" TAP CHl Y DLfOC LAM S A N G 108 Tap 9 - S6 1 /2014
Nghien cuu nong do kem huyet thanh 6* cac benh nhan vo sinh nam
Research the Concentration of Serum Zinc in Male Infertility Patients
Nfjuyen Gia Binh Khoa Sinh Hoa Benh vien Trung wa'ng Qudn ddi 108
Muc tieu: 1) Xac dinh ndng dp kem huyet thanh cua cac benh nhan vd sinh nam 2) Danh gia mdi tuong quan giUa ham lUOng kem huyet thanh vdi ham luong hooe mdn testosteron ciia cac benh nhan vd sinh nam. Dditugng va phuong phdp: nghien cdu duac tien hanh tren 514 mau huyet thanh cua cac benh nhan vd sinh nam, 22- 44 tudi. Nhdm ddi chdng la 425 mau huyet thanh ngudi binh thudng. De tai sddung phuong phap nghien eUu md ta cat ngang, cd so sanh vdi nhdm ddi chdng. Ket luan: Ndng dp kem huyet thanh cua cac benh nhan vd smh nam la 0,71 ± 0,49 mg/l, thap hon ham luong kem huyet thanh cua nhdm chUng (1,10 ± 0,40 mg/t) vdi p < 0,001. 2) Khdng cd mdi tuong quan gida ham lupng testosteron va kem huyet thanh trong tUng nhdm (nhdm chu'ng : r = 0,21; nhdm nghien cUu: r = 0,27).
Tdkhda: kem, vd sinh, nam, testosteron.
Summary:
Determination of serum zinc concentration in male patients with infertility 2) Evaluation of the relationship between serum zinc level and the level of the hormone testosterone in male infertility patients. Materials and Methods: The research was done on 514 serum samples of male infertility patients, 22- 44 years old. The control group consisted of 425 serum samples of healthy people. The method used is descriptive cross-sectional, which compared with the control group.
Conclusions: 1) The serum zinc concentration in male patients with infertility was 0.71 ± 0.49 m g / l , lower than the serum zinc level in the control group (1.10 ± 0 . 4 0 mg/l) with p <0.001. 2) There was no correlation between the levels of serum zinc and serum testosterone in each group (control group: r ^ 0 . 2 1 ; research group, r ^ 0.27).
/Ceywords.'zinc, infertility, male, testosterone.
I.Datvande: canh d d cd m d t sd trudng hop v d sinh khdng t i m thay nguyen nhan.
Vd sinh theo djnh nghTa cua Td chUc y t e the ^^^^^ ^ ^ i ^^^ ^^^ l^hd xac djnh nguyen nhan gay gidi (WHO) la t i n h trang m d t cap v d chdng t r o n g do ^ ^ ^j^h do nam bdi thieu eae tieu chuan chan doan tudi sinh san sdng chung vdi nhau va khdng ap xac dinh m p t each chac chan. Cho den nay, p h u o n g dung bat ky bien phap tranh thai nao ma van khdng phap chinh de chan doan vd sinh nam t h u d n g dUa cd con sau t h d i gian m d t nam. Nguyen nhan vd sinh tren ket qua cua t i n h dich do theo tieu chuan eua do nd thudng chiem khoang 30-40%, do nam chiem WHO. Thdng qua tinh dich dd, cd the danh gia kha ,, . -,„„, . , , , u - i u • -ino/ QA,^ nanq sinh san cua ngUdi nam, hudng tdi cac xet khoang 30%, cae t r u a n g h o p khac khoang 20%. Ben ^ -- .. ^ - - - u , u-
^ y f ^ nghiem can lam tiep theo de co cac p h u o n g phap dieu tri phu hap.
I'haii bi^ii khoa UQC: PGS TS LE NGOC HA
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 9 - Nr^ /2014
Cd rat nhieu yeu t d anh h u d n g den sd luang va chat luong t i n h t r u n g , nhU ndi tiet, bat thUdng giai phau, t h d i quen sinh hoat, lam d u n g thudc, thieu hut vitamin n h d m C, ehat d i n h dUdng . . . t r o n g d d , nguyen t d vi iUdng ed anh hUdng quan t r o n g la kem. Kem t h a m gia vao qua trinh hinh t h a n h cac hooe m d n sinh due nam (chu yeu la testosteron);
dam bao qua t r i n h sinh t i n h dUdc binh t h u d n g [1],[2],[4],[7],[8], [15]. Ben canh d d , kem cdn cd vai t r d quan t r o n g t r o n g m d t sd chdc nang sinh ly cua t i n h t r u n g , m o t luang kem dUOc tien liet tuyen dua vao nhan t i n h t r u n g g d p phan lam ben vUng cau true cua nhiem sac the, bao ve su t o a n ven eho bd gen [8],[9],[11].Tuy kem cd vai t r d quan t r p n g , nhUng cac xet nghiem, cac nghien eUu ve ham lupng kem ddi vdi cae t r u d n g hap vd sinh nam ehUa dUde tien hanh m d t each he t h d n g , cung n h d chua cd cac danh gia cu the ve cac mdi lien quan giUa ham luang kem vdi cac hooe m d n smh due nam. Xuat phat t d cac ly d o tren, chung tdi tien hanh de tai; Nghien cdu hdm luong kem huyet thanh d benh nhdn vd sinh nam.
D e t a i ed eae muc tieu:
1. Xac d i n h n d n g dp kem huyet t h a n h cua cac benh nhan vd sinh nam.
2. Danh gia mdi t u a n g quan gida ndng dp kem huyet thanh vdi ham lUdng hooe m d n testosteron cua cac benh nhan vd sinh nam.
2. D o i t u o n g va p h U d n g p h a p n g h i e n cufu 2.1. Doi tuang nghiin eUu 2.1.1. Nhdm nghien cUu
Gdm 514 m l u huyet thanh eua cac benh nhan vd sinh nam, 22- AA tuoi den kham va dieu trj tai Benh vien Phu san Trung Udng. Loai t r d cac benh nhan m l e cac benh kem theo nhu tieu dUdng, gan, Wilson va ung t h u de khdng lam anh hUdng den ket qua ham luang kem huyet thanh trong nghien cdu. Cac benh nhan duac xac dinh la vd sinh theo tieu ehua'n cua WHO dua tren ket qua tinh dich dd [14], [15].
2.1.2. Nhdm chu'ng
425 mau huyet t h a n h ngudi khde m a n h , cd con,
2.2. Phuang phip nghien cUu
- Phuong phap nghien edu m d ta cat ngang, cd so sanh vdi n h d m ddi ehdng.
- Ham l u a n g kem h u y e t t h a n h dUdc phan tidi t h e o phUdng p h a p q u a n g p h d hap t h u nguyen t&
tren t h i e t bj AAS - 3300 cua hang Perkin - Elmertai Vien Hda- Vien Han lam Khoa hpc va Cdng nghe Viet
- Ham l u o n g Testosteron d u o c xac djnh theo p h u a n g p h a p dien hda phat q u a n g tren thiet bj Elecsys 2010 cua hang Roche tai Benh vien Trung u a n g Quan ddi 108.
- Xil ly so lieu bang p h u a n g phap thong key hpc tren phan m e m excel 2003.
3. Ket q u a n g h i e n cufu
3.1. Him luang Icem huyit thanh Nham danh gia su t h a y ddi ham luang kem huyet t h a n h cua cac benh nhan vd sinh nam, chung t d i da tien hanh xac d j n h va so sanh vdi ham luong kem huyet t h a n h d ngudi binh t h d d n g . Ket qu3 duae t r i n h bay d bang 3.1.
Bang 3 . 1 . Ham lUcrng k e m h u y e t t h a n h cua hai nhom
Nhom
ChCfng Nghien cifu
n
425 514
Ham li/gng kem (mg/l) X ± S D 1,10 ±0,40 0,71 ±0,49
P
P i j < 0,001
Nhdn xet: Cd sU khac biet ve ham lUpng kem huyet thanh gida nhdm nghien edu (0,71 ± 0,49 mg//) va nhdm chUng (1,10 + 0,40 mg//) vdi p < 0,001.
3.2. Him lupng testosteron huyet thanh Vdi cac chUe nang quan trong n h u hinh thanh cac dac trUng ve gidi, dam bao su toan ven bd gen cho cac the he sau.... Testosteron ed the dai dien eho chat luong tinh triing eCia nam gidi. Chinh vi vay, chung toi da xac djnh ham luang testosteron huyet thanh cda 2 nhdm, ket qua dUde trinh bay d bang 3.2
Bang 3.2. H a m l u o n g t e s t o s t e r o n h u y e t thanh cua hai n h o m
Nhom Chirng Nghien cu'u
n 425 514
Ham luong testosteron (nmol/l)
X ± S D 12,29±2,14 10,91 ±3,22
• 1 P
P u ' ' 0,05 :
TAP CHi Y DU'Q'C LAM S A N G lOi Tap 9 - S6 1 /2014
Nhdn xet: Khdng cd sU khac biet ve ham luang testosteron huyet t h a n h gida n h d m nghien cdu (10,91 ± 3,22 nmol/l) va n h d m ehdng (12,29 ± 2,14 nmol/l) vdi p > 0,05.
3.3. Moi tUcrng quan giiira cac chi tieu nghien CLITU
Nh^m danh gia m d i t u a n g quan gida ham luong kem huyet t h a n h vdi ham luang hooe m d n testosteron eua cac benh nhan v d sinh nam, de tai xac dinh va so sanh m d i t u a n g quan giUa cac chi tieu trong mdi nhdm, ket qua duac t r i n h bay d bang 3.3
Bang 3.3. TUOng quan giCfa cac chi so nghien cUu trong tCfng nhom
Kem nhdm chUng n = 425 Testosteron nghien cUu n = 514
Kem nhdm nghien cdu n - 5 1 4
r ^ 0 , 2 1 ; p > 0,05
Testosteron nhdm chUng
n - 4 2 5 r = 0,27; p > 0,05
Nhdn xet: Khdng cd mdi t u a n g quan giQa ham luong testosteron huyet thanh va ham lUdng kem huyet thanh t r o n g t d n g n h d m (nhdm chUng:
r = 0,27; nhdm nghien cUu: r = 0,21).
Testosteron (nmol'l) 15
0 02 0,4 0.6 0.8 1 1-2 K^m (mg 1)
Do thj 3.1: Tuong quan gida hdm luang kem vd testosteron huyet thanh nhdm chdng
Testosteron (nmoll) B'-0.00441
' • • ' • ' • ^ & .
•••. v
0 0.2 0.4 0.6
Do thi 3.2: Tuang quan gida hdm lugng kem vd testosteron huyet thanh nhdm nghien cUu 4. Ban luan
4.1. Ham lUpng Item huyet thanh cae nhom d nam gidi, kem cd mat vdi ham lUdng Idn t r o n g tien liet tuyen dam bao cho qua trinh sinh tinh binh t h u d n g . Tinh t r u n g dugc tao ra t d cac te bao sinh t i n h (Sertoli). Sau khi dUOc hinh thanh, t i n h trung se di chuyen den mao t m h , tai day qua trinh trudng thanh cua tinh trung se dUOc hoan tat. Kem g i d vai trd quan trong trong mdt sd chdc nang sinh ly cua tinh trung. Cae nghien cdu da chi ra rang, sau khi xuat tinh, luong kem trong tinh trung tang len, dd la do tinh trung dUOc tich luy kem trong qua trinh di chuyen t d t i n h hoan den nieu dao [10], [12], [13]. Ket qua cho thay, ham lUong kem huyet thanh cua nhdm chdng la hoan toan trong gidi han binh thudng (1,10 + 0,40 mg/l), trong khi do ham luang kem huyet thanh cua nhdm nghien cUu (vd sinh nam) thap hon ed y nghla thdng ke (0,71 ± 0,49 mg/l).
Ket qua nghien cdu cua ehung tdi la phu hdp vdi sd lieu cua Nguyen Bich Diep nam 2005, Tiejian Wu nam 2004. Cae tac gia cOng dda ra nhdng nhan dinh t u a n g t u .
4.2. Ham lUpng testosteron huyet thanh cac nhdm
Trong he sinh san cua nam, tinh hoan cd hai chdc nang do la san xuat giao tU (tinh trimg) va bai tiet cac hooe m d n sinh due nam (testosteron).
Testosteron ed hai tac d u n g chinh la nam hda va ehuyen hda. Sau khi tre dUOc sinh ra, testosteron dam b^o su trudng thanh, dan tdi day thi, lam xuati hien va bao t d n nhdng dac tinh smh due t h d phat va ban nang smh due tren dan d n g . Ben canh d d ,
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JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY
testosteron cdn dam bao su sinh san n h d t h a m gia tao thanh t i n h t r u n g .
Ket qua xae djnh ham Iddng testosteron huyet thanh cua ca hai nhdm khdng cd sU khae biet (bang 3.2), mac du qua danh gia, cd mdt ty le nhat djnh trong nhdm nghien cUu ham luang nay giam han so vdi gidi han cho phep d ngUdi binh thudng. Cac yeu t d nhd: Ida tudi (sau 40 tudi, testosterone giam 20 - 30%/nam gay nen hdi chdng man due nam); che dp an, viec luyen tap the thao, sU dyng cae thudc... cua ca hai nhdm la nhdng nguyen nhan ly giai cho ket qua xac djnh ham luong testosteron trong hai nhdm cua de tai.
4.3. Moi tuang quan giUa cac chi tiiu nghiin cOu Qua danh gia mdi lien quan gida kem va testosteron huyet thanh dea hai nhdm nghien cdu, ket qua cho thay khdng cd mdi tUOng quan giUa cac chi tieu trong ca hai nhdm (chUng, nghien cUu) vdi he sd tuong quan la 0,27 va 0,21. Ket qua nay ed sU khac biet so vdi nghien eUu eua mdt sd tac gia khae nhU: Anada S. Prasad (nam 1996), Nishi Y (nam (1996). Cac tac gia da chi ra cd mdi tuang quan thuan gida ham luang testosteron va kem bach cau va tieu cau. Khi bd sung kemgluconatvdi lieu IU0ng459 |imoI/ngay trong vdng 6 thang thi ham luong testosteron cd sU tang len rd ret (8,3 nmol/l len tdi 16 nmol/l).
Cd the ly giai sd khac biet ket qua nay la do sU da dang ve ehung tdc gida cac nghien cdu, Ida t u o i , cac che dp sinh hoat, p h u a n g phap xet n g h i e m . . . . Hon nda, nghien edu eua chung tdi chua phan tich duac ham luong kem ndi bao, ma 6hy la ngudn ehinh lien quan den sU chuyen hda testosteron. Vi vay, ddi hdi ed nhdng nghien cdu ehuyen biet hon nda de danh gia mdi tUong quan gida hai ehi tieu nay.
5. Ket l u a n
5.1. Ham luang kem huyet thanh eua cac benh nhan vd sinh nam la 0,71 ± 0,49 m g / l , thap hon ham luong kem huyet thanh eua n h d m chUng (1,10 ± 0,40 mg//) vdi p < 0,001.
5.2. Khdng ed mdi tUong quan gida ham lUOng testosteron va kem huyet thanh t r o n g tUng n h d m (nhdm chdng : r = 0,21; n h d m nghien cUu: r = 0,27) 6. Kien n g h |
Can nghien eUu. b d sung xet nghiem ham luong kem huyet thanh ddi vdi viec chan doan, theo ddi dieu tri ddi vdi cac benh nhan vd sinh nam.
Tai lieu t h a m khao
I . Dang Quang Vinh (2001), Ty le vd sinh 6 thdng i^
ndm 2001 tai binh vien TUdu, TapTzhi sinh sinvi sdc khde, sd2,15-17
^. Le Ddc Trinh (2003), Hooe mdn vd ndi tiet hgc, Nha x u a t b a n y h g c , t r l 0 0 - 1 0 5
3. Cherry F.F., Sandstead H.H.. Rojas P., et al., (1989), Adolescent pregnancy: associations among body weight, zinc nutrient, and pregnancy outcome.
Am J Clin Nutr 1989; 50: 945 - 954.
4. Goldenberg R.L., Tamura T., Neggers Y., et al, (1995), The effect of zinc supplementation on pregnancy outcome. JAMA 1995; 274:463 - 468.
5. Argiratos V., Samman S., (1994), The effect of calcium carbonate and calcium citrate on the absorption of zinc in healthy female subjects. ErJ Clin Nutr 1994; 4 8 : 1 9 8 - 2 0 4 .
6. Dawson E.B., Albers J., McGanity W.J. Serum zinc changes due to iron supplementation in teen-age pregnancy. Am J Clin Nutr 1990, 50:848 - 852.
7 Crofton R. W., Gvozdanovie S., et al, (1989), Inorganic Zinc and the intestinal absorption of ferrous. Am J Clin Nutr 1989, 50,141 - 144, 8. Anada S. Prasad et al: Zinc status and serum
testosterone levels of healthy adults. Am J Clin Nutr 1996, Vol.12, No.5, 3 4 4 - 3 4 8 .
9. Akira Shiroi et al, (2002), Indifieation of insulin- producing derived from embryonic stem cell by z i n c - c h e l a t i n g dithizone. Journal of stem cell, Vol.
20, 284 - 292.
10. Tiejian Wu et al, (2004), Serum iron, copper and zinc concentration and risk of cancer mortality in US adult. AFP, Vol.14, No.3,195 - 201.
I I . Anuraj H Shankar and Anada 5 Prasad, (1998), Zinc and Immune function: the Biological basic of altered resistance to infection. Am J Clin Nutr, 447 - 463.
12. Martino G, Matera MG, (1993), Relationship between zinc and obesity. J-Med 24,177 -183.
13. Sharma VP, Parikh V, (1993), Serum copper and zinc level in patients with solid tumor. Ind-J- cancer, 21,1 - 6 .
14. Worid health organization, (1999), WHO laboratory manual for examination of human semen and sperm-cervical mucus interation, 4 edition, Cambridge university press.
15. Masayaki Kaii, (2001), Zn in endocrinology, international pediatrics, vol 16, No 3, pp 1 - 7.
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