Роль антиоксидантов в лечении бесплодных мужчин с варикоцеле

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.

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