来曲唑治疗睾丸生精功能障碍疗效及对性激素水平的影响  

Effect ofletrozole on the patients with testicular spermatogenesis dysfunction

作　　者：王澍弘[1] 李晶[2] 李行[1] 李美材 李晓霞[1] 龙腾博 王顺德[1] WANG Shuhong;LI Jing;LI Hang;LI Meicai;LI Xiaoxia;LONG Tengbo;WANG Shunde(Department of Andrology,Chongqing Three Gorges Central Hospital,404000)

机构地区：[1]重庆三峡中心医院男性科,404000 [2]重庆三峡中心医院中心实验室

出　　处：《中国生育健康杂志》2020年第3期223-226,249,共5页Chinese Journal of Reproductive Health

基　　金：重庆市卫生计生委面上项目(项目编号:2016MSXM114)。

摘　　要：目的探讨来曲唑对睾丸生精功能障碍疗效及对雌二醇(Estradiol,E2)、睾酮(testosterone,T)、卵泡刺激素(follicle stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、泌乳素(prolactin,PRL)、T/E2、抑制素B(inhibin B,INH-B)的影响。方法选取2014年6月—2017年8月期间在我科经来曲唑治疗的203例睾丸生精功能障碍患者为研究对象,包括中重度少精子症组(n=165)和无精症组(n=38),均给予来曲唑治疗至少6个月(2.5 mg/d),观察给药前后的性激素水平、精液分析与睾丸活检结果,以及不良反应情况。结果(1)给药后患者的血T、FSH、LH、INH-B水平、T/E2的比值显著升高,血E2水平显著降低,差异有统计学意义(P<0.05),而血PRL水平给药前后无明显变化,差异无统计学意义(P>0.05)。(2)中重度少精子症组患者给药6个月后的精子总数、形态正常率、存活率、a+b级的精子比例、有效精子总数比给药前均显著升高,差异有统计学意义(P<0.05),仅有11例(6.7%)患者的精液分析结果无改善。(3)无精症组38例患者中仅有2.6%患者给药6个月后的精液中出现精子,其有效精子总数的平均值为0.43×106/ml,在睾丸活检方面,给药前JOHNSEN评分为(6.8±2.4)分,治疗6个月后JOHNSEN评分为(8.5±0.9)分,组间比较具有统计学意义。(4)全部患者在治疗期间均未出现严重并发症,耐受性良好,所有不良事件在停药后均消失。结论来曲唑能显著降低睾丸生精功能障碍患者的血E2水平,提高血T、FSH、LH、INH-B的水平,明显改善生精功能可为无精症治疗提供一个新的选择,具备进一步研究价值。Objective To investigate the effect of letrozole on Estradiol(E2),testosterone(T),follicle stimulating hormone(FSH),luteinizing hormone(LH),prolactin(PRL),T/E2 and inhibin B in patients with testicular spermatogenesis dysfunction.Methods203patients with testicular spermatogenesis dysfunction who received letrozole treatment from June 2014 to August 2017 were enrolled for the study,and divided into moderate-severe oligospermatism group(n=165)and azoospermia group(n=38).All cases were treated with letrozole for at least 6 months(2.5mg/d),and then observed their hormone level,semen analysis,testicular biopsy results and adverse reaction conditions.Results(1)The blood levels of T,FSH,LH,INH-B,T/E2 increased significantly after administration,and the blood level of E2 was significantly decreased(P<0.05).There was no statistically significant difference in the blood PRL level before and after administration of letrozole(P>0.05).(2)The total sperm count,percentages of normal morphology,survival,grade a+b sperm and effective sperm number in moderate-severe oligospermatism group at 6 months after treatment were significantly better than that before administration(P<0.05),and only 11 cases(6.7%)patients′semen analysis results showed no improvement.(3)In the azoospermia group,only 2.6%patients were emerge semen in sperm at 6 months after treatment,and the value of total number of effective sperm was 0.43×106/ml.In terms of testicular biopsy,JOHNSEN before administration was scored(6.8±2.4),and JOHNSEN was scored(8.5±0.9)six months after treatment,with statistically significant intergroup comparisons(t=4.1,P=0.0).(4)None of the patients had serious complications during the treatment,and all the adverse events disappeared after discontinuation.ConclusionLetrozole could significantly reduce the blood E2 level and increase the levels of T,FSH,LH and INH-B in patients with testicular spermatogenesis dysfunction,and significantly improve the spermatogenic function.And provide a new choice for treatment of azoospermia,so it h

关 键 词：来曲唑 生精功能 性激素 睾丸 

分 类 号：R69[医药卫生—泌尿科学]