目的：为进一步了解肥胖对男性生育力影响，探究不同体重指数（BMI）、精浆中游离脂肪酸（Free fatty acid, FFA）和抑制素B（Inhibin B, INHB）对于精液参数的影响，以及三者之间的相关关系。方法通过整群抽样抽取177个男性不育患者，其中正常体质量组：58人；超质量组：60人；肥胖组：59人。通过检测精液常规， ELISA法检测精浆中FFA、INHB。结果超质量组精液量（2.27±0.98）mL与正常体重组精液量（2.71±0.92）mL相比精液量减少，（P＜0.05）。肥胖组精液量（1.96±0.76）mL少于正常体重组精液量，（P＜0.05）。肥胖组与超质量组相比较，（P＞0.05）。肥胖组总精子数（103.75±78.38）×106低于正常体质量组总精子数（146.39±111.87）×106，（P＜0.05）。肥胖组精液的畸形精子率（80.46±9.92）%高于正常体质量组（76.59±9.92）%，（P＜0.05）。正常体质量组精浆中FFA（348.64±119.72）ng/mL，超质量组（535.81±133.90）ng/mL，肥胖组（595.26±146.69） ng/mL，正常体质量组与超质量组比较（P＜0.05），正常体质量组与肥胖组比较（P＜0.05），超质量组与肥胖组比较差异有显著性（P＜0.05）。精浆中FFA与体重指数呈显著正相关（r=0.57，P＜0.01）。正常体质量组精浆中INHB（30.61±11.17）ng/L，超质量组（48.09±11.66）ng/L，肥胖组（48.40±13.95）ng/L，正常体质量组与超质量组（P＜0.05），正常体质量组与肥胖组比较（P＜0.05），超质量组与肥胖组比较（P＞0.05）。精浆中INHB与BMI显著正相关（r=0.46，P＜0.01）。精浆中FFA与INHB也呈正相关（r=0.47，P＜0.01）。结论在随着BMI增加，精液量减少，精子畸形率增加，精浆中FFA、INHB也增加，为临床分析肥胖影响男性生育的病因，也为临床治疗肥胖男性不育患者提供依据。%Objective To better understand the effect of obesity on male fertility and analyze the correlation of body mass index, free fatty acid and inhibin B in the seminal plasma with seminal parameter. Methods Using simple cluster selection, 177 male infertile patients were enrolled and divided into three group such as normal weight group(58 patients), overweight group(60 patients) and obese group(59 patients). Semen samples were analyzed by conventional methods. The levels of FFA and INHB in seminal plasma were detected by ELISA. Results The volume of semen in overweight group (2.27±0.98)mL was lower than that in normal weight group(2.71±0.92)mL, (P<0.05). The volume of semen of Obesity group(1.96±0.76)mL was lower than that of normal weight group,(P<0.05). There was no significant difference in the volume of semen betwen Obese group and overweight group (P>0.05). Rate of deformity sperm in obese group(80.46±9.92)%wae significantly higher than that in normal weight group(76.59±9.92)%, (P<0.05). Total sperm amount in Obesity group(103.75 ±78.38)×106 was lower than that in the normal weight group (146.39±111.87) ×106, there was a significant difference (P<0.05). In addition,the seminal plasma concentration of FFA in Normal weight group, overweight, obesity group were (348.64 ±119.72) ng/mL, (535.81±133.90 )ng/mL and (595.26±146.69) ng/mL respectively, there was a significant between normal weight and overweight (P<0.05), between normal weight and obese group (P<0.05), between overweight and obesity group (P<0.05). FFA in the seminal plasma was positively correlated with BMI (r=0.569, P<0.01). The concentration of INHB in seminal plasma of the normal weight group , overweight group obesity group were (30.61±11.17)ng/L (48.09±11.66)ng/L, and (48.40±13.95)ng/L, respectively. There was a significant difference between normal weight group and overweight group(P<0.05), between normal weight group and obese group (P<0.05), but there was no significant difference between overweight and obesity group (P>0.05). INHB in the seminal plasma was positively correlated with BMI mass index (r=0.46, P<0.01), and FFA in seminal plasma (r=0.47, P<0.01). Conclusion With the increase of BMI, the levels of FFA and INHB in the seminal plasma and rate of deformity sperm also increased. To detect the level of FFA and INHB in seminal plasma will be helpful to explain obesity-caused male infertility, and provide certain theoretical basis and reference for clinical treatment.
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