纤毛不动综合征伴男性不育的诊断和治疗探讨(附6例报告)  

Diagnosis and treatment of male infertility associated with immotile cilia syndrome:a report of 6 cases

作　　者：费前进[1] 黄学锋[1] 张李雅[1] 吴永根[1] 李澄棣[1] 

机构地区：[1]温州医学院附属第一医院生殖医学中心,浙江温州325000

出　　处：《生殖医学杂志》2010年第3期235-239,共5页Journal of Reproductive Medicine

摘　　要：目的探讨纤毛不动综合征(ICS)伴男性不育的临床特点、诊断和治疗方法。方法回顾性分析6例ICS伴男性不育患者的临床资料。结果患者临床特点均表现为反复上下呼吸道感染和男性不育。6例均患有鼻窦炎、支气管炎或支气管扩张,2例有全内脏反位。患者性激素水平、染色体核型和无精子症因子(AZF)均正常。6例均为严重弱精子症,5例精液无活动精子,1例精液偶见活动精子。电镜检查发现6例精子尾部鞭毛轴丝"9+2"结构排列紊乱或缺失、内外动力蛋白臂缺失,1例支气管纤毛内动力臂缺失。5例患者共行6个周期卵胞浆内单精子注射(ICSI)治疗,受精率、卵裂率和优质胚胎率分别为50.0、69.2和55.6%,2例获得临床妊娠,1例生化妊娠,其中1例已分娩1健康男婴。结论纤毛的超微结构缺陷是ICS的重要诊断依据,而ICSI是治疗ICS伴男性不育的有效方法。Objective： To investigate the clinical characteristics, diagnosis and treatment of male infertility associated with immotile cilia syndrome （ICS）. Methods： The clinical data of six cases of male infertility associated with ICS were analyzed retrospectively. Results： The clinical features in all cases included chronic or recurrent infections of the upper and lower airways and male infertility. Sinusitis, bronchitis and bronchiectasis were found in all cases and situs inversus totalis found in two cases. Sex hormones, chromosome karyotype and Y chromosome azoospermia factor analysis in all cases were normal. All cases were diagnosed as severe asthenospermia by routine semen analysis. Five cases had no motile spermatozoa found in semen, while there were less than 0.2 % of motile sperm in one case. The total sperm count and sperm viability were normal in four cases and there were very few immotile sperm in other two cases. Transmission electron microscopic examination of sperm flagellum revealed a disarrangement or a partial absence of 9 ＋ 2 microtubules and/or an absence of the dynein arms in six cases. The bronchial cilia in one case showed to be devoid of inner dynein arms. Five cases underwent six intracytoplasmic sperm injection （ICSI） cycles and the rates of fertilization, embryo cleavage and good quality embryos were 50. 0%, 69. 2% and 55. 6%, respectively. Two clinical pregnancies and one chemical pregnancy were achieved, with one birth of a healthy baby boy. Conclusions： The ultrastruetural defect of cilia or flagellum is the most important diagnostic proof of ICS. ICSI is an effective treatment for male infertility associated with ICS.

关 键 词：纤毛不动综合征 男性不育 超微结构 单精子卵胞浆内注射术 

分 类 号：R[医药卫生]