多种无创性检测方法评价无精子症患者生精功能的临床研究

Clinicalstudy of noninvasive methods in evaluating the spermatogenic function of patients with azoospermia

目的探讨多种无创性检测方法在无精子症患者生精功能中的应用效果。方法选择2015年6月至2017年7月自愿到南宁市第二人民医院生殖中心接受治疗的无精子症患者235例,入院后患者均行经皮附睾睾丸穿刺术及睾丸活检术,根据睾丸内有无精子分为少精组(n=128)和无精组(n=107)。采用Prader椭圆型睾丸测量模型完成患者睾丸体积测量;采用电化学发光法测定各组血清促卵泡激素(FSH)水平;采用酶联免疫吸附试验方法测定各组抑制素B(InhB)水平;采用多重PCR技术测定各组Y染色体无精子基因(AZF)基因微缺失情况。结果少精组睾丸大小> 5mL、5 ml～8ml、8 ml～12ml人数,均少于无精组,差异具有统计学意义(P <0. 05);少精组睾丸大小≥12ml例数,多于无精组,差异具有统计学意义(P <0. 05);少精组<正常值下限例数,高于无精组,差异具有统计学意义(P <0. 05);少精组≥正常值上限≤正常值2倍、≥正常值2倍例数,均低于无精组,差异具有统计学意义(P <0. 05);少精组A区缺失、B区缺失、C区缺失及联合缺失率,均低于无精组,差异具有统计学意义(P <0. 05);少精组无缺失率,高于少精组,差异具有统计学意义(P <0. 05);少精组InhB≥正常值下限例数,多于无精组,差异具有统计学意义(P <0. 05);少精组InhB≥正常值下限1/2 <正常值下限、<正常值下限1/2例数,少于无精组,差异具有统计学意义(P <0. 05);相关性分析显示:无精子症患者生精功能与睾丸体积、InhB呈正相关性,差异具有统计学意义(P <0. 05);无精子症患者生精功能与FSH及AZF基因缺失呈负相关性。结论将多种无创性检测方法用于无精子症患者生精功能患者中能发挥不同检测方法优势,能评估患者睾丸生精功能,值得推广应用。

Objective To investigate the effect of multiple noninvasive detection methods in evaluating the spermatogenic function of patients with azoospermia.Methods 235 patients with azoospermia who volunteered to receive treatment from June 2015 to July 2017 were enrolled.All patients underwent percutaneous epididymal testicular biopsy and testicular biopsy.According to the presence of sperm,they were divided in to oligospermia group(n=128)and azoospermia group(n=107).The testicular volume was measured by Prader ellipse testis model.The levels of serum FSH in each group were determined by electrochemiluminescence.The levels of inhibin B(InhB)were determined by enzyme-linked immunosorbent assay(ELISA).PCR technique was used to detect the microdeletions of Y chromosome Azoospermia gene(AZF)in each group.Results The number of testis volume larger than 5mL,5~8ml and 8~12ml in oligospermia group were less than those in azoospermia group accordingly(P<0.05).The number of testis volume no less than 12ml in oligospermia group was higher than that of azoospermia group(P<0.05).The number of testis volume lower than normal value in oligospermia group was higher than that in azoospermia group(P<0.05).The number of testis volume no less than normal value and no larger than 2 times of normal value,and the number of testis volume no less than 2 times of normal value in oligospermia group were lower than those in azoospermia group respectively(P<0.05).The rates of region A deletion,region B deletion,region C deletion and multiple deletion in oligospermia group were all lower than those in azoospermia group respectively(P<0.05).The rate of no deletion in oligospermia group was higher than that in azoospermia group.The number of InhB no less than normal value of oligospermia group was higher than that of azoospermia group(P<0.05).The number of InhB no less than half of the normal value and less than normal value,and the number of InhB less than half of the normal value in oligospermia group were lower than those in azoospermia group respectively(P<0.05).The correlation analysis showed that there was a positive correlation between spermatogenic function and testicular volume and InhB in patients with azoospermia(P<0.05),while a negative correlation between spermatogenic function and FSH and AZF gene loss.Conclusions It is worthy to popularize the application of multiple noninvasive methods in patients with azoospermia.