睾丸精曲小管精子发生功能量化评价法分析无精子症患者睾丸生精功能

Seminiferous Tubule Scores Used for Quantitative Assessment of Spermatogenic Function of Patients with Azoospermia

目的 :分析无精子症患者临床和病理资料 ,研究病理学量化评价睾丸精曲小管精子发生功能的方法的临床意义。 方法 :无精子症患者 112例 ,年龄 2 2～ 4 6 (2 9.0± 4 .4 )岁 ,婚龄 2～ 12 (4 .0± 2 .8)年、病程 2～ 6 (2 .70±1.0 2 )年 ,其中原发性无精子症 96例 ,继发性无精子症 16例 ;梗阻性无精子症 7例。不育症患者精液常规检查 3次确认无精子症 ,检测性激素水平 ,常规消毒下睾丸活检病理检查 ,在高倍镜下计数每个精曲小管中各类生精细胞数 ,测定小管直径、生精上皮高度和固有层厚度 ,按制定的精曲小管精子发生功能 10分 5级分度法加以评分 ,进行统计学分析。 结果 :精曲小管生精上皮 10分分度法评分结果 ,1分 5例 (4 .5 % ) ,2分 38例 (33.9% ) ,3分 2例(1.8% ) ,4分 6例 (5 .4 % ) ,5分 2例 (1.8% ) ,6分 17例 (15 .2 % ) ,7分 6例 (5 .4 % ) ,8分 19例 (17% ) ,9分 10例(8.9% ) ,10分 7例 (6 .3% )。精曲小管精子发生功能 5级分度法结果 ,1级 5例 (4 .5 % ) ,2级 38例 (33.9% ) ,3级 33例 (2 9.5 % ) ,4级 2 9例 (2 5 .9% ) ,5级 7例 (6 .3% )。多元回归分析结果 ,精曲小管精子发生功能分级与生精上皮高度、固有层厚度、精曲小管直径和血清卵泡刺激素 (FSH)具有极显著相关性 (P <0 .0 1)。

Objective: To investigate the clinical reliability of quantitative evaluation by seminiferous tubule scores on spermatogenesis dysfunction, using the testis tissues of azoospermia patients for analysis of histological changes. Methods: One hundred and twelve Chinese patients with azoospermia underwent open testiclar biopsy and their testicular biopsy specimens were evaluated by 10-score (on testicular biopsy) and 5-Grade (on seminiferous tubule spermatogenesis) scale. The 112 patient, 22 to 46 years old [( 29.0± 4.4 ) years old] included 105 cases of obstructive and 7 cases non-obstructive azoospermia. Of the total number, there were 96 primary infertile cases and 16 secondary infertile cases with infertile marriage of 2～12 years [( 4.0± 2.8) years]. Various seminiferous tubule characteristics were categorized by 10-score as follows:degenerating Sertoli cells and no germinal epithelium; no germ cells and only Sertoli cells; no spermatids and primary spermatocytes and only spermatogonia; no spermatids and few primary spermatocytes; no spermatids and numerous primary spermatocytes; no mature spermatids and few round immature spermatids; no mature spermatids and numerous round immature spermatids; <20 mature spermatids/tubules, germinal epithelium height<80 μm and spermiation absent; >20mature spermatids/tubules, germinal epithelium height<80 μm and spermiation rarely<80 μm; >20 mature spermatids/tubule and germinal epithelium height 80 μm and spermiation common. Seminiferous tubule spermatogenesis was catagorized by 5-Grade scale as follows:tubular sclerosis; sertoli cell only; arrested spermatogenesis; reduced spermatogenesis; intact spermatogenesis. Results: In terms of the 10-score scale on testicular biopsy, scores of 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 corresponded with total patient numbers of 5 ( 4.5%), 38( 33.9%), 2( 1.8%), 6( 5.4%), 2( 1.8%), 17( 15.2%), 6( 5.4%), 19(17%), 10( 8.9%) and 7( 6.3%), respectively. According to the 5-Grade scale on the seminiferous tubule spermatogenesis,Grades 1, 2, 3, 4 and 5 corresponded with 5( 4.5%), 38( 33.9%) , 33( 29.5%), 29( 25.9%)and 7( 6.3%), respectively. Tubular diameter, the thickness of the lamina propria, the height of the germinal epithelium and serum FSH correlated with the average seminiferous tubule scores (P< 0.01). Conclusion: The seminiferous tubule scores obtained through testicular biopsy may provide important quantitative information concerning the etiology and pathogenesis and of azoospermia may serve as a helpful guide to the fundamental, clinical and therapeutical study of element, clinic and therapy.