声脉冲辐射力成像定量技术评估精索静脉曲张非不育患者睾丸组织的研究

doi:10.16150/j.1671-2870.2019.05.011

摘要/Abstract

摘要：

目的：运用声脉冲辐射力成像定量技术评估不同程度左侧精索静脉曲张（varicocele,VC）非不育患者睾丸组织硬度与精液质量之间的关系。方法：选取143例左侧VC非不育患者（VC组）,并依据临床触诊及超声检查结果将其按曲张程度由轻到重分为亚临床型精索静脉曲张（subclinical varicocele,SVC）组（42例）、VC1组（33例）、VC2组（49例）、VC3组（19例）4个亚组,另选择67名正常人作为对照组。所有受检者均行精液分析及常规超声,并使用声辐射力触诊成像（acoustic radiation force impulse, ARFI）技术测定睾丸组织的剪切波速度（shear wave velocity,SWV）。结果：与对照组比较,VC组及VC2、VC3组双侧睾丸组织的SWV值及精子密度均降低（Z_vc-对照=-5.015,Z_vc2-对照= -7.841,Z_vc3-对照=-6.182,P<0.01;Z_vc-对照=-6.878,Z_vc2-对照=-8.258,Z_vc3-对照=-8.695,P<0.01）;与SVC组比较,VC2、VC3组的双侧睾丸组织SWV值及精子密度均降低（Z_vc2-svc=6.674,Z_vc3-svc=5.557,P<0.01;Z_vc2-svc=6.407,Z_vc3-svc=7.432,P<0.01）;与VC1组比较,VC2、VC3组的双侧睾丸组织SWV值及精子密度均降低（Z_vc2-vc1=6.480,Z_vc3-vc1=5.529,P<0.01;Z_vc2-vc1=4.471,Z_vc3-vc1=5.953,P<0.01）。Pearson相关分析显示,VC组患者的睾丸SWV值与精子密度、睾丸体积呈正相关（r_左=0.732,r_右=0.664,P<0.01;r_左=0.595,r_右=0.417,P<0.01）;VC组患者的左侧精索静脉内径值与SWV值则呈负相关（r_左=-0.758,r_右=-0.775,P<0.01）。结论：睾丸组织SWV值能作为客观评估VC患者睾丸组织硬度和睾丸生精功能变化趋势的参考指标之一。

关键词: 精索静脉曲张, 声脉冲辐射力成像技术, 剪切波速度, 睾丸体积, 精液质量

Abstract:

Objective: To investigate the correlation between the change of testicular tissue stiffness and the semen quality of non-sterility left varicocele(VC) patients by using acoustic radiation force impulse imaging(ARFI). Methods: According to the results of palpation and ultrasonic examination,143 cases of non-sterility left varicocele(VC) patients were divided into subclinical varicocele(SVC) group(42 cases), grade VC1 group (33 cases), grade VC2 group (49 cases),grade VC3 group (19 cases); in addition, 67 cases of normal subjects were served as controls.All subjects underwent semen examination and routine ultrasound examination. The shear wave velocity (SWV) in testis of all subjects were determined by acoustic pulse radiation imaging. The rank-sum test was used to compare the difference of SWV values and sperm quality between VC groups and control group. Pearson correlation analysis was used to analyze the correlation between sperm density, testicular volume, internal diameter of varicose veins and SWV in VC patients. Results: Compared with the control group, SWV value of testis decreased in VC group and VC2, VC3 group(Z_vc-CG=-5.015, Z_vc2-CG=-7.841, Z_vc3-CG=-6.182, P<0.01), sperm density decreased in the VC group and VC2, VC3 groups(Z_vc-CG=-6.878,Z_vc2-CG=-8.258,Z_vc3-XG=-8.695, P<0.01). Compared with the SVC group, SWV value of testis decreased in VC2, VC3 groups (Z_vc2-svc=6.674, Z_vc3-svc=5.557, P<0.01), sperm density decreased in VC2, VC3 group(Z_vc2-svc=6.407, Z_vc3-svc=7.432, P<0.01). Compared with VC1 group, SWV value of testis decreased in VC2, VC3 groups (Z_vc2-vc1=6.480, Z_vc3-vc1=5.529, P<0.01), sperm density in VC2, VC3 groups also decreased (Z_vc2-vc1=4.471, Z_vc3-vc1=5.953, P<0.01). Pearson correlation analysis showed that there was a positive correlation between SWV value and sperm density and testicular volume in VC group（r_left=0.732,r_right=0.664, P<0.01; r_left=0.595,r_right=0.417, P<0.01）. And there was a negative correlation between SWV value and internal diameter of spermatic vein（r_left=-0.758, r_right=-0.775, P<0.01）. Conclusions: The SWV value of testis can be used as a reference index to evaluate the change of testicular tissue stiffness and testicular spermatogenesis in VC patients.

Key words: Varicocele, Acoustic radation force impulse imaging, Shear wave velocity, Testis volume, Semen quality

中图分类号:

R445.1

李敏, 柳俊, 王之倩, 詹维伟. 声脉冲辐射力成像定量技术评估精索静脉曲张非不育患者睾丸组织的研究[J]. 诊断学理论与实践, 2019, 18(05): 543-547.

LI Min, LIU Jun, WANG Zhiqian, ZHAN Weiwei. Research on acoustic radiation force impulse imaging in quantitative assessment of testicular stiffness in non-sterility varicocele patients[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(05): 543-547.

图/表 2

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组别	例数（n）	SWV值		精子密度（×10⁶/mL）
组别	例数（n）	右侧	左侧	精子密度（×10⁶/mL）
对照组	67	0.73±0.08	0.75±0.10	77.00±12.00
VC组	143	0.69±0.14^a)	0.68±0.16^a)	61.00±22.00^a)
SVC组	42	0.76±0.08	0.75±0.10	75.50±13.00
VC1组	33	0.75±0.10	0.76±0.07	70.00±16.00
VC2组	49	0.62±0.08^a),b),c)	0.62±0.07^a),b),c)	53.00±17.00^a),b),c)
VC3组	19	0.58±0.12^a),b),c)	0.57±0.11^a),b),c)	25.00±10.00^a),b),c)