血清生殖激素和精子参数与显微睾丸切开取精手术结局的相关性  

Relationship between serum reproductive hormones and sperm parameters and surgical outcomes in Micro-TESE

作　　者：邓琛耀 刘德风[2] 唐文豪[1,3] 赵连明[1,3] 林浩成[1,3] 毛加明[2] 张哲[1,3] 杨宇卓[2] 张海涛[1,3] 姜辉[1,2,3] 洪锴[2,3] DENG Chenyao;LIU Defeng;TANG Wenhao;ZHAO Lianming;LIN Haocheng;MAO Jiaming;ZHANG Zhe;YANG Yuzhuo;ZHANG Haitao;JIANG Hui;HONG Kai(Department of Urology,Peking University Third Hospital,Beijing 100191,China;Center for Reproduction,Peking University Third Hospital,Beijing 100191,China;Center for Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院泌尿外科,北京100191 [2]北京大学第三医院生殖中心,北京100191 [3]北京大学第三医院男科中心,北京100191

出　　处：《现代泌尿外科杂志》2023年第12期1032-1037,1052,共7页Journal of Modern Urology

基　　金：北京大学临床医学青年特别基金项目(No.PKU20222LCXQ042);2022年度首都卫生发展科研专项项目(首发2022-2-4094)。

摘　　要：目的探究血清生殖激素和精子参数与显微睾丸切开取精(Micro-TESE)手术结局的关系。方法回顾性分析2021年1月-12月在北京大学第三医院男科就诊的1091例患者的临床资料。根据精子计数分为非梗阻性无精子症(NOA)组(A组,n=418)、精子计数正常组(B组,n=615)、轻中度少精子症组(C组,n=18)、重度少精子症组(D组,n=18)、梗阻性无精子症组(E组,n=22)。在A组中有244例接受Micro-TESE手术治疗,其中获得精子组(Micro-TESE阳性组,n=82),未获得精子组(Micro-TESE阴性组,n=162),并根据术中获取睾丸的病理类型分为正常睾丸组织、生精功能低下(HYPO组,n=129)、成熟阻滞(MA组,n=10)、唯支持细胞综合征(SCO组,n=122)。比较各组之间的精子参数以及生殖激素水平。结果在精子计数分组中,A组的睾丸体积低于B组和E组(P<0.05),A组的卵泡刺激素(FSH)和促黄体生成素(LH)水平最高(P<0.05),但其睾酮(T)水平最低(P<0.05),A组的抗苗勒氏管激素(AMH)和血清抑制素B(INHB)水平低于B组和E组(P<0.05),B组的精子正常形态率大于A组和E组(P<0.05),B组的前向运动精子百分率最高(P<0.05)。Pearson相关性分析发现,精子计数、精子正常形态率和前向运动精子百分率与年龄、FSH、LH成负相关(P<0.05),与睾丸体积、T、AMH、INHB成正相关(P<0.05)。NOA患者根据睾丸组织学病理分组,SCO组的INHB水平是三组中最低的(P<0.05),SCO组的FSH和LH水平高于MA组(P<0.05),HYPO组的17β-雌二醇(E_(2))水平高于SCO组(P<0.05)。NOA患者接受Micro-TESE手术治疗结果分组,Micro-TESE阳性组和阴性组间AMH和INHB水平差异有统计学意义(P<0.05)。影响NOA患者Micro-TESE结局的二元逻辑回归分析:AMH与Micro-TESE结局具有负相关性(OR=0.904,95%CI:0.91~1.08,P<0.05)。结论年龄、FSH、LH、AMH和INHB与精子计数、精子正常形态率和前向运动精子百分率具有相关性。SCO组中的INHB水平最低。NOA患者中,血清AMH对Micro-TESE结局具�Objective To investigate the relationship between serum reproductive hormones and sperm parameters and outcomes of micro-testicular sperm extraction(Micro-TESE).Methods Clinical data of 1091 patients treated in our hospital during Jan.and Dec.2021 were retrospectively analyzed.According to the sperm concentration,the patients were divided into non-obstructive azoospermia(NOA)group(group A,n=418),normal sperm concentration group(group B,n=615),mild to moderate oligospermia group(group C,n=18),severe oligospermia group(group D,n=18),and obstructive azoospermia group(group E,n=22).In group A,244 cases treated with Micro-TESE were grouped into the sperm-acquired group(Micro-TESE positive group,n=82)and non-sperm-acquired group(Micro-TESE negative group,n=162),and according to the pathological types of testicular tissue,the patients were divided into normal testicular tissue with hypospermatogenesis group(HYPO group,n=129),maturation arrest group(MA group,n=10),and support-only cell syndrome group(SCO group,n=122).Differences in semen parameters and reproductive hormone levels were compared,and relationship between reproductive hormones and sperm parameters and Micro-TESE outcomes was determined with Pearson correlation analysis.Results In the sperm concentration subgroup,the testicular volume of group A was lower than that of group B and group E(P<0.05);the levels of follicle stimulating hormone(FSH)and luteinizing hormone(LH)in group A were the highest(P<0.05),but the level of testosterone(T)was the lowest(P<0.05);the levels of anti-mullerian hormone(AMH)and serum inhibin B(INHB)in group A were lower than those in group B and group E(P<0.05),the normal sperm morphology rate in group B was higher than that in group A and group E(P<0.05);the percentage of forward moving sperm in group B was the highest(P<0.05).Pearson correlation analysis revealed that sperm concentration,normal sperm morphology rate,and percentage of forward moving sperm were negatively correlated with age,FSH,LH(P<0.05),and positively correlated wit

关 键 词：生殖激素 男性不育 非梗阻性无精子症 抗苗勒氏管激素 显微睾丸切开取精(Micro-TESE) 精子形态 精子计数 精子前向运动 

分 类 号：R698.2[医药卫生—泌尿科学]