不同睾丸活检术对睾丸功能及抗精子抗体的影响

Impacts of different procedures of testicular sperm retrieval on testicular function and antisperm antibodies in azoospermia patients

目的:研究不同睾丸活检术对无精子症患者血清抑制素B(INHB)、血清抗精子抗体(As Ab)、卵泡刺激素(FSH)、睾酮(T)的影响。方法:选取无精子症患者210例,根据不同的睾丸活检手术方式,分为睾丸切开活检取精术(TESE)组50例、睾丸穿刺抽吸取精术(TESA)组56例、睾丸细针穿刺抽吸取精术(TEFNA)组64例、显微睾丸切开取精术(micro-TESE)组40例,分别检测睾丸活检术前及术后1、3个月患者血清INHB、FSH、T水平和As Ab阳性率。结果:4组患者术后1、3个月FSH与术前比较均无显著性差异[TESE:(8.76±3.07)IU/L、(7.24±3.32)IU/L vs(8.51±4.34)IU/L;TESA:(7.90±4.57)IU/L、(8.04±3.65)IU/L vs(7.70±2.72)IU/L;TEFNA:(6.08±2.70)IU/L、(6.10±3.32)IU/L vs(6.04±3.17)IU/L;micro-TESE:(6.89±1.78)IU/L、(6.75±2.57)IU/L vs(6.59±2.74)IU/L,P均>0.05]。TESE组和micro-TESE组术后1个月As Ab Ig M阳性率(14.00%和15.00%)较术前(0.00和2.50%)明显升高(P<0.05)。TESE组和micro-TESE组患者术后1个月T水平[(9.25±5.76)nmol/L和(8.23±4.12)nmol/L]较术前[(16.52±6.25)nmol/L和(14.16±5.45)nmol/L]明显下降(P均<0.05)。TESE、TESA、TEFNA、micro-TESE4组患者术后1、3个月血清INHB较术前均明显下降[TESE:(42.63±15.34)pg/ml、(44.05±18.47)pg/ml vs(70.56±23.17)pg/ml;TESA:(40.55±20.51)pg/ml、(42.11±19.34)pg/ml vs(68.71±14.74)pg/ml;TEFNA:(46.31±19.28)pg/ml、(48.32±20.54)pg/ml vs(76.81±27.04)pg/ml;micro-TESE:(45.27±18.83)pg/ml、(47.64±28.34)pg/ml vs(74.74±28.35)pg/ml,P均<0.05],但不同方法组组间无统计学差异(P>0.05)。结论:不同睾丸活检术对无精子症患者睾丸功能及As Ab有影响,且存在一定差异。

Objective ： To investigate the influence of different procedures of testicular sperm retrieval on the levels of serum in- hibin B （INHB）, antisperm antibodies （AsAb）, follicle-stimulating hormone （FSH）, and testosterone （T） in patients with azoosper- mia. Methods： We randomly assigned 210 azoospermia patients to receive testicular sperm extraction （TESE, n = 50）, testicular sperm aspiration （TESA, n = 56）, testicular fine needle aspiration （TEFNA, n = 64）, or microscopic TESE （micro-TESE, n = 40）. We measured the levels of serum INHB, FSH, and T and the positive rate of AsAb before and at 1 and 3 months after surgery. Results ： Compared with the baseline, the levels of serum FSH at 1 and 3 months after surgery showed no statistically significant differ- encesintheTESE （[8.51 ± 4.34] vs [8.76 ± 3.07] and [7.24 ±3.32] IU/L,P 〉0.05）, TESA （[7.70 ± 2.72] vs [7.90 ± 4.57] and [8.04± 3.651 IU/L, P 〉0.05）, TEFNA （[6.04 ± 3.17] vs [6.08 ± 2.70] and[6.10 ±3.32] IU/L,P 〉 0.05 ）, or miero-TESE group （ 16.59 ±2.74 ] vs [6.89 ± 1.78 ] and [ 6.75 ± 2.57 ] IU/L, P 〉 0.05） ; the positive rate of As- Ab （IgM） was significantly increased at 1 month in the TESE （0.00 vs 14.00% , P 〈0.05） and miero-TESE groups （2.50% vs 15.00%, P 〈0.05）, while the serum T level markedly decreased in the two groups （ [ 16.52 ± 6.25] vs[9.25 ± 5.76] nmol/L and [ 14.16 ± 5. 45] vs [8.23 ± 4.12] nmol/L, P 〈0.05） ; the levels of serum INHB were remarkably reduced at 1 and 3 months in the TESE （[70.56 ± 23.17] vs [42.63 ± 15.34] and [44.05 ± 18.47] pg/ml, P 〈0.05）, TESA （[68.71± 14.74] vs [40.55 ± 20.51] and [42.11 ± 19.34] pg/ml, P 〈0.05）, TEFNA （[76.81 ± 27.04] vs [46.31 ±19.28] and [48.32 ± 20.54 ] pg/ml, P 〈 0.05 ）, and miero-TESE groups （[ 74.74± 28.35 ] vs [45.2± 18.83 ] and [ 47.64 ± 28.34 ] pg/ml, P 〈 0.05 ）, but with no statistically significant differences among the four groups （P 〉 0.05 ）. Conclusion ： Different procedures of tes- tieular sperm retrieval have different impacts on the testieular function and AsAb in patients with azoospermia.