附睾炎：基于临床和基础研究的总结启示

Epididymitis： revelations at the convergence of clinical and basic sciences

急性附睾炎在泌尿外科门诊的病人中有共同的临床表现。大多数情况下，性传播疾病或者泌尿系的感染都会引起病原菌的感染，并通过泌尿生殖道逆行引发急性附睾炎。虽然保守治疗可能对大多数患者有效并能根除病原菌，但有研究表明这类患者中少精子症甚至无精子症患者升高至40%。为了探讨引起这种现象和随后对精子功能损伤的潜在原因，我们建立了附睾炎的动物模型。研究数据表明附睾管里聚集着异常表达的免疫细胞、免疫调节基因以及病原菌敏感分子。我们推测在附睾头部存在一个耐药微环境，而炎症反应常发生在附睾尾部。这与附睾在不需要降低自身抵抗上行感染能力的前提下，当精子从睾丸中射出后，保护其不受新产生的抗精子抗体损害的观点相一致。然而，严重的炎症反应，特别是在附睾尾部，也可能迁延引发附睾结构和功能的损害。通过对动物模型临床观察研究，我们更好地理解附睾的免疫微环境，附睾炎的易感因素以及合理的治疗，在此基础上减轻附睾炎对附睾的损害，降低这类人群不育的发生率。

Acute epididymitis represents a common medical condition in the urological outpatient clinic. Mostly, epididymitis is caused by bacterial ascent through the urogenital tract, with pathogens originating either from sexually transmitted diseases or urinary tract infections. Although conservative antimicrobial therapy is possible in the majority of patients and is usually sufficient to eradicate the pathogen, studies have shown persistent oligozoospermia and azoospermia in up to 40% of these patients. Animal models of epididymitis are created to delineate the underlying reasons for this observation and the additional impairment of sperm function that is often associated with the disease. Accumulated data provide evidence of a differential expression of immune cells, immunoregulatory genes and pathogen-sensing molecules along the length of the epididymal duct. The evidence suggests that a tolerogenic environment exists in the caput epididymidis, but that inflammatory responses are most intense toward the cauda epididymidis. This is consistent with the need to provide protection for the neo-antigens of spermatozoa emerging from the testis, without compromising the ability to respond to ascending infections. However, severe inflammatory responses, particularly in the cauda, may lead to collateral damage to the structure and function of the epididymis. Convergence of the clinical observations with appropriate animal studies should lead to better understanding of the immunological environment throughout the epididymis, the parameters underlying susceptibility to epididymitis, and to therapeutic approaches that can mitigate epididymal damage and subsequent fertility problems.