147例唯支持细胞综合征患者的睾丸病理分型和性激素分析  

Analysis of the pathological changes and sex hormones in 147 cases of Sertoli cell only syndrome

作　　者：刘雯[1] 李婷[1] 于瑞梅[1] 解磊[1] 高选[1] LIU Wen LI Ting YU Ruimei XIE Lei GAO Xuan(Center for Reproductive Medicine, Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Key Laboratory of Reproductive Endocrinology （ Shandong University）, Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan 250001, Shandong, China)

机构地区：[1]山东大学附属生殖医院国家辅助生殖与优生工程技术研究中心生殖内分泌教育部重点实验室(山东大学)山东省生殖医学重点实验室,山东济南250001

出　　处：《山东大学学报（医学版）》2017年第1期75-79,84,共6页Journal of Shandong University:Health Sciences

基　　金：山东省计生委项目2012年第2号

摘　　要：目的分析唯支持细胞综合征(SCOS)患者的病理变化分型及其性激素水平,探讨不同对症治疗的可行性。方法选取147例(病例组)SCOS睾丸活检标本,其中Ⅰ型74例和Ⅱ型73例,通过光镜、电镜观察其形态学改变,并同时测定病例组及正常组(100例)睾丸体积大小及性激素血清卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)水平。结果病例组标本光镜下主要表现为曲细精管内生精细胞完全缺如,生精上皮仅由支持细胞组成,支持细胞显著增生,排列紊乱,其中有61例为曲细精管广泛纤维化、透明变性,管腔变小甚至闭锁,间质细胞相对增生。电镜下主要表现为界膜胶原纤维组织增生,支持细胞胞浆内质网丰富,线粒体嵴消失并发生空泡变,支持细胞胞浆内出现较多自噬溶酶体。FSH、LH较正常组水平升高(P<0.05),而T在两组间的差异无统计学意义(P>0.05)。结论通过睾丸活检,按照曲细精管界膜状态的病理变化对SCOS进行分型,SCOS不同病理分型的血清FSH水平均升高,界膜状态及性激素水平变化可为不同病因SCOS的对症治疗提供依据。Objective To observe the pathological changes and sex hormones levels in patients with Sertoli cell only syndrome（ SCOS）,and to analyze the feasibility of etiological treatment. Methods The testis biopsy samples of 147 SCOS cases were selected,including 74 cases（ type I） and 73 cases（ type II）. The morphological changes were observed with light and electron microscope,and the testicular volume was determined. Sex hormones including follicle stimulating hormone（ FSH）,luteinizing hormone（ LH） and testosterone（ T） levels were detected in these patients and100 healthy controls. Results Under light microscope,the SCOS cases exhibited complete absence of sperm cells; the seminiferous epithelium was composed of sertoli cells,which were disorderly arranged; the seminiferous tubule of 61 SCOS cases showed extensive fibrosis and hyaline degeneration; the lumen was smaller even blocked,and the interstitial cells were hyperplasia. Electron microscope observed that collagen fibrous tissue hyperplasia in the membranes,and abundant endoplasmic reticulum in the cytoplasm of sertoli cells; mitochondria cristae disappeared and became vacuous,and much autolysosome was found in the cytoplasm of sertoli cells. FSH and LH levels were elevated in SCOS cases（ P 0. 05）,while there was no difference in T levels between SCOS cases and normal controls（ P 0. 05）.Conclusion By testicular biopsy,we might classify SCOS according to the state of the seminiferous tubule membrane.The serum FSH level elevates in different pathological types of SCOS. Therefore,the state of seminiferous tubule membrane and changes of sex hormones might provide information for the treatment of SCOS with different pathogenesis.

关 键 词：唯支持细胞综合征 病理变化 性激素 曲细精管界膜 

分 类 号：R588.1[医药卫生—内分泌]