超声联合精浆生化检查在无精子症诊断中的应用

Application of ultrasound combined with the detection of seminal neutral alpha-glucosidase and fructose in the diagnosis of azoospermia

目的评价经阴囊及经直肠超声与精浆生化指标检测联合应用在无精子症诊断中的价值。方法选取2007年1月到9月本院男性不育症门诊无精子症患者142例,按世界卫生组织标准进行精液分析,离心留取精浆检测中性α糖苷酶(NAG)活性及果糖含量。患者均行经阴囊及经直肠超声检查睾丸及精道情况。在必要检查后行附睾/睾丸穿刺或活检并按结果分组:A组66例,经附睾穿刺可发现精子;B组14例,附睾穿刺未见精子,睾丸穿刺见精子或经活检提示睾丸局灶性生精功能障碍;C组62例,穿刺和活检均未见精子。结果A组中精道超声异常表现多见(P<0.01),C组中睾丸体积10ml以下或血流信号减弱者多见(P<0.01)。A组患者精浆NAG水平均低于正常,存在精囊缺如或射精管囊肿者果糖显著低于正常。B组患者NAG及果糖水平正常。C组中精道超声无异常表现者,NAG及果糖水平正常。结论经阴囊及直肠超声与精浆生化指标检测有助于明确梗阻性无精子症精道梗阻部位、程度及范围,经阴囊超声评估睾丸体积及血供对睾丸生精功能具有一定提示作用。联合应用这两种无创手段可为无精子症临床决策提供有效信息。

Objective To assess the value of scrotal and transurethral ultrasound together with seminal neutral alphaglucosidase （NAG） and fructose detection as a diagnostic tool for azoospermia. Methods From January 2007 to September 2007, ejaculates from 142 men assessed for azoospermia in Renji Hospital Andrology outpatient department were analyzed according to WHO guidelines. NAG activity and fructose levels in seminal plasma were measured to assess the function of the epididymis and seminal vesicles. All of them underwent scrotal and transrectal ultrasound. Patients were divided into three groups based on the results of percutaneous epididymal sperm aspiration （PESA） / testicular fine needle aspiration （TEFNA） or testicular biopsy. Group A （66 cases）： sperm could be retrieved by PESA; Group B （14 cases）： sperm were only present in the fragment of seminiferous tubular brought out by TEFNA; Group C （62 cases）： testicular biopsy indicated that spermatogenic failure. Results There were more ultrasonography abnormal appearances of seminal ducts in Group A （P〈0.01）, and more patients were with decrease testicular volume （≤10ml） and bloodstream （P〈0.01） in Group C. The average NAG activity in Group A was significantly lower, and the average fructose level was also lower in those with seminal vesicle absence and distal seminal ducts obstruction. NAG activity and fructose level were normal in the patients without definitely obstructive signs. Conclusion The application of scrotal and transurethral ultrasound together with NAG and fructose detection is valuable for understanding the situation of seminal ducts and testicle. The combination of these non-invasive examinations can provide solid evidences for clinical decision regarding azoospermia.