摘要
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.
出处
《中华男科学杂志》
CAS
CSCD
2004年第2期94-99,102,共7页
National Journal of Andrology
基金
北京大学医学部"十五""2 11工程"建设项目 ( 2 19)资助
关键词
无精子症
精曲小管
精子发生
量化评价
睾丸
azoospermia
seminiferous tubule
spermatogenesis
quantitative evaluation
testis