实验性睾丸缺血超声表现与别嘌醇药物保护作用的相关性研究

Ultrasonographic appearance of experimental testicular ischemia and protective effect of allopurinol

目的:探讨不同程度急性单侧睾丸缺血及再灌注后的灰阶、彩色多普勒及超声造影表现与别嘌醇药物保护疗效的相关性。方法:42只新西兰大白兔随机分成对照组、缺血组(A、B、C组)和缺血给药组(D、E、F组),每组6只。缺血组与缺血给药组在超声监测下制成不同程度的单侧睾丸缺血模型,A组与D组,睾丸回声均匀、血流信号轻度减少;B组与E组,睾丸回声不均匀、血流信号明显减少;C组与F组,睾丸出现放射状或小片状低回声、血流信号消失。A、B、C组分别出现上述声像图变化后直接予以再灌注。缺血给药组出现上述声像图变化后腹腔注射别嘌醇(200 mg/kg)后予以再灌注。各组再灌注前及再灌注后3 d分别行双侧睾丸超声造影。再灌注3 d后观察各组术侧睾丸的病理变化与丙二醛(m alond ialdehyde,MDA)含量改变。比对分析不同程度急性单侧睾丸缺血超声表现与别嘌醇治疗疗效之间的关系。结果:睾丸超声造影表现,对照组呈"快进快退";再灌注前,A组与B组呈"慢进慢退,"C组呈大面积中央型"充盈缺损",再灌注后3 d,各缺血组呈"快进慢退",以C组最明显;D、E、F组超声造影表现均分别与A、B、C组相同。D组[(9.10±0.23)分]与A组[(8.53±0.22)分]比较,E组[(7.03±0.20)分]与B组[(5.82±0.33)分]比较,Johnsen's评分均有明显提高(P<0.05),F组[(2.45±0.33)分]与C组[(2.30±0.53)分]比较,Johnsen's评分无明显提高(P>0.05);D组[(1.68±0.43)%]与A组[(7.12±0.84)%]比较,E组[(12.53±0.59)%]与B组[(20.87±1.59)%]比较,凋亡指数均有明显降低(P<0.05),F组[(51.23±2.53)%]与C组[(52.93±2.62)%]比较,凋亡指数无明显降低(P>0.05)。D组[(0.64±0.05)nmol/mg prot]、E组[(1.59±0.06)nmol/mg prot]、F组[(3.10±0.17)nmol/mg prot]分别与A组[(1.38±0.07)nmol/mg prot]、B组[(2.11±0.08)nmol/mg prot]、C组[(3.25±0.14)nmol/mg prot]比较,缺血侧睾丸MDA含量均有明显降低(P<0.05)。结论:睾丸表现为轻度或中度缺血时,别嘌醇对睾丸生精功能的恢复有帮助,当表现为重度缺血时,别嘌醇对睾丸生精功能的恢复无明显效果。超声技术尤其是超声造影有助于指导睾丸缺血的药物治疗及预测疗效。

Objective：To investigate the correlation of the ultrasonographic appearance of different degrees of experimentally induced acute unilateral testicular ischemia with the protective effect of allopurinol.Methods：Forty-two male white rabbits were equally randomized into 7 groups：sham-operation control,ischemic A,B and C,and treatment D,E and F.Models of different degrees of unilateral testicular ischemia were established in the ischemic and treatment groups under the dynamic observation by color Doppler ultrasound.The ischemic testes showed slightly decreased homogeneous echoes and flow signals in groups A and D,obviously decreased heterogeneous echoes and flow signals in groups B and E,and radial or fragmental low-echo areas and disappearance of flow signals in groups C and F.The ischemic groups received reperfusion after the appearance of the above ultrasonographic changes,while the treatment groups following the intraperitoneal injection of allopurinol at 200 mg/kg.Contrast-enhanced ultrasonography（CEUS） was performed on the bilateral testes before and 3 days after the reperfusion.After 3 days of breeding,the histological changes and malondialdehyde（MDA） contents of the ischemic testes were observed,and the correlation was analyzed between the protective effect of allopurinol and the ultrasonographic appearance of different degrees of acute unilateral testicular ischemia.Results：CEUS showed fast wash-in and fast wash-out in the sham-operation control group,slow wash-in and slow wash-out in groups A and B and extensive central filling defect in group C before the reperfusion.Fast wash-in and slow wash-out were observed in all the ischemic groups 3 days after the reperfusion,most obviously in group C.Groups D,E and F exhibited the same CEUS appearance as A,B and C before and 3 days after the reperfusion.Johnsen＇s scores were significantly increased in groups D（9.10±0.23） and E（7.03±0.20） in comparison with A（8.53±0.22） and B（5.82±0.33）（P〈0.05）,but with no significant differences between C（2.30±0.53） and F（2.45±0.33）（P〈0.05）.The rates of apoptosis were significantly decreased in groups D（[1.68±0.43]%） and E（[12.53±0.59]%） compared with A（[7.12±0.84]%） and B（[20.87±1.59]%）（P〈0.05）,but with no significant differences between C（[52.93±2.62]%） and F（[51.23±2.53]%）（P〈0.05）.Significant decreases of MDA contents in the ischemic testes were observed in groups D（[0.64±0.05] nmol/mg prot）,E（[1.59±0.06] nmol/mg prot） and F（[3.10±0.17] nmol/mg prot） in comparison with A（[1.38±0.07] nmol/mg prot）,B（[2.11±0.08] nmol/mg prot） and C（[3.25±0.14] nmol/mg prot）（P〈0.05）.Conclusion：Allopurinol contributes to the recovery of spermatogenesis when testicular ischemia is sonographically shown to be mild or moderate,but produces no significant effect when it is shown to be severe.Ultrasonography helps to choose the right therapy of testicular torsion and predict spermatogenesis of ischemic testes after reperfusion.