尿促性腺素与绒促性腺素联合应用在不明原因非梗阻性无精子症治疗中的扳机作用  

Trigger effect of h MG and hCG in the treatment of unexplainable non-obstructive azoospermia

作　　者：胡皓睿 聂洪川 杨卫民[1] 孙袁[1] 黄绘[1] 谢方刚 

机构地区：[1]贵州省妇幼保健院(贵阳市妇幼保健院)辅助生殖科,贵州贵阳550002 [2]中信湘雅生殖与遗传专科医院精子库,湖南长沙410007

出　　处：《中华男科学杂志》2017年第9期813-816,共4页National Journal of Andrology

基　　金：贵州省科技计划项目(黔科合LH字[2014]7312号)~~

摘　　要：目的:探索尿促性腺素(HMG)联合绒促性腺素(hCG)的扳机作用对于不明原因的非梗阻性无精子症患者的治疗是否有效。方法:回顾性分析2010年1月至2017年5月间在贵州省妇幼保健院就诊的282例不明原因的非梗阻性无精子症患者资料,扳机治疗方法为每例患者第1周和第2周进行HMG每次75 IU肌肉注射,每周3次。第3周和第4周hCG每次2 000 IU肌肉注射,每周2次,并结合维生素E、左卡尼汀、他莫昔芬口服辅助治疗,治疗3个月至1年。结果:接受治疗的282例非梗阻性无精子症患者,27例未完成治疗而失访,完成治疗的255例患者治疗后精液中发现有精子的58例,均为严重少弱精子症,其中47例接受辅助生殖技术助孕,2例失访,女方获得临床妊娠18例;其余197例治疗后精液检查中未发现有精子,其中25例行附睾或睾丸穿刺活检,有6例发现精子,均接受辅助生殖助孕,女方获得临床妊娠3例。共64例精液中或附睾、睾丸穿刺发现精子,有效率25.1%。结论:HMG联合hCG药物扳机治疗结合口服药物辅助治疗对不明原因的非梗阻性无精子症有一定效果。Objective： To investigate whether the trigger effect of human menopausal gonadotropins （hMG） and human chori- onic gonadotropins （hCG） attributes to the treatment of unexplainable non-obstructive azoospermia （NOA）. Methods ： We retro- spectively analyzed the clinical data about 282 cases of unexplainable NOA treated in the Maternity and Child Health Hospital of Guizhou Province from January 2010 to May 2017. All the patients underwent trigger treatment by intramuscular injection of hMG at 75 IU 3 times a week for 2 weeks, followed by hCG at 2 000 IU twice a week for another 2 weeks, and meanwhile took vitamin E, Le- vocarnitine and Tamoxifen as an adjunctive therapy. The treatment lasted 3 - 12 months. Results ： Fifty-eight of the 255 patients that completed the treatment were found with sperm in the semen after treatment, all with severe oligoasthenospermia. Forty-seven of the 58 cases received assisted reproductive technology （ART）, of which 18 achieved clinical pregnancy. Semen centrifugation revealed no sperm in the other cases, of which 6 were found with epididymal sperm at epididymal and testicular biopsy after treatment and 3 of themachieved clinical pregnancy after ART. Sperm was found in the semen or at epididymal or testicular biopsy in 64 of the patients after treatmenl, with an effectiveness rate of 25.1%. Conclusion ： Trigger treatment hy injection of hMG and hCG combined with adjunc- tive oral medication has a certain effect on unexplainable NOA NatlJAndrol, 2017, 23（9） ： 813 -816

关 键 词：非梗阻性无精子症 经皮附睾精子抽吸术 睾丸精子抽提术 药物治疗 

分 类 号：R698.2[医药卫生—泌尿科学]