精浆生化指标与性激素在无精子症不同病理分型患者中的差异及临床意义

The difference and clinical significance of seminal plasma biochemical indexes and sex hormones in patients with different pathological types of azoospermia

目的探讨精浆生化指标与性激素在无精子症不同病理分型患者中的差异及临床意义。方法选取2017年1月至2019年7月于该院生殖男科就诊的226例男性无精子症患者为研究对象,根据睾丸活检病理分型结果,将患者分为生精功能低下(HS)组、生精功能阻滞(MA)组和唯支持细胞综合征(SCOS)组;同时根据睾丸活检镜下曲细精管中是否查见精子分为镜下未见精子组(MA+SCOS)及镜下见精子组(HS)。检测患者精浆生化指标[果糖、弹性蛋白酶及中性α-葡萄糖苷酶(NAG)]、性激素[卵泡刺激素(FSH)、黄体生成素(LH)和睾酮(T)]水平及睾丸体积。结果睾丸活检标本病理检查结果显示,226例无精子症患者中包括HS 76例,MA 24例,SCOS 126例。左右侧睾丸体积、果糖、NAG、FSH、LH水平在HS组、MA组和SCOS组间比较,差异有统计学意义(P<0.05)。左右侧睾丸体积、NAG、FSH、LH水平在镜下未见精子组及镜下见精子组间比较,差异有统计学意义(P<0.05)。FSH水平升高是影响无精子症患者精子获取率的独立危险因素(P<0.05)。结论无精子症不同病理分型患者精浆果糖、NAG,性激素FSH、LH水平及睾丸体积存在差异,且FSH水平升高是影响无精子症患者精子获取率的独立危险因素,考虑可将FSH检测与睾丸活检联合用于判断无精子症患者的精子获取情况。

Objective To investigate the difference and clinical significance of seminal plasma biochemical indexes and sex hormones in patients with different pathological types of azoospermia.Methods A total of 226 male azoospermia patients treated in the department of reproductive andrology of the hospital from January 2017 to July 2019 were selected.According to the pathological classification results of testicular biopsy,the patients were divided into hypospermatogenesis(HS)group,germ cell mature arrest(MA)group and Sertoli cell-only syndrome(SCOS)group.At the same time,according to whether the sperm could be found in the seminiferous tubules under the testicular biopsy microscope,they were divided into the group without sperm under the microscope(MA+SCOS)and the group with sperm under the microscope(HS).The levels of biochemical indexes of seminal plasma[fructose,elastase and neutralα-glucosidase(NAG)],sex hormones[follicle stimulating hormone(FSH),luteinizing hormone(LH)and testosterone(T)]and testicular volume were detected.Results Pathological examination results of testicular biopsy specimens showed that 226 cases of azoospermia patients included 76 cases of HS,24 cases of MA,and 126 cases of SCOS.The left and right testicular volume,fructose,NAG,FSH,LH levels were compared among HS group,MA group and SCOS group,and the differences were statistically significant(P<0.05).The left and right testicular volume,NAG,FSH,LH levels were compared between the group without sperm under the microscope and the group with sperm under the microscope,the differences were statistically significant(P<0.05).Increased of FSH level was an independent risk factor that affects the sperm acquisition rate of azoospermia patients(P<0.05).Conclusion There are differences on seminal plasma fructose,NAG,sex hormone FSH,LH and testicular volume in patients with different pathological types of azoospermia,increased of FSH level is an independent risk factor affecting sperm acquisition rate in azoospermia patients.It is considered that FSH and testicular biopsy could be combined to judge the sperm acquisition of azoospermia patients.