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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2021, Vol. 07 ›› Issue (02) : 108 -115. doi: 10.3877/cma.j.issn.2095-9605.2021.02.008

循证医学

减重手术对男性精子质量影响的Meta分析
高志光1,†(), 张涛1, 梁煜芝2   
  1. 1. 523326　东莞；东莞市松山湖中心医院普通外科
    2. 523326　东莞；东莞市松山湖中心医院医学影像科
  • 收稿日期:2021-04-08 出版日期:2021-05-30
  • 通信作者: 高志光
  • 基金资助:
    东莞市社会发展科技重点项目(20211800902451)

Effect of bariatric surgery on male’s semen quality: a meta-analysis.

Zhiguang Gao1,†(), Tao Zhang1, Yuzhi Liang2   

  1. 1. Department of General Surgery, the Affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan 523326, China
    2. Department of Medical Imaging, the Affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan 523326, China
  • Received:2021-04-08 Published:2021-05-30
  • Corresponding author: Zhiguang Gao
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高志光, 张涛, 梁煜芝. 减重手术对男性精子质量影响的Meta分析[J]. 中华肥胖与代谢病电子杂志, 2021, 07(02): 108-115.

Zhiguang Gao, Tao Zhang, Yuzhi Liang. Effect of bariatric surgery on male’s semen quality: a meta-analysis.[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 07(02): 108-115.

目的

系统评价减重手术对男性精子质量的影响。

方法

计算机检索医学文献数据库，包括EMBASE、PubMed、Cochrane Library、万方、中国知网等，检索时间均从建库开始至2020年12月。搜集关于男性肥胖患者减重手术前后精子质量变化的文献，并对纳入文献进行质量评估，提取数据后采用Review Manager 5.3统计软件分析。

结果

共纳入6项队列研究。Meta分析结果示：减重手术对男性肥胖患者射精量、精子浓度、运动精子（%）、向前运动精子（%）及正常形态精子（%）无明显影响，甚至可引起患者的精子总数下降（MD=43.29，95%CI: 3.24~83.34，P<0.03）。

结论

减重手术不能改善精子质量，这需要更大样本及更长随访时间的随机前瞻性研究来证实。

关键词: 减重手术, 肥胖, 精子质量, 精液参数, Meta分析
Objective

To systematically review the effect of bariatric surgery for male’s semen quality.

Methods

Computer retrieval of medical literature databases, including EMBASE, PubMed, Cochrane Library, Wanfang, CNKI and so on, was conducted from the establishment of the database to December 2020. To collect the literatures about the effect of bariatric surgery on obesity with semen quality, and evaluate the quality of the included literatures. After extracting the data, the Review Manager 5.3 statistical software was used to analyze.

Results

A total of 6 before-after studies were included. The results of meta-analysis showed that there was no significant difference in semen volume, sperm concentration, total motility (%), progressive motility (%), normal morphology (%). In addition, bariatric surgery could reduce sperm number (MD = 43.29, 95%CI: 3.24 to 83.34, P<0.03).

Conclusions

Bariatric surgery did not improve semen quality in obese male patients. Randomized prospective studies with larger samples and longer follow-up are needed to confirm these findings.

Key words: Bariatric surgery, Obesity, Sperm quality, Semen parameters, Meta-analysis
图1 文献筛选流程与结果
表1 纳入文献基本资料
作者 发表年份 国家 文献类型 手术方式 样本量 年龄（岁） 随访时间（月） 术前BMI（kg/m2） 术后BMI（kg/m2）
Calderón[15] 2019 多米尼加共和国 前瞻性研究 RYGB/VG 20 40±8 24 50±10 32±7
Carette[16] 2019 法国 前瞻性研究 GB/SG 46 38.9 ±7.9 12 44.1±5.7 31.4 ±5.3
Samavat[8] 2018 意大利 前瞻性研究 GB 23 38±9 6 45.8 ± 7.4 34.7 ± 5.3
El Bardisi[17] 2016 美国 前瞻性研究 SG 46 29-44 12 42.9-96.2 32.2-76.9
Legro[18] 2015 美国 前瞻性研究 RYGB 6 30-40 12 48±7 32±7
Oliveira Reis[7] 2012 巴西 前瞻性研究 GB 10 36.7±11.5 24 55.7 ±7.8 31.0 ± 5.3
Total         197        
表2 减重手术前后精液参数变化情况
作者/发表年份 手术前
精液量(mL) 精子浓度(106/mL) 精子总数(106) 运动精子(%) 向前运动精子(%) 正常形态精子(%)
Calderón 2019[15] - 18±69 - 35±35 20±30 2±4
Carette 2019[16] 2.75±1.26 - 177.7±177.7 35.0±12.6 - 15.4±8.7
Samavat 2018[12] 2.2±1.3 83.0±100.0 130.0±150.0 48.7±19.3 38.9±19.7 8.5±7.8
El Bardisi 2016[17] 5.13±3.63 37±35.75 - 40.25±23.75 22.5±17.5 56.5±25
Legro 2015[18] 2.1±1.1 65±73 - 46±25 - 10±8
Oliveira Reis 2012[7] 2.9±0.8 78.7±58.6 - 34.0±8.9 - 8.2±4.0
作者/发表年份 手术后
精液量(mL) 精子浓度(106/mL) 精子总数(106) 运动精子(%) 向前运动精子(%) 正常形态精子(%)
Calderón 2019[15] 2.3（1.8） - - 35±50 25±35 2±4
Carette 2019[16] 2.71±1.22 - 108.2±92.9 31.8±12.0 - 12.4±6.4
Samavat 2018[12] 2.8±1.4 55.00±63.0 150.0±230.0 55.2±20.6 43.0±21.1 5.0±4.6
El Bardisi 2016[17] 3.33±1.93 35.6±32 - 34.25±18.25 23.25±16.75 67.5±25
Legro 2015[18] 2.0±2.0 99±148 - 55±28 - 7±11
Oliveira Reis 2012[7] 4.1±0.8 104.0±66.5 - 36.0±8.5 - 11.0±2.6
表3 纳入研究的MINORS条目文献质量评分
文献 研究目的明确 患者纳入是否连贯 预期数据的收集 终点指标能否反映研究目的 终点指标评价的客观性 随访时间是否充足 失访率<5% 是否估算了样本量 总分
Calderón 2019[15] 2 2 1 2 2 2 2 0 13
Carette 2019[16] 2 2 1 2 2 2 2 0 13
Samavat 2018[8] 2 2 2 2 2 1 2 0 13
El Bardisi 2016[17] 2 2 1 2 2 2 2 0 13
Legro 2015[18] 2 2 1 2 2 2 2 0 13
Oliveira Reis 2012[7] 2 2 1 2 2 2 2 0 13
图2 减重手术对射精量的影响
图3 减重手术对精子浓度的影响
图4 减重手术对精子总数的影响
图5 减重手术对运动精子（%）的影响
图6 减重手术对向前运动精子（%）的影响
图7 减重手术对正常形态精子（%）的影响
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