机临床试验(RCT)的筛选、资料提取和质量评价,随机对照试验研究的文献质量使用Jadad Quality。Jadad量表主要项目包括:文献是否随机、是否双盲、退出和失访有无记录(表1),总分5分,要求纳入的文献评分不小于3分。文献由两例研究者独立进行质量评价,评分出现差异时经讨论决定取舍。数据采用Rev Man5.3软件进行Meta分析。结果:初步检索发现1180篇相关文献,假设1(精索静脉曲张可降低精液质量):共纳入8个研究,310位无曲张患者,165位曲张患者。精子浓度:Std.Mean Difference=0.79,95%CI(0.30-1.29)。合并效应量Z=3.16,P值0.05,表明精索静脉曲张组精子浓度较低。精子活力:Std.Mean Difference=0.62,95%CI(0.18-1.05)。合并效应量Z=2.79,P值0.05,精子活力曲张组下降。假设2:(精索静脉曲张治疗可提高精液质量):共纳入6个研究,术前与术后精液分析样本均为160人。精子浓度:Std.Mean Difference=1.4,95%CI(0.30-2.51)。合并效应量Z=2.49,P值0.05,精索静脉曲张治疗后精子浓度得到改善。精子活力:Std.Mean Difference=1.47,95%CI(0.14-2.79)。合并效应量Z=2.17,P值0.05,表明精索静脉曲术后精子活力得到改善。结论:青年人群中,精索静脉曲张可对精子浓度、精子活力产生负面影响。精索静脉曲张的治疗,可使精子浓度及精子活力得到轻度至中度的提高。早期发现与合理治疗精索静脉曲张对于国人后代健康的意义重大,作为临床医务工作者,应提醒人们关注青年身体发育期的各种常见疾病的预防、诊治。
[Abstract]:Objective: to study the semen quality of young people with varicocele and varicocele by meta analysis. Methods: a computer search of Pub Medtrol Cochrane Medline was conducted to find out all the randomized controlled trials in which semen changes of varicocele and semen after varicocele were compared in young population. The search time was from January 1, 1995 to January 1, 2015. All randomized controlled trials were conducted to compare the effects of varicocele and its treatment on semen in young adults. Whether or not the blind method is mentioned, the data are required to be detailed and accurate. Exclusion of repeated papers; reviews, reviews, or lectures; studies that do not report sperm concentration or sperm motility; studies that do not extract statistical content. The sieve literature was classified into two hypothetical groups. Hypothesis 1 (varicocele may reduce semen quality): the study must include clinically diagnosed young men with varicocele and a corresponding control group. Suppose 2: (varicocele treatment improves semen quality: the included study could be a self-control of participants or a control with untreated young patients with varicocele. Inclusion of exclusion criteria varies slightly according to different assumptions. According to the exclusion criteria, two individuals were independently selected for randomized clinical trial (RCT), data extraction and quality evaluation. The main items of literature quality using Jadad Quality.Jadad scale in randomized controlled trial included: whether the literature was random, whether the literature was double-blind or not. There are no records of withdrawal and missing interviews (Table 1, total score 5, required to be included with a document score of not less than 3 points. The literature was evaluated independently by two researchers. The data were analyzed by Meta using Rev Man5.3 software. Results: 1180 related literatures were preliminarily searched, assuming that 1 (varicocele could reduce semen quality): a total of 310 patients with varicocele and 165 patients with varicocele were included in 8 studies. Sperm concentration: Std.Mean difference between 0.79 and 95CI0.30-1.29. The combined effect quantity ZG 3.16 P value was 0.05, which indicated that the spermatozoa concentration of varicocele group was lower than that of varicocele group. Sperm motility: Std.Mean difference between 0.62 and 95CI0.18-1.05. The combined effect of Z _ (2.79) P value was 0.05, and the sperm motility varicose group was decreased. Suppose that 2: 1 (varicocele treatment can improve semen quality): a total of 6 studies were conducted, and 160 semen samples were obtained both before and after operation. Sperm concentration: Std.Mean difference between 1.4 and 95CI 0.30-2.51. The spermatozoa concentration was improved after varicocele treatment. Sperm motility: Std.Mean difference between 1.47 and 95CI0.14-2.79. The combined effect of Z 2. 17 P value was 0. 05, which indicated that sperm motility was improved after spermatic varicocele. Conclusion: varicocele has a negative effect on sperm concentration and sperm motility in young people. The treatment of varicocele can increase sperm concentration and sperm motility mildly to moderately. The early detection and rational treatment of varicocele is of great significance to the health of Chinese offspring. As a clinical medical worker, people should be reminded to pay attention to the prevention, treatment and treatment of various common diseases in the period of physical development of young people.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R697.24

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