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Article(id=1240929926992417630, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202309263, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1694880000000, receivedDateStr=2023-09-17, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773790349957, onlineDateStr=2026-03-18, pubDate=1717948800000, pubDateStr=2024-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773790349957, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773790349957, creator=13701087609, updateTime=1773790349957, updator=13701087609, issue=Issue{id=1240929920461886112, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773790348400, creator=13701087609, updateTime=1773827281389, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241084828704109275, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241084828704109276, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1968, endPage=1974, ext={EN=ArticleExt(id=1240929927353127800, articleId=1240929926992417630, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of correlation between semen quality and exposure level of air pollutants in different stages of sperm development, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=

Objective To analyze the effects of air pollutants on male semen quality and different stages of sperm development in Taiyuan. Methods Totally 7 614 men who were admitted to the Reproductive Department of the First Hospital of Shanxi Medical University from January 1 to December 31, 2019 were enrolled. Their age, semen collection season, and semen parameters were recorded. At the same time, the monitoring data of six air pollutants (SO2, NO2, CO, O3, PM2.5, and PM10) were collected, and the exposure of air pollutants in the whole developmental period (0 to 90 days before semen collection) and three critical developmental periods (0-9 days, 10-14 days, and 70-90 days) were calculated. Nonparametric Mann-Whitney U test was used to compare the data difference between qualified and unqualified semen parameters. The generalized estimation equation was used to explore the effects of six kinds of air pollutants on the quality parameters of each sperm at different stages of sperm development. Results During the whole period of sperm development, the exposure concentrations of SO2, NO2, O3, and PM2.5 were different between the qualified and unqualified groups of normal sperm morphology. The exposure to PM10 at 10 and 14 days before semen collection was positively correlated with semen volume (OR=1.245, 95%CI: 1.057-1.467), sperm concentration (OR=1.247, 95%CI: 1.027-1.514), total sperm count (OR=1.385, 95%CI: 1.167-1.643), total motility (OR=1.236,95%CI: 1.085-1.409), and forward movement (OR=1.207, 95%CI: 1.059-1.376). The O3 exposure was positively correlated with sperm concentration (OR=1.250, 95%CI: 1.002-1.558; OR=1.173, 95%CI: 1.025-1.343), total sperm count (OR=1.255,95%CI: 1.026-1.537; OR=1.218, 95%CI: 1.074-1.380), and normal sperm morphology (OR=1.295, 95%CI: 1.047-1.602; OR=1.229, 95%CI: 1.076-1.404). Conclusion Exposure to air pollutants increases the risk of unqualified semen parameters at all stages of sperm development, and the critical window period focuses on 10-14 days before semen collection, which is the developmental stage of sperm motility. PM10 and O3 are the main reproductive toxins affecting the decline of male sperm quality in Taiyuan, which need to be paid attention to.

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目的 分析太原市大气污染物对男性精液质量及不同精子发育时期的影响。方法 纳入2019年1月1日—12月31日就诊于山西医科大学第一医院生殖科的7 614名男性为研究对象，记录其年龄、精液采集季节和精液参数等信息。同时收集6种大气污染物（SO2、NO2、CO、O3、PM2.5、PM10）监测数据，计算精子整个发育期（精液采集前0～90 d）和三个发育关键期（精液采集前0～9 d、10～14 d和70～90 d）的大气污染物暴露情况。采用非参数检验Mann-Whitney U检验比较精液参数合格组与不合格组之间数据差异。采用广义估计方程，探讨精子各发育时期内六种大气污染物对每个精子质量参数的影响。结果 在精子整个发育时期，SO2、NO2、O3和PM2.5暴露浓度在正常精子形态合格与不合格分组中均有差异。精液采集前10～14 d，PM10暴露与精液体积(OR=1.245，95%CI:1.057～1.467)、精子浓度(OR=1.247，95%CI:1.027～1.514)、精子总数(OR=1.385，95%CI:1.167～1.643)、总活力(OR=1.236，95%CI:1.085～1.409)和前向运动(OR= 1.207，95%CI:1.059～1.376)不合格呈正相关；O3暴露与精子浓度(OR=1.250，95%CI:1.002～1.558；OR=1.173，95%CI:1.025～1.343)、精子总数(OR=1.255，95%CI:1.026～1.537；OR=1.218，95%CI:1.074～1.380)、正常精子形态(OR= 1.295，95%CI:1.047～1.602；OR=1.229，95%CI:1.076～1.404)不合格呈正相关。结论 在精子各发育阶段，大气污染物暴露均增加各精液参数不合格的风险，而关键窗口期集中于精液采集前10～14 d，即精子活力的发育阶段。PM10和O3是影响太原市男性精子质量下降的主要生殖毒物，需引起关注。

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白淘，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=hivnwzJ6/PryMXG63Pdc8A==, magXml=J/L8iBFpjAYjdiE9TBTmfw==, pdfUrl=null, pdf=0S7GIqj+481uDM1stXToag==, pdfFileSize=1864814, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=8Ix6PqOk7co/rBgsC8rAWw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=KlRSIVYZQfr50MAqQTDb4w==, mapNumber=null, authorCompany=null, fund=null, authors=

蔡可（1999—），女，硕士在读，研究方向：环境暴露对生殖健康的影响

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蔡可（1999—），女，硕士在读，研究方向：环境暴露对生殖健康的影响

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蔡可（1999—），女，硕士在读，研究方向：环境暴露对生殖健康的影响

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注：*P<0.05,**P<0.01,***P<0.001。

, figureFileSmall=TM9GciPqtxKnCW+nWHz7IQ==, figureFileBig=8Ix6PqOk7co/rBgsC8rAWw==, tableContent=null), ArticleFig(id=1240929933346787721, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926992417630, language=EN, label=Figure 2, caption=Correlation of air pollutants with semen parameters in different age subgroups, figureFileSmall=t9yX78oACzS3aLFOrRqDqw==, figureFileBig=f7EpWOaLiK7HVtRJArQQdQ==, tableContent=null), ArticleFig(id=1240929933460033939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926992417630, language=CN, label=图2, caption=大气污染物在不同年龄亚组中与精液参数的相关性

注：*P<0.05,**P<0.01。

, figureFileSmall=t9yX78oACzS3aLFOrRqDqw==, figureFileBig=f7EpWOaLiK7HVtRJArQQdQ==, tableContent=null), ArticleFig(id=1240929933581668763, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926992417630, language=EN, label=Table 1, caption=

Atmospheric pollutant exposure in Taiyuan city during the study period

, figureFileSmall=null, figureFileBig=null, tableContent=
大气污染物平均值±标准差最小值最大值中位数四分位间距
SO2（μg/m3）23.0±16.95.0106.017.017.0
NO2（μg/m3）49.1±17.812.0108.048.026.0
O3（μg/m3）110.1±61.018.0294.097.089.0
CO（mg/m3）1.0±0.40.33.30.90.5
PM2.5（μg/m3）55.9±37.29.0286.046.041.0
PM10（μg/m3）113.3±59.819.0392.0100.078.0
), ArticleFig(id=1240929933682332068, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926992417630, language=CN, label=表1, caption=

研究期间太原市大气污染物暴露情况

, figureFileSmall=null, figureFileBig=null, tableContent=
大气污染物平均值±标准差最小值最大值中位数四分位间距
SO2（μg/m3）23.0±16.95.0106.017.017.0
NO2（μg/m3）49.1±17.812.0108.048.026.0
O3（μg/m3）110.1±61.018.0294.097.089.0
CO（mg/m3）1.0±0.40.33.30.90.5
PM2.5（μg/m3）55.9±37.29.0286.046.041.0
PM10（μg/m3）113.3±59.819.0392.0100.078.0
), ArticleFig(id=1240929933753635243, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926992417630, language=EN, label=Table 2, caption=

Comparison of exposure levels of atmospheric pollutants in the critical period of sperm development between qualified group and unqualified group for various semen parameter [M (QR）]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标分组人数SO2（μg/m3）NO2（μg/m3）
0～90 d0～9 d10～14 d70～90 d0～90 d0～9 d10～14 d70～90 d
精液体积合格6 21615.2 (13.9)14.7 (9.4)14.5 (11.2)15.0 (22.1)46.1 (12.8)44.1 (15.8)43.5 (15.4)45.2 (18.8)
不合格1 39815.4 (15.7)14.9 (8.5)14.7 (11.7)15.0 (22.3)45.9 (13.7)43.8 (16.5)43.9 (16.0)44.8 (18.9)
z值-0.164-0.523-0.638-0.066-0.255-0.659-0.161-0.114
精子浓度合格6 18015.2 (13.9)14.7 (8.6)14.5 (11.2)15.0 (22.1)46.1 (12.7)44.1 (16.0)43.4 (15.4)45.2 (18.0)
不合格1 43415.6 (15.8)14.9 (10.0)15.0 (11.2)14.9(22.3)46.5 (13.7)44.3(15.5)44.6 (15.7)44.8 (20.5)
z值-0.403-3.039*-2.120*-1.396-1.380-1.580-1.313-0.782
精子总数合格5 72315.2 (13.8)14.7 (20.3)14.5 (22.8)15.0 (34.4)46.3 (12.8)44.3 (15.9)43.4 (16.1)45.2 (18.2)
不合格1 89115.5 (14.0)14.7(21.1)14.5 (22.4)15.0 (34.4)45.9 (13.5)43.8 (15.7)44.1 (15.1)44.8 (19.3)
z值-0.589-1.474-0.746-1.155-0.021-0.567-0.431-1.367
精子总活力合格4 80115.6 (27.9)14.7 (8.4)14.7 (11.6)15.2 (22.4)46.6 (12.6)44.8 (15.8)43.4 (15.4)45.6 (17.7)
不合格2 81314.8 (23.0)14.7 (9.2)14.5 (11.3)14.7 (21.8)44.7 (12.9)43.8 (16.2)43.9 (15.5)44.6 (17.7)
z值-4.303*-1.725-1.368-4.792*-3.562*-1.542-0.241-4.361*
精子前向运动合格4 89215.6 (15.9)14.7 (8.5)14.7 (11.6)15.2 (22.3)44.7 (12.6)44.3 (15.9)43.4 (15.4)45.6 (17.7)
不合格2 72214.8 (11.3)14.7 (9.1)14.5 (11.3)14.7 (21.8)46.5 (13.0)43.8 (16.2)44.1 (16.0)46.6 (15.6)
z值-4.424*-1.694-1.388-4.882*-3.615*-1.176-0.595-4.613*
正常精子形态合格6 04715.2 (13.8)14.7 (8.2)14.3 (11.2)15.0 (22.0)45.9 (12.8)44.0 (15.9)43.1 (15.7)45.1 (17.2)
不合格1 56715.8 (16.9)15.6 (11.1)15.4 (12.0)15.0 (22.4)46.8 (13.1)45.2 (16.3)44.8 (16.5)45.2 (19.2)
z值-2.295*-4.555*-4.116*-1.182-3.801*-2.581*-2.762*-1.106
指标分组人数CO（mg/m3）O3（μg/m3）
0～90 d0～9 d10～14 d70～90 d0～90 d0～9 d10～14 d70～90 d
精液体积合格6 2160.9 (0.2)0.9 (0.3)0.9 (0.2)0.9 (0.5)124.7 (79.3)126.6 (93.4)120.2 (93.8)127.8 (86.3)
不合格1 3980.9 (0.3)0.9 (0.2)0.8 (0.2)0.8 (0.5)125.7 (79.7)126.6 (93.4)116.3 (94.2)128.6 (89.2)
z值-0.365-0.318-1.213-1.459-0.139-0.299-0.054-0.143
精子浓度合格6 1800.9 (0.2)0.9 (0.2)0.9 (0.2)0.9 (0.5)125.7 (78.9)126.8 (92.2)120.5 (93.9)127.9 (86.3)
不合格1 4340.9 (0.3)0.9 (0.3)0.8 (0.3)0.9 (0.5)124.1 (84.3)123.3 (90.3)114.6 (92.9)128.2 (87.5)
z值-2.211*-1.360-0.508-1.412-1.978*-2.959*-1.944-0.066
精子总数合格5 7230.9 (0.2)0.9 (0.3)0.9 (0.2)0.9 (0.5)124.7 (79.6)126.7 (94.4)120.2 (93.8)127.9 (85.0)
不合格1 8910.9 (0.2)0.9 (0.2)0.8 (0.2)0.9 (0.5)126.2 (78.3)126.6 (91.7)116.7 (93.3)127.8 (89.9)
z值-0.609-0.286-1.102-0.166-0.502-1.163-0.243-0.502
精子总活力合格4 8010.9 (0.3)0.9 (0.3)0.8 (0.2)0.9 (0.5)123.5 (78.1)126.7 (92.4)119.0 (93.3)125.8 (84.3)
不合格2 8130.9 (0.2)0.9 (0.2)0.9 (0.2)0.8 (0.5)130.6 (83.5)126.6 (94.4)116.8 (99.9)131.9 (92.5)
z值-3.182*-0.030-1.582-4.364*-3.158*-1.366-0.497-4.678*
精子前向运动合格4 8920.9 (0.3)0.9 (0.2)0.8 (0.2)0.9 (0.5)123.5 (78.1)126.7 (92.6)118.1 (93.8)125.8 (84.3)
不合格2 7220.9 (0.2)0.9 (0.3)0.9 (0.3)0.9 (0.5)130.6 (83.5)126.6 (93.2)119.6 (99.9)131.9 (92.8)
z值-2.874*-0.011-1.825-4.075*-3.019*-1.545-0.299-4.779*
正常精子形态合格6 0470.9 (0.2)0.9 (0.2)0.8 (0.2)0.9 (0.3)126.2 (78.9)126.8 (91.2)126.2 (97.1)119.4 (73.0)
不合格1 5670.9 (0.3)0.9 (0.3)0.9 (0.3)0.9 (0.2)121.3 (83.0)121.9 (96.1)113.4 (88.3)118.5 (74.4)
z值-3.310*-1.387-2.835*-1.680-4.120*-4.522*-4.107*-1.812
指标分组人数PM2.5（μg/m3）PM10（μg/m3）
0～90 d0～9 d10～14 d70～90 d0～90 d0～9 d10～14 d70～90 d
精液体积合格6 21644.8 (25.7)44.9 (26.5)44.4 (27.0)47.8 (39.3)103.6 (49.9)97.0 (59.5)87.9 (56.3)119.4 (73.0)
不合格1 39844.8 (28.6)44.5 (27.7)43.1 (24.7)46.1 (39.8)102.7 (49.9)97.0 (64.3)92.0 (87.9)118.5 (73.9)
z值-0.031-0.267-0.931-1.001-0.131-0.236-0.468-0.191
精子浓度合格6 18044.8 (25.7)44.8 (26.9)44.2 (26.7)47.8 (39.1)103.6 (49.9)97.0 (61.1)87.9 (54.9)119.4 (73.5)
不合格1 43445.1 (28.8)45.1 (27.2)45.2 (27.1)48.2 (42.5)104.3 (52.0)101.0 (60.9)94.8 (57.8)117.4 (74.3)
z值-0.150-1.882-0.837-0.219-0.087-2.163*-1.957-0.726
精子总数合格5 72344.8 (25.7)44.9 (26.7)44.4 (26.7)47.8 (39.1)103.6 (49.4)97.0 (61.0)90.2 (56.3)119.6 (73.5)
不合格1 89144.8 (26.3)44.8 (26.4)44.2 (24.8)47.4 (42.0)103.5 (53.5)100.3(62.3)87.9 (53.0)117.7 (73.6)
z值-0.961-0.318-1.167-0.102-0.679-0.596-0.005-0.842
精子总活力合格4 80145.1 (28.1)45.1 (26.8)45.0 (26.7)48.4 (40.4)106.0 (49.3)100.3 (62.3)90.2 (55.2)120.2 (73.6)
不合格2 81344.3 (25.5)44.8 (26.9)44.2 (26.2)44.5 (38.2)99.6 (52.2)95.5 (60.0)87.9 (56.8)116.7 (72.3)
z值-4.355*-1.582-0.709-3.662*-4.560*-2.927*-1.265-3.703*
精子前向运动合格4 89245.1 (28.1)45.1 (26.8)45.0 (26.5)48.4 (40.4)105.6 (49.3)100.3 (62.3)90.2 (55.2)120.2 (73.6)
不合格2 72244.2 (26.0)44.8 (26.9)44.2 (27.1)44.4 (38.2)99.6 (54.3)92.9 (60.0)87.9 (56.8)116.6 (72.5)
z值-4.432*-1.718-0.503-3.663*-4.741*-3.088*-1.208-3.910*
正常精子形态合格6 04744.8 (25.6)44.8 (26.6)43.6 (25.3)47.4 (39.1)103.5 (51.8)96.5 (60.2)87.2 (54.9)119.4 (73.0)
不合格1 56745.3 (28.1)45.4 (27.8)46.9 (26.8)48.2 (43.0)105.1 (50.2)102.3 (61.2)97.4 (59.2)118.5 (74.4)
z值-2.065*-2.704*-3.697*-0.308-1.839-3.001*-4.276*-0.402
), ArticleFig(id=1240929933896241587, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926992417630, language=CN, label=表2, caption=

各精液参数合格组与不合格组之间精子发育关键期大气污染物暴露水平比较[M（QR）]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标分组人数SO2（μg/m3）NO2（μg/m3）
0～90 d0～9 d10～14 d70～90 d0～90 d0～9 d10～14 d70～90 d
精液体积合格6 21615.2 (13.9)14.7 (9.4)14.5 (11.2)15.0 (22.1)46.1 (12.8)44.1 (15.8)43.5 (15.4)45.2 (18.8)
不合格1 39815.4 (15.7)14.9 (8.5)14.7 (11.7)15.0 (22.3)45.9 (13.7)43.8 (16.5)43.9 (16.0)44.8 (18.9)
z值-0.164-0.523-0.638-0.066-0.255-0.659-0.161-0.114
精子浓度合格6 18015.2 (13.9)14.7 (8.6)14.5 (11.2)15.0 (22.1)46.1 (12.7)44.1 (16.0)43.4 (15.4)45.2 (18.0)
不合格1 43415.6 (15.8)14.9 (10.0)15.0 (11.2)14.9(22.3)46.5 (13.7)44.3(15.5)44.6 (15.7)44.8 (20.5)
z值-0.403-3.039*-2.120*-1.396-1.380-1.580-1.313-0.782
精子总数合格5 72315.2 (13.8)14.7 (20.3)14.5 (22.8)15.0 (34.4)46.3 (12.8)44.3 (15.9)43.4 (16.1)45.2 (18.2)
不合格1 89115.5 (14.0)14.7(21.1)14.5 (22.4)15.0 (34.4)45.9 (13.5)43.8 (15.7)44.1 (15.1)44.8 (19.3)
z值-0.589-1.474-0.746-1.155-0.021-0.567-0.431-1.367
精子总活力合格4 80115.6 (27.9)14.7 (8.4)14.7 (11.6)15.2 (22.4)46.6 (12.6)44.8 (15.8)43.4 (15.4)45.6 (17.7)
不合格2 81314.8 (23.0)14.7 (9.2)14.5 (11.3)14.7 (21.8)44.7 (12.9)43.8 (16.2)43.9 (15.5)44.6 (17.7)
z值-4.303*-1.725-1.368-4.792*-3.562*-1.542-0.241-4.361*
精子前向运动合格4 89215.6 (15.9)14.7 (8.5)14.7 (11.6)15.2 (22.3)44.7 (12.6)44.3 (15.9)43.4 (15.4)45.6 (17.7)
不合格2 72214.8 (11.3)14.7 (9.1)14.5 (11.3)14.7 (21.8)46.5 (13.0)43.8 (16.2)44.1 (16.0)46.6 (15.6)
z值-4.424*-1.694-1.388-4.882*-3.615*-1.176-0.595-4.613*
正常精子形态合格6 04715.2 (13.8)14.7 (8.2)14.3 (11.2)15.0 (22.0)45.9 (12.8)44.0 (15.9)43.1 (15.7)45.1 (17.2)
不合格1 56715.8 (16.9)15.6 (11.1)15.4 (12.0)15.0 (22.4)46.8 (13.1)45.2 (16.3)44.8 (16.5)45.2 (19.2)
z值-2.295*-4.555*-4.116*-1.182-3.801*-2.581*-2.762*-1.106
指标分组人数CO（mg/m3）O3（μg/m3）
0～90 d0～9 d10～14 d70～90 d0～90 d0～9 d10～14 d70～90 d
精液体积合格6 2160.9 (0.2)0.9 (0.3)0.9 (0.2)0.9 (0.5)124.7 (79.3)126.6 (93.4)120.2 (93.8)127.8 (86.3)
不合格1 3980.9 (0.3)0.9 (0.2)0.8 (0.2)0.8 (0.5)125.7 (79.7)126.6 (93.4)116.3 (94.2)128.6 (89.2)
z值-0.365-0.318-1.213-1.459-0.139-0.299-0.054-0.143
精子浓度合格6 1800.9 (0.2)0.9 (0.2)0.9 (0.2)0.9 (0.5)125.7 (78.9)126.8 (92.2)120.5 (93.9)127.9 (86.3)
不合格1 4340.9 (0.3)0.9 (0.3)0.8 (0.3)0.9 (0.5)124.1 (84.3)123.3 (90.3)114.6 (92.9)128.2 (87.5)
z值-2.211*-1.360-0.508-1.412-1.978*-2.959*-1.944-0.066
精子总数合格5 7230.9 (0.2)0.9 (0.3)0.9 (0.2)0.9 (0.5)124.7 (79.6)126.7 (94.4)120.2 (93.8)127.9 (85.0)
不合格1 8910.9 (0.2)0.9 (0.2)0.8 (0.2)0.9 (0.5)126.2 (78.3)126.6 (91.7)116.7 (93.3)127.8 (89.9)
z值-0.609-0.286-1.102-0.166-0.502-1.163-0.243-0.502
精子总活力合格4 8010.9 (0.3)0.9 (0.3)0.8 (0.2)0.9 (0.5)123.5 (78.1)126.7 (92.4)119.0 (93.3)125.8 (84.3)
不合格2 8130.9 (0.2)0.9 (0.2)0.9 (0.2)0.8 (0.5)130.6 (83.5)126.6 (94.4)116.8 (99.9)131.9 (92.5)
z值-3.182*-0.030-1.582-4.364*-3.158*-1.366-0.497-4.678*
精子前向运动合格4 8920.9 (0.3)0.9 (0.2)0.8 (0.2)0.9 (0.5)123.5 (78.1)126.7 (92.6)118.1 (93.8)125.8 (84.3)
不合格2 7220.9 (0.2)0.9 (0.3)0.9 (0.3)0.9 (0.5)130.6 (83.5)126.6 (93.2)119.6 (99.9)131.9 (92.8)
z值-2.874*-0.011-1.825-4.075*-3.019*-1.545-0.299-4.779*
正常精子形态合格6 0470.9 (0.2)0.9 (0.2)0.8 (0.2)0.9 (0.3)126.2 (78.9)126.8 (91.2)126.2 (97.1)119.4 (73.0)
不合格1 5670.9 (0.3)0.9 (0.3)0.9 (0.3)0.9 (0.2)121.3 (83.0)121.9 (96.1)113.4 (88.3)118.5 (74.4)
z值-3.310*-1.387-2.835*-1.680-4.120*-4.522*-4.107*-1.812
指标分组人数PM2.5（μg/m3）PM10（μg/m3）
0～90 d0～9 d10～14 d70～90 d0～90 d0～9 d10～14 d70～90 d
精液体积合格6 21644.8 (25.7)44.9 (26.5)44.4 (27.0)47.8 (39.3)103.6 (49.9)97.0 (59.5)87.9 (56.3)119.4 (73.0)
不合格1 39844.8 (28.6)44.5 (27.7)43.1 (24.7)46.1 (39.8)102.7 (49.9)97.0 (64.3)92.0 (87.9)118.5 (73.9)
z值-0.031-0.267-0.931-1.001-0.131-0.236-0.468-0.191
精子浓度合格6 18044.8 (25.7)44.8 (26.9)44.2 (26.7)47.8 (39.1)103.6 (49.9)97.0 (61.1)87.9 (54.9)119.4 (73.5)
不合格1 43445.1 (28.8)45.1 (27.2)45.2 (27.1)48.2 (42.5)104.3 (52.0)101.0 (60.9)94.8 (57.8)117.4 (74.3)
z值-0.150-1.882-0.837-0.219-0.087-2.163*-1.957-0.726
精子总数合格5 72344.8 (25.7)44.9 (26.7)44.4 (26.7)47.8 (39.1)103.6 (49.4)97.0 (61.0)90.2 (56.3)119.6 (73.5)
不合格1 89144.8 (26.3)44.8 (26.4)44.2 (24.8)47.4 (42.0)103.5 (53.5)100.3(62.3)87.9 (53.0)117.7 (73.6)
z值-0.961-0.318-1.167-0.102-0.679-0.596-0.005-0.842
精子总活力合格4 80145.1 (28.1)45.1 (26.8)45.0 (26.7)48.4 (40.4)106.0 (49.3)100.3 (62.3)90.2 (55.2)120.2 (73.6)
不合格2 81344.3 (25.5)44.8 (26.9)44.2 (26.2)44.5 (38.2)99.6 (52.2)95.5 (60.0)87.9 (56.8)116.7 (72.3)
z值-4.355*-1.582-0.709-3.662*-4.560*-2.927*-1.265-3.703*
精子前向运动合格4 89245.1 (28.1)45.1 (26.8)45.0 (26.5)48.4 (40.4)105.6 (49.3)100.3 (62.3)90.2 (55.2)120.2 (73.6)
不合格2 72244.2 (26.0)44.8 (26.9)44.2 (27.1)44.4 (38.2)99.6 (54.3)92.9 (60.0)87.9 (56.8)116.6 (72.5)
z值-4.432*-1.718-0.503-3.663*-4.741*-3.088*-1.208-3.910*
正常精子形态合格6 04744.8 (25.6)44.8 (26.6)43.6 (25.3)47.4 (39.1)103.5 (51.8)96.5 (60.2)87.2 (54.9)119.4 (73.0)
不合格1 56745.3 (28.1)45.4 (27.8)46.9 (26.8)48.2 (43.0)105.1 (50.2)102.3 (61.2)97.4 (59.2)118.5 (74.4)
z值-2.065*-2.704*-3.697*-0.308-1.839-3.001*-4.276*-0.402
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精液质量与不同精子发育期大气污染物暴露水平相关性分析
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蔡可 1 , 王莉 1, 2 , 崔馨月 1 , 白淘 1, 3 , 王立言 4
现代预防医学 | 环境与职业卫生 2024,51(11): 1968-1974
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现代预防医学 | 环境与职业卫生 2024, 51(11): 1968-1974
精液质量与不同精子发育期大气污染物暴露水平相关性分析
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蔡可1, 王莉1, 2, 崔馨月1, 白淘1, 3 , 王立言4
作者信息
  • 1.山西医科大学公共卫生学院儿少卫生教研室，山西 太原 030001
  • 2.煤炭环境致病与防治教育部重点实验室
  • 3.山西医科大学第一医院病理科，山西 太原 030001
  • 4.山西医科大学汾阳医学院

    • 蔡可（1999—），女，硕士在读，研究方向：环境暴露对生殖健康的影响

通讯作者:

白淘，E-mail:
Analysis of correlation between semen quality and exposure level of air pollutants in different stages of sperm development
Ke CAI1, Li WANG1, 2, Xin-yue CUI1, Tao BAI1, 3 , Li-yan WANG4
Affiliations
  • Department of Pediatric Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi 030001, China
出版时间: 2024-06-10 doi: 10.20043/j.cnki.MPM.202309263
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摘要
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目的 分析太原市大气污染物对男性精液质量及不同精子发育时期的影响。方法 纳入2019年1月1日—12月31日就诊于山西医科大学第一医院生殖科的7 614名男性为研究对象，记录其年龄、精液采集季节和精液参数等信息。同时收集6种大气污染物（SO2、NO2、CO、O3、PM2.5、PM10）监测数据，计算精子整个发育期（精液采集前0～90 d）和三个发育关键期（精液采集前0～9 d、10～14 d和70～90 d）的大气污染物暴露情况。采用非参数检验Mann-Whitney U检验比较精液参数合格组与不合格组之间数据差异。采用广义估计方程，探讨精子各发育时期内六种大气污染物对每个精子质量参数的影响。结果 在精子整个发育时期，SO2、NO2、O3和PM2.5暴露浓度在正常精子形态合格与不合格分组中均有差异。精液采集前10～14 d，PM10暴露与精液体积(OR=1.245，95%CI:1.057～1.467)、精子浓度(OR=1.247，95%CI:1.027～1.514)、精子总数(OR=1.385，95%CI:1.167～1.643)、总活力(OR=1.236，95%CI:1.085～1.409)和前向运动(OR= 1.207，95%CI:1.059～1.376)不合格呈正相关；O3暴露与精子浓度(OR=1.250，95%CI:1.002～1.558；OR=1.173，95%CI:1.025～1.343)、精子总数(OR=1.255，95%CI:1.026～1.537；OR=1.218，95%CI:1.074～1.380)、正常精子形态(OR= 1.295，95%CI:1.047～1.602；OR=1.229，95%CI:1.076～1.404)不合格呈正相关。结论 在精子各发育阶段，大气污染物暴露均增加各精液参数不合格的风险，而关键窗口期集中于精液采集前10～14 d，即精子活力的发育阶段。PM10和O3是影响太原市男性精子质量下降的主要生殖毒物，需引起关注。

大气污染物  /  精液质量  /  PM10  /  O3  /  关键窗口期

Objective To analyze the effects of air pollutants on male semen quality and different stages of sperm development in Taiyuan. Methods Totally 7 614 men who were admitted to the Reproductive Department of the First Hospital of Shanxi Medical University from January 1 to December 31, 2019 were enrolled. Their age, semen collection season, and semen parameters were recorded. At the same time, the monitoring data of six air pollutants (SO2, NO2, CO, O3, PM2.5, and PM10) were collected, and the exposure of air pollutants in the whole developmental period (0 to 90 days before semen collection) and three critical developmental periods (0-9 days, 10-14 days, and 70-90 days) were calculated. Nonparametric Mann-Whitney U test was used to compare the data difference between qualified and unqualified semen parameters. The generalized estimation equation was used to explore the effects of six kinds of air pollutants on the quality parameters of each sperm at different stages of sperm development. Results During the whole period of sperm development, the exposure concentrations of SO2, NO2, O3, and PM2.5 were different between the qualified and unqualified groups of normal sperm morphology. The exposure to PM10 at 10 and 14 days before semen collection was positively correlated with semen volume (OR=1.245, 95%CI: 1.057-1.467), sperm concentration (OR=1.247, 95%CI: 1.027-1.514), total sperm count (OR=1.385, 95%CI: 1.167-1.643), total motility (OR=1.236,95%CI: 1.085-1.409), and forward movement (OR=1.207, 95%CI: 1.059-1.376). The O3 exposure was positively correlated with sperm concentration (OR=1.250, 95%CI: 1.002-1.558; OR=1.173, 95%CI: 1.025-1.343), total sperm count (OR=1.255,95%CI: 1.026-1.537; OR=1.218, 95%CI: 1.074-1.380), and normal sperm morphology (OR=1.295, 95%CI: 1.047-1.602; OR=1.229, 95%CI: 1.076-1.404). Conclusion Exposure to air pollutants increases the risk of unqualified semen parameters at all stages of sperm development, and the critical window period focuses on 10-14 days before semen collection, which is the developmental stage of sperm motility. PM10 and O3 are the main reproductive toxins affecting the decline of male sperm quality in Taiyuan, which need to be paid attention to.

Air pollutants  /  Semen quality  /  Critical window period  /  PM10  /  O3
蔡可, 王莉, 崔馨月, 白淘, 王立言. 精液质量与不同精子发育期大气污染物暴露水平相关性分析. 现代预防医学, 2024 , 51 (11) : 1968 -1974 . DOI: 10.20043/j.cnki.MPM.202309263
Ke CAI, Li WANG, Xin-yue CUI, Tao BAI, Li-yan WANG. Analysis of correlation between semen quality and exposure level of air pollutants in different stages of sperm development[J]. Modern Preventive Medicine, 2024 , 51 (11) : 1968 -1974 . DOI: 10.20043/j.cnki.MPM.202309263
正文
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近年来，在不孕不育夫妇中由男性不育因素造成的比例不断上升，男性不育成为了全球重要的公共卫生问题[1]。精液参数异常是检验男性不育的重要指标[2]。多项研究表明大气污染物是造成精液参数异常的潜在影响因素。Wang等[3]对1 852名男性的精液样本进行了检测，发现精子发育过程中大气污染物对精液质量有很强的不利影响。然而国外一项评估空气污染与男性精液质量相关的研究表明多数大气污染物与精液参数的关联很小[4]，提示关于大气污染物对精液参数影响的研究结果尚不统一。
精子的发育需要90 d。精液采集前0～9 d（附睾储存）、前10～14 d（精子活力的发育）以及前70～90 d（生精阶段）是精子发育的三个关键期[5]。以往大多数环境因素与男性精液参数相关的研究都集中在精子的整个发育时期[6-8]，即使近年来对精子发育关键期的研究逐渐增多[9-11]，但着重关注精子发育各关键窗口期内大气污染物与精液参数的关系的研究仍很少。本研究收集了2019年太原市7 614名男性的精液参数，探讨精子整个发育时期（精液采集前0～90 d）和不同关键窗口期空气污染物暴露对精液质量参数的影响，提供了大气污染物暴露对精液质量影响的关键窗口期信息。
1　对象与方法
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1.1　研究对象
本研究纳入2019年1月1日—12月31日于山西医科大学第一医院生殖门诊就诊的男性患者8 784名。记录其精液质量参数和个人基本信息（年龄，检查日期）等。排除标准：精液质量参数信息不完整、个人基本信息缺失者；无精子症患者，以及可能影响精液质量的精索静脉曲张、腮腺炎等疾病史的患者；有尿道手术、睾丸手术、输卵管结扎术等手术史的患者；禁欲时间过长（>7 d）或过短（<2 d）者。排除了年龄信息缺失者64例，部分精液信息缺失者522例，无精子症474例，患有性传播疾病者2例，染色体异常者3例，精索静脉曲张者24例，有可能影响精液质量手术史的患者35例及禁欲时间不合格者46例，最终纳入了7 614例。中位年龄为30岁。山西医科大学第一附属医院伦理委员会批准了这项研究（批准号：NO. KYLL-2023-056），并且所有数据都是匿名使用的。
1.2　空气质量数据
由于大气污染物的影响存在滞后性和累积性以及精子发育的时间为90 d，根据研究对象的纳入时间，采集2018年10月3日—2019年12月31日山西省太原市各监测点的空气质量数据，包括SO2（μg/m3）、NO2（μg/m3）、CO（mg/m3）、O3（μg/m3）、PM2.5（μg/m3）、PM10（μg/m3）六种大气污染物的日平均浓度数值。以上数据均来源于全国城市空气质量实时发布平台（https://air.cnemc.cn:18007/）。计算精液检查前90 d、0～9 d、10～14 d和70～90 d的大气污染物日均暴露浓度，作为研究对象的个体暴露值。
1.3　精液检查
精液质量分析按照WHO《人类精液检查与处理实验室手册》（第5版）的要求进行。精液采集前要求患者禁欲为2～7 d.以手淫法取精后放置清洁广口塑料容器内。实验室严格执行了质量控制，以确保结果的准确性。
WHO指南中的精液正常参考水平：（1）精液体积≥1.5 ml；（2）精子浓度≥15×106/ml；（3）精子总数≥39×106/次射精；（4）精子总活力≥40%；（5）精子前向运动≥32%；（6）精子正常形态≥4 %[12]。
1.4　统计分析
采用Excel 2010软件整理数据，用SPSS 25.0软件对数据进行统计分析。精液参数和大气污染物数据均不符合正态检验，用中位数（M）和四分位数间距（QR）描述。根据各精液正常参考水平将研究对象分为精液参数合格组与不合格组，采用非参数检验Mann-Whitney U检验比较两组间污染物暴露水平的差异。在调整了年龄、精液采集季节后，使用广义估计方程来分析大气污染物的各关键窗口期暴露浓度与精液参数不合格的关系。为了消除多重共线性的影响，一次只纳入一种大气污染物，并将大气污染物浓度按四分位数法分为Q1～Q4，Q1作为参考对照。此外，按年龄对人群进行亚组分析，进一步提供敏感人群的相关证据。检验水准α=0.05。
2　结果
收起
2.1　研究对象精液参数总体水平
7 614例精液样本中，精液体积M（QR）为2.5（2.2）ml，合格率为81.6%；精子浓度M（QR）为37.1（38.9）×106 /ml，合格率为81.1%；精子总数M（QR）为90.3（125.6）×106/次射精，合格率为75.1%；精子总活力M（QR）为50.0%（39.0%），合格率为63.0%；精子前向运动M（QR）为42.0%（35.0%），合格率为64.2%；正常精子形态M（QR）为11.0%（3.5%），合格率为79.4%。
2.2　大气污染物暴露情况
2018年10月3日—2019年12月31日期间太原市六种大气污染物的暴露情况如表1所示，其中日均浓度居前三位的依次是CO、PM10、O3，提示2019年太原市的主要大气污染物暴露是CO、PM10和O3。
2.3　各精液参数合格组与不合格组之间不同精子发育时期大气污染物暴露水平
在精液采集前0～9 d，精子浓度不合格组SO2和PM10暴露水平均高于合格组，O3暴露水平低于合格组，差异均有统计学意义（P<0.05）。在精液采集前90 d和70～90 d，精子总活力、精子前向运动不合格组SO2、NO2、CO、PM2.5、PM10暴露水平均低于合格组，O3暴露水平高于合格组，差异均有统计学意义（P<0.05）。在精液采集前90 d、0～9 d和10～14 d，正常精子形态不合格组SO2、NO2、PM2.5暴露水平均高于合格组，O3暴露水平低于合格组，差异均有统计学意义（P<0.05）。见表2。
2.4　大气污染物各关键暴露期浓度与精液参数不合格的关联
分别以精液体积、精子浓度、精子总数、精子总活力、精子前向运动和正常精子形态是否合格（合格=0，不合格=1）为因变量，以三个关键窗口期SO2、NO2、CO、O3、PM2.5、PM10六种大气污染物暴露浓度的Q1～Q4值为自变量，调整年龄和精液采集季节（冬季=0，春季=1，夏季=2，秋季=3）因素后，采用广义估计方程进行分析。
结果如图1显示，精液体积不合格与精液采集前10～14 d PM10暴露浓度呈正相关。精子浓度和精子总数不合格分别与精液采集前10～14 d SO2、O3、PM10暴露浓度及精液采集前0～9 d、70～90 d的PM2.5暴露浓度呈正相关。精子总活力不合格与精液采集前10～14 d SO2、NO2、CO、PM10暴露浓度及精液采集前0～9 d的NO2、O3、PM10暴露浓度呈正相关。精子前向运动不合格分别与精液采集前10～14 d SO2、NO2、PM10暴露浓度及精液采集前0～9 d的NO2、O3、PM10暴露浓度呈正相关。正常精子形态不合格分别与精液采集前0～9 d CO暴露浓度及每个关键暴露期的O3都呈正相关。提示各大气污染物对精液参数不合格的影响主要集中于精液采集前10～14 d。
2.5　敏感性分析
按照年龄进行亚组分析，进一步探讨六种大气污染物暴露在不同年龄亚组（<35岁、≥35岁）对男性精液参数的影响。发现相较于Q1水平，部分污染物（SO2、O3、PM2.5、PM10）较高暴露水平与年龄<35岁组男性的精子浓度和精子总数不合格呈正相关（P<0.05），未发现在年龄≥35岁组存在关联性。尚未发现其他污染物暴露水平与不同年龄组男性精液参数存在关联性（P均大于0.05）。年龄亚组中对大气污染物对精液参数影响有差异的结果见图2。
3　讨论
收起
本研究评估了2019年太原市7 614名男性的精液参数，结果表明在精子整个发育时期和精液采集前0～9 d、10～14 d，SO2、NO2、O3、PM2.5暴露浓度在正常精子形态合格与不合格分组中均有差异。之前的研究仅限于对常见的精液参数的分析，例如精子浓度、精子总数和精子活力[13]，对正常精子形态的分析很少。Lao等[14]对2001—2014年在台湾参加标准体检的6 475名男性的精液样本进行分析，观察到PM2.5与正常精子形态下降之间存在强关联，这与本研究得出的结果相似，所以结合本次及以往研究，提示正常精子形态也是研究大气污染物暴露对精液参数影响的重要指标之一。
本研究进一步采用广义估计方程分析大气污染物对精液参数的影响，发现PM2.5会增加精子浓度和精子总数不合格率，PM10暴露会增加精液体积、精子浓度、精子总数、总活力和前向运动不合格率。以前的研究也证实了颗粒物对精液参数的不利影响。Sun等[15]招募了2011—2013年间在武汉不孕不育诊所就诊的1 061名男性，发现在整个生精期暴露于PM10与精子浓度、精子数量、总活力和精子前向运动下降有关。Dai等[16]在温州医科大学附属第一医院生殖中心的一项研究纳入了1 494名不育男性，发现PM2.5暴露可能会引起精子前向运动下降。有研究表明PM2.5和PM10是太原市空气污染的主导因素[17]，所以我们应该特别关注颗粒物对太原市男性精液质量的影响。
近年来，我国O3浓度呈现整体增长趋势[18]，我们不应该忽视它对精液质量的影响。在本研究中发现，O3暴露会增加除精液体积外其他五个精液参数不合格率。O3暴露对精液质量产生不利影响的研究结果与同类流行病学调查研究一致。Farhat等[19]调查圣保罗都会区空气污染物暴露对精液质量的有害影响，研究显示暴露于O3中精子浓度与精子总数会降低。一项队列研究分析了广东省精子库的3 797份精液样本，发现精子发育后期的活力下降与O3暴露有关[20]。本研究还发现SO2与NO2会增加总活力和前向运动不合格率。安徽的一项大型纵向辅助生殖队列分析了空气污染物暴露与15 112名男性精液质量的关联，结果显示SO2暴露可能会对精液质量产生不利影响[21]。Cheng等[22]纳入2014—2016年间1 607名育龄男性，调查了中国长期空气污染物暴露与14项精液质量参数的关系，发现NO2与精子总活力呈负相关。
本研究观察到各空气污染物暴露与精液质量下降主要发生在精子活力的发育阶段（精液采集前10～14 d），这与在广东省计划生育科学技术研究院纳入的1 259名男性精液质量与空气污染物暴露窗口关系一致[20]。而另一项研究调查了大量可育男性中PM暴露与精液质量之间的关系，发现PM2.5暴露与精液质量之间的关联通常在较早暴露窗口（精液采集前70～90 d）比近期暴露（精液采集前0～9、10～14或15～69 d）更强[23]。目前大气污染物暴露对精子发育关键期影响的研究结果尚不统一，需要更多研究来证实我们的观点。
值得注意的是，在年龄亚组的分析中发现，部分大气污染物对精液参数的不利影响集中在年龄<35岁组，特别是对精子浓度、精子总数、精子前向运动的影响；影响的关键窗口期集中在精液采集前10～14 d，即精子活力的发育阶段。提示<35岁的男性，其精子的发育过程可能对大气污染暴露更敏感。基于目前大多研究只把年龄当作协变量纳入大气污染物对精液质量影响的模型中，尚未发现同时考虑不同年龄亚组中精液质量和大气污染物暴露水平相关的研究，因此需要在今后的研究中对大气污染物影响精液质量的高敏感人群做进一步的探讨。
本研究有以下局限性：一是本研究尽管调整了一些重要的协变量，如年龄和精液采集季节，但由于门诊数据信息的限制，未能控制其他可能影响男性精液质量的因素，如职业、吸烟、饮酒情况、饮食习惯和心理因素等，这可能会影响部分结果的准确性。本课题组进一步设计了男性精液质量影响因素问卷，将在后续的研究中更全面考虑生活方式因素及社会心理因素。二是研究对象选择的是山西省医科大学附属第一医院生殖门诊进行检查的男性，其不育风险较大，也可能对研究结果造成一定的偏倚，但是基于本研究样本量较大并且精液参数合格率较高，具有一定的参考价值。三是本研究使用太原市九个监测点大气污染物日均浓度来评估研究人群的个体暴露水平，缺乏研究人群具体的地理位置分布，无法精确计算个体大气污染物的暴露。四是每个地区大气污染物的浓度和组成不同，对精液质量的影响也会产生差异。相比于其他污染物，本研究PM10和O3暴露对精液参数的影响较为密切。在未来的研究中可以进一步采用拟合线性或者非线性回归分析，探索空气污染物暴露对精液参数影响的风险阈值信息。
综上所述，六种大气污染物在各个精子发育关键暴露期内不同程度地影响各精液参数。关键窗口期集中于精液采集前10～14 d。本研究为明确大气污染物暴露影响精液质量的精子发育关键期，促进男性生殖健康提供科学依据。
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doi: 10.20043/j.cnki.MPM.202309263
  • 接收时间：2023-09-17
  • 首发时间：2026-03-18
  • 出版时间：2024-06-10
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  • 收稿日期：2023-09-17
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    1.山西医科大学公共卫生学院儿少卫生教研室，山西 太原 030001
    2.煤炭环境致病与防治教育部重点实验室
    3.山西医科大学第一医院病理科，山西 太原 030001
    4.山西医科大学汾阳医学院

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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