medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-13-23-33medsovet-6396Research ArticleРепродуктивное здоровье и ВРТReproductive health and ARTРоль антиоксидантов в лечении бесплодных мужчин с варикоцелеThe role of antioxidants in the treatment of infertile men with varicocelehttps://orcid.org/0000-0002-3902-9236ШатылкоТ. В.ShatylkoT. V.

Шатылко Тарас Валерьевич, к.м.н., врач-уролог отделения андрологии и урологии

117997, Россия, Москва, ул. Академика Опарина, д. 4

Taras V. Shatylko, Cand. Sci. (Med.), Urologist, Department of Andrology and Urology

4, Academician Oparin St., Moscow, 117997, Russia 

dialectic.law@gmail.comhttps://orcid.org/0000-0002-9128-2714ГамидовС. И.GamidovS. I.

Гамидов Сафар Исраилович, д.м.н., заведующий отделением андрологии и урологии; профессор кафедры урологии и оперативной нефрологии 

117997, Россия, Москва, ул. Академика Опарина, д. 4

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

Safail I. Gamidov, Dr. Sci. (Med.), Head of the Department of Andrology and Urology; Professor of the Department of Urology and Operative Nephrolog 

4, Academician Oparin St., Moscow, 117997, Russia 

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russia

safargamidov@yandex.ruhttps://orcid.org/0000-0003-1163-5602ПоповаА. Ю.PopovaA. Yu.

Попова Алина Юрьевна, к.м.н., старший научный сотрудник отделения андрологии и урологии 

117997, Россия, Москва, ул. Академика Опарина, д. 4

Alina Yu. Popova, Cand. Sci. (Med.), Senior Researcher, Department of Andrology and Urology

4, Academician Oparin St., Moscow, 117997, Russia 

alina-dock@yandex.ruhttps://orcid.org/0000-0002-9690-6338БицоевТ. Б.BitsoevT. B.

Бицоев Тимур Борисович, аспирант кафедры акушерства, гинекологии, перинатологии и репродуктологии

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

Timur B. Bitsoev, Post Graduate Student of the Department of Obstetrics, Gynecology, Perinatology and Reproductology

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russia

6646362@mail.ruНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. КулаковаРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian FederationНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова; Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияKulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology; Sechenov First Moscow State Medical University (Sechenov University)Russian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation2021151020210132333Copyright © Шатылко Т.В., Гамидов С.И., Попова А.Ю., Бицоев Т.Б., 20212021Шатылко Т.В., Гамидов С.И., Попова А.Ю., Бицоев Т.Б.Shatylko T.V., Gamidov S.I., Popova A.Y., Bitsoev T.B.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6396

Варикоцеле является распространенным заболеванием, встречающимся у 35–40% мужчин с первичным бесплодием и у 80% мужчин – с вторичным. Нарушение микроциркуляции в яичках, возникающее на фоне варикоцеле, приводит к ишемии и гипоксии яичек, провоцирующим дегенеративные изменения всех тестикулярных клеточных популяций. Ретроградный кровоток из яичковой и кремастерных вен в гроздьевидное сплетение приводит к повышению гидростатического давления в сосудистой сети яичка и подъему температуры, а также способствует развитию асептического воспаления. Общепризнанными элементами патогенеза бесплодия, ассоциированного с варикоцеле, являются оксидативный стресс, нитрозативный стресс и гипоксия. Известно, что при достижении супрафизиологического уровня активных форм кислорода в эякуляте их концентрация нарушает структуру и функцию сперматозоидов. Поскольку оксид азота (NO) участвует в регуляции температуры тела, не исключено, что NO-зависимые механизмы вносят свой вклад в повышение температуры мошонки при варикоцеле. Физиологическая концентрация NO, создаваемая тестикулярными макрофагами, стимулирует стероидогенез в клетках Лейдига. Однако в присутствии некоторых активных форм кислорода NO может превращаться в пероксинитрит и другие сильные цитотоксические метаболиты, которые приводят к дисрегуляции синтеза тестостерона, участвующего в процессе сперматогенеза. Также проявлениями варикоцеле у бесплодных мужчин являются снижение уровня экспрессии тестикулярноспецифического белка теплового шока – HSPA2 и аномальное метилирование ДНК сперматозоидов. В связи с этим прием комбинированных антиоксидантных добавок в рамках адъювантной терапии после хирургического лечения либо в качестве самостоятельного применения в некоторых клинических случаях представляется адекватной стратегией для оптимизации фертильности у пациентов с варикоцеле. В этом обзоре мы оценили значение различных антиоксидантов, таких как витамин E, фолиевая кислота, карнитин, инозитол, аргинин, ацетилцистеин, цинк, селен, в процессе сперматогенеза и их влияние на репродуктивную функцию при варикоцеле.

Varicocele is a common disease that occurs in 35–40% of men with primary infertility and in 80% of men with secondary infertility Disturbance of microcirculation in the testicles, which occurs during varicocele, lead to ischemia and hypoxia of the testicles, which provoke degenerative changes in all testicular cell populations. Retrograde blood flow from the testicular vein and the external spermatic vein into pampiniform venous plexus leads to an increase of hydrostatic pressure in the testicular vascular system and rise of temperature, and it also contributes to the development of sterile inflammation. Oxidative stress, nitrosative stress, and hypoxia are generally recognized elements of the pathogenesis of infertility associated with varicocele. It is known that when the supraphysiological level of reactive oxygen species in the ejaculate is reached, their concentration disrupts the structure and function of spermatozoa. Nitric oxide (NO) is involved in the regulation of body temperature, NO-dependent mechanisms may contribute to the increased scrotal temperature during varicocele. The physiological concentration of NO pro duced by testicular macrophages stimulates steroidogenesis in Leydig cells. However, in the presence of certain reactive oxygen species, NO can transform into peroxynitrite and other strong cytotoxic metabolites, which lead to dysregulation of testosterone synthesis involved in spermatogenesis. Also, manifestations of varicocele among infertile men have decreased expression levels of the testis-specific heat-shock protein, HSPA2, and abnormal methylation of sperm DNA. Therefore, the use of combined anti oxidant supplements as part of adjuvant therapy after surgical treatment or as an independent application in some clinical cases appears to be an adequate strategy to optimize fertility in patients with varicocele. In this review, we evaluated the importance of various antioxidants, such as vitamin E, folic acid, carnitine, inositol, arginine, acetylcysteine, zinc, selenium in spermatogenesis and their effect on reproductive function during varicocele.

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The authors declare that there are no conflicts of interest present.