睾丸性无精子症中医证型间睾丸病理类型、IgG、IgM的比较研究

Study on the relationship of pathology, IgG, IgM of testicular tissue between testiculogenic azoospermic patients with deficiency syndrome of the kidney and blood stasis syndrome

目的通过对睾丸性无精子症肾虚证组、血瘀证组患者睾丸病理类型、IgG、IgM、的比较研究,为辨证论治睾丸性无精子症提供理论依据。方法31例睾丸性无精子症患者的睾丸组织,其中肾虚证者16例,血瘀证者15例。正常对照组睾丸5例。进行病理检查,睾丸病变程度行Makler评分,利用免疫组织化学ABC法检测睾丸组织中IgG、IgM沉积情况,并对上述结果行统计学处理。结果两组患者的病理类型都以生精阻滞为主,但血瘀证组患者的睾丸病变更为严重而复杂。31例患者中22例有IgG沉积,11例有IgM沉积,两组间比较无显著性差异,免疫复合物的沉积与睾丸病变程度无关。结论血瘀证患者睾丸组织病变更为严重。自身免疫在肾虚证、血瘀证患者中普遍存在,但免疫因素在睾丸性无精症的发病机制中不占主导地位,自身免疫与证型无关。

Objective To expore the relationship of pathology, immune mechanism in testiculogenic azoospermia patients with deficiency syndrome of the kidney and blood stasis syndrome. Methods 31 azoospermic patients were selected as subjects, in which 16 patients belong to deficiency syndrome of the kidney group, 15 patients belong to blood stasis syndrome group, and 5 patients with normal testicular tissue as control. All patient＇s testicular tissue were studied with pathology and immunohistochemistry. Results The pathologic type of 74.2% patients were spermatogenesis arrest. Lesion in blood stasis syndrome group is more severe than in deficiency syndrome of the kidney group （P 〈 0.05）. In 16 patients＇ testicular tissue with deficiency syndrome of the kidney and 12 with blood stasis syndrome studied by immunohistochemistry, 12 were IgG positive, 7 were IgM positive in deficiency syndrome of the kidney group, and 10 were IgG positive, and 4 were IgM positive in blood stasis group. There was no significant difference of IgG, IgM between the two groups （P〉0.05）. There is no linear correlation between lesions of testicular tissue and immune deposition （P〉0.05）. Conclusion Lesion of testicular tissue in blood stasis group is more severe and complicated than in kidney deficiency group. Autoimmune is always present in testiculogenic azoospermic patients with deficiency syndrome of the kidney and blood stasis syndrome, but immune mechanism is not a dominant etiological factor in testiculogenic azoospermia. There is no significant correlaton between autoimmune and syndrome pattern.