324例无精子症患者临床分析

无精子症是男性不育较常见的病因之一,现将我院1990年以来收治的资料保存较为完整的324例无精子症患者报告如下.     

无精子症263例病因诊断分析

本文对１９８６～１９９２年门诊收治的２６０３例男子不育症中的２６３例无精子症患者进行病因诊断分析。提出无精子症病因诊断应根据病史、体检、第二性征、睾丸体积、精液分析、生殖激素等检查方法，首先区别是梗阻性的还是非梗阻性的。按ＷＨＯ男性不育诊断流程图的诊断标准对无精子症２６３例进行病因分类，提出其常见病因依次为先天异常不育８９例，特发性无精子症５５例和附属性腺感染不育４５例。对睾丸功能、阴囊探查和睾丸活检在无精子症病因诊断中的作用作了介绍。     

梗阻性无精子症的定位诊断及病因分析

目的探讨梗阻性无精子症的定位诊断及病因.方法回顾性分析2009年6月至2011年12月期间收治的47例梗阻性无精子症患者的临床资料,包括病史、查体、精浆生化检测、经直肠超声检查,通过手术探查最终确定的梗阻部位.结果47例梗阻性无精子症患者中,先天性双侧输精管缺如4例,精囊发育不良3例,射精管梗阻15例,双侧输精管梗阻5例,双侧附睾尾部梗阻13例,双侧附睾头部梗阻3例,附睾一侧头部对侧体部梗阻2例,附睾一侧体部对侧尾部梗阻2例.结论梗阻性无精子症的致病因素为先天发育不良及后天的炎症、创伤等,通过详细的病史采集、查体、精浆生化检测、经直肠超声检查,术前可对大部分梗阻部位作出判断.     

无精子症263例病因诊断分析

本文对１９８６－１９９２年门诊收治的２６０３年男子不育症中的２６３例无精子症患者进行了病因诊断分析。提出无精子症病因诊断应根据病史，体检、第二性征、睾丸体积、精液分析，生殖激素检查方法，首先区别是梗阻性的性的还是非梗阻性的。     

248例无精子症临床治疗结局分析

目的 探讨治疗无精子症的最佳治疗方案。方法 回顾性分析2002年1月-2003年12月就诊于我院的248例无精子症患者的临床资料，其中208例接受供精人工授精（AID），8例行附睾精子抽吸术（ESA）结合卵细胞内单精子注射（ICSI），32例接受供精体外受精胚胎移植（IVF-D）。分析其临床结局和相关影响因素。结果 208例接受AID患者共行624个人工授精周期，采用双次宫颈管内人工授精（ICI）或宫腔内人工授精（IUI），周期妊娠率15．22％（95／624）；ESA＋ICSI8例，共行12个治疗周期，妊娠率为25％（3／12）；接受IVF—D患者32例，共行47个移植周期，妊娠率31．91％（15／47）。AID妊娠率低于ICSI和IVF—D（P〈0．05）。多胎妊娠率AID为6．32％（6／95），显著低于ICSI[33．33％（1／3）]和IVF-D[33．33％（5／15）1（P〈0．05）。AID自然流产率与ICSI和IVF—D组相比无统计学差异（P〉0．05）。结论 AID是治疗无精子症最常用的方法，具有简便和经济等优点；阻塞性无精子症患者宁可选择ESA结合ICSI获得自己的后代；如合并其它不孕因素则可选择IVF-D提高妊娠率。     

54例无精子症、少精子症患者Y染色体AZF微缺失的检测

目的 探讨Y染色体上AZF微缺失与男性无精子症及少精子症之间的关系。方法 采用多重PCR技术，对54例无精子症及少精子症患者AZF4个区的15个序列标签位点(STS)进行了微缺失检测，并同时做了细胞遗传学检查。结果 54例患者中共有4例发现微缺失(7．4％)，其中有2例在17例无精子症患者中发现(11．8％)，另2例在37例少精子症患者中发现(5．4％)。结论 AZF微缺失是导致男性无精子及少精子的重要原因之一，细胞遗传学检查与AZF微缺失无相关性。     

212例染色体正常的无精子症患者临床研究

目的了解染色体正常的男性无精子症患者的发病情况,探讨其病因和诊断、处理。方法入选染色体正常的无精子症患者212例,从年龄、职业、身高、体重、腮腺炎病史、棉籽油服用史、睾丸大小、激素水平、睾丸活检等15个方面分析总结流行病学和临床资料。结果在男性无精子症病因中,腮腺炎病史、棉籽油服用史、附睾炎史所占比例较高。在睾丸体积<12ml且FSH明显升高患者,睾丸活检未发现有成熟精子。结论预防腮腺炎的发生,避免食用棉籽油和预防附睾炎发生可以减少部分无精子症的发生。睾丸大小、质地与性激素水平对临床判断无精子症的类别有重要的意义。     

无精子症病因及临床诊断探讨(附46例报告)

无精子症是指射出的精液经离心沉淀后经显微镜观察，连续3次均未发现精子。占男性不育症的10％-20％，是目前男性不育的较大诊治难题。无精子症分为精子通路梗阻或缺如导致的梗阻性无精子症和精子发生障碍导致的非梗阻性无精子症。探讨无精子症诊治规范化，系统的合理运用成熟的实验指标使其发挥最大的功效，寻求一种适合我国国情的无精子症诊治方法，并为辅助生殖技术提供科学的技术评估方法，     

原发性无精子症与严重少精子症患者AZF微缺失筛查

目的:观察Y染色体AZF微缺失与原发性无精子症和严重少精子症之间的关系。方法:所有筛选入实验组的研究对象均进行外周血生殖内分泌激素卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)的检测及染色体核型分析,排除激素水平异常者及染色体结构与数目异常者。将符合纳入标准的实验对象67例分为原发性无精子症组(A组)49例与原发性严重少精子症组(B组)18例,正常生育男性对照(C组)40例。确定了8个实验用序列标签位点(STS),分别是:sY84、sY86、sY127、sY134、sY152、sY153、sY254、sY255,并以X/Y连锁锌指蛋白基因(ZFX/Y)为内对照进行多重PCR筛查AZF微缺失。结果:67例实验组样本中,共检测出AZF微缺失8例,缺失率为11.94%,其中AZFc区缺失的有4例,AZFa+AZFc区缺失的有2例,AZFb+AZFc区缺失的有1例,AZFb区缺失的有1例。对照组未检出AZF基因微缺失。经χ2检验,实验组与对照组AZF区域STS总缺失率有显著性差异,实验组高于对照组。结论:Y染色体长臂AZF微缺失与原发性无精子症和严重少精子症相关,多重PCR是一种快速、有效的筛查方法。     

Status of vitamin E and reduced glutathione in semen of oligozoospermic and azoospermic patients

Aim: To investigate the status of seminal plasma reduced glutathione (GSH) and vitamin E in three different conditions of spennatogenesis: azoospennia, oligozoospennia and nonnospennia. Methods: Reduced glutathione was measured in the seminal plasma by the method of Moron et al (1979), and vitamin E estimation was performed by the method of Taylor et al ( 1976). Results. Vitamin E levels in seminal plasma of oligospermic and azoospelxnic sampies were significantly decreased to 65.54% and 66.04% respectively as compared to the nonnospermic group. Levels of reduced glutathione were also significantly decreased in oligospermic and azoospennic group, and the reduction in azoospermic group (76.73 % ) was more pronounced than oligozoospermic group (62.07 % ). Conclusion: The decrease in reduced glutathione, an endogenous antioxidant, levels in azoospermic and oligozoospermic conditions may cause disruption in the membrane integrity of spermatozoa as a consequence of increased oxidative stress.     

无精子症患者瘦素水平及其临床应用价值初探

目的:检测无精子症患者的精浆及血清瘦素(leptin,Lep)水平,探索精浆、血清Lep单独以及联合血清卵泡刺激素(FSH)鉴别梗阻性无精子症(OA)和非梗阻性无精子症(NOA)的方法及意义。方法:选取OA患者45例、原因不明的NOA患者41例,精液参数正常对照30例。无精子症患者行附睾/睾丸细针穿刺精子抽吸术及睾丸活检,所有研究对象均检测血清FSH、精浆及血清Lep。用Fisher判别分析结合ROC曲线法,对单个或多个联合指标进行分析评价。结果:在体重指数无差别的情况下,与精液参数正常对照者相比,OA患者精浆Lep水平显著增高,有统计学意义(P=0.048);NOA患者血清FSH(P=0.000)、血清Lep(P=0.000)及精浆Lep(P=0.000)都显著增高。与OA患者相比,NOA患者血清FSH(P=0.000)、血清Lep(P=0.006)及精浆Lep(P=0.033)都显著增高。在区别OA及NOA方面,精浆Lep及血清Lep的ROC曲线下面积(AUCROC)分别为0.658、0.702,均显著大于0.5,P值分别为0.014、0.002;精浆Lep、血清Lep及FSH三者联合,AUCROC最大(0.953),且以0.026×精浆Lep+0.05×血清Lep+0.106×FSH-2.197为联合指标值,以-0.289为临界值(≥临界值,判定为NOA),其敏感度及特异度均达到最高,分别为0.878及0.902。结论:在鉴别OA和NOA方面,精浆及血清Lep水平有一定价值,联合精浆Lep、血清Lep及FSH,可能优于单个指标。     

1 756例无精子症患者病因构成比分挝

目的 研究男性不育无精子症病因构成比情况.方法 对1756例在广东省计划生育专科医院诊断为无精子症的病例,按照WHO的诊断分类标准,进行回顾性分析.结果 在1756例无精子症中,先天性异常1164例（66.3%）,特发性无精子症321例（18.3%）,梗阻性无精子症114例（6.5%）,获得性睾丸损伤71例（4.0%）,内分泌病因7例（0.4%）,精索静脉曲张79例（4.5%）.结论 男性不育无精子症的主要病因是先天性异常、特发性无精子症等非梗阻性无精子症.预后较差,辅助生殖技术是治疗的有效方法,但遗传问题尚待进一步研究.     

无精子症精道造影209例分析

目的总结分析近6．5年来的输精管造影经验。方法对初步诊断为梗阻性无精子症的男性不育209例施行单人操作经皮穿刺输精管精道造影，对经皮穿刺失败者顿行开放穿刺。两侧穿刺成功后同时注射76％泛影葡胺一次摄片。结果209例中，异常50例（23．9％），其中输精管梗阻31例，射精管梗阻7例，其他异常12例。结论精道造影显影清晰直观，对梗阻性无精子症梗阻部位的确定和治疗方案的选择具有独特价值。     

它莫西芬治疗特发性少精症70例分析

自１９９２年２月～１９９６年１０月，我科使用它莫西芬治疗７０例特发性少精症。在三个月为一疗程的治疗后，７８．６％的精子数量有一定程度提高，但是各人的差异较大，３８．２％的精子数量提高到２０×１０６／ｍｌ以上，虽然它莫西芬能提高精子的数量，但对精液的其它参数，如ｐＨ、精子活率、活力及液化时间均无明显影响。本文仅有７例原精子质量较好的病人经治疗后使其妻受孕。治疗前后的性激素检查发现，ＦＳＨ、ＬＨ和Ｔ有明显的提高，而ＰＲＬ和Ｅ２变化甚微。病人在治疗期间没有明显副作用发生。     

Diagnostic findings from testis fine needle aspiration mapping in obstructed and nonobstructed azoospermic men

PURPOSE: Although helpful for defining extratesticular obstruction, the testis biopsy offers limited information on nonobstructive azoospermic testes. Guided by diagnostic biopsies, testis sperm extraction procedures fail in 25% to 50% of patients with nonobstructive azoospermia, largely because it is clinically difficult to know where sperm are located. To provide a more complete assessment of spermatogenesis in nonobstructive azoospermic patients and to simplify the confirmation of sperm production in men with obstruction, we use a systematic, fine needle aspiration "mapping" procedure. We summarize the diagnostic findings in a series of azoospermic men. MATERIALS AND METHODS: From 118 azoospermic infertile men (22 with obstructed and 96 with nonobstructed azoospermia) fine needle aspiration data were used to generate location specific, sperm frequency maps for obstructed and nonobstructive azoospermic testes to determine if "sperm rich" locations existed. RESULTS: Fine needle aspiration map analysis revealed that all aspiration locations from obstructed cases showed sperm. In men with nonobstructive azoospermia, sperm was identified in the right testis in 134 of 652 (20.5%) and in the left testis in 151 of 716 (21.1%) separate aspirations. Rates of sperm detection among various intratesticular sites were not statistically different. In 27.1% of cases the fine needle aspiration map found sperm in men with sperm negative biopsies. The likelihood of heterogeneity in fine needle aspiration sperm findings was 25% within individual nonobstructive azoospermic testes and 19.2% between testis sides. At post-procedure followup of 88 patients (74%), no clinical or surgical complications were observed. CONCLUSIONS: Testis fine needle aspiration mapping is a simple, reliable and informative diagnostic tool in the evaluation of azoospermic infertile men.     

肾移植后霉酚酸酯所致白细胞减少的临床分析

目的 探讨肾移植后应用霉酚酸酯(MMF)所致白细胞减少的发生机理及治疗策略。方法对应用MMF后发生白细胞减少、须停药的25例肾移植患者的资料进行回顾性分析。结果MMF所致白细胞减少的发生率为4％(25／632)，其中重度及危重度患者13例，中度减少12例，暂停或永久停用MMF，重度及危重度患者应用重组人粒细胞集落刺激因子(rhG—CSF)治疗的有效率为92％(12／13)；患者停用MMF期间加用百令胶囊6．0～9．0g／d。结论 肾移植后应用MMF所致须停药的白细胞减少并不少见，其发生可能与体内血中游离的霉酚酸浓度较高有关；严重者可用rhG～CSF治疗，大多数可逆；肾功能不全者应适当减少MMF的用量。     

Testicular fine needle aspiration as a diagnostic tool in non-obstructive azoospermia

Aim： To report the fine needle aspiration cytology （FNAC） of the testes used as a diagnostic tool in non-obstructive azoospermic patients. Methods： One hundred and twenty-five non-obstructive azoospermic male candidates to intracytoplasmic sperm injetion （ICSI） were analysed for follicle stimulating hormone （FSH）, luteinizing hormone （LH）, testosterone and inhibin B plasma levels. They were classified into three groups on the basis of FNAC： 1） Sertoli cell-only syndrome （SCOS） （70）; 2） severe hypospermatogenesis （42）; and 3） maturation arrest （13）, Then, all men underwent testicular sperm extraction （TESE） for sperm recovery for ICSI. Results： Mature spermatozoa were detected by FNAC in 24 of 42 men with severe hypospermatogenesis and nine of 13 men with maturation arrest; while they were retrieved by TESE in 29 of 70 men with SCOS, 35 of 42 men with severe hypospermatogenesis （including the 24 by FNAC） and 10 of 13 men with maturation arrest （including the nine by FNAC）. The sensitivity and specificity of FNAC were 44.6 % and 100 %, respectively. There was no difference on testicular volume and hormonal parameters in men with and without sperm retrieved. Conclusion： These findings suggest that FNAC may be a simple and valid diagnostic parameter in non-obstructive azoospermic men and it may represent a valid positive prognostic parameter for sperm recovery at TESE, （Asian J Androl 2005 Sep; 7： 289-294）     

Probability to retrieve testicular spermatozoa in azoospermic patients

Aim: The degree of probability to retrieve spermatozoa from testicular tissue for intracytoplasmic sperm injection intooocytes is of interest for counselling of infertility patients. We investigated the relation of sperm retrieval to clinical dataand histological pattern in testicular biopsies from azoospermic patients. Methods: In 264 testicular biopsies from142 azoospermic patients, the testicular tissue was shredded to separate the spermatozoa, histological semi-thin sec-tions of which were then evaluated using Johnsen score. Results: The retrieval of spermatozoa correlated signifi-cantly (P < 0.001) with the testicular volume (r = 0.49), the FSH concentration ( r = -0.66), the maximum score(r = 0.85) and the mean Johnsen score (r = 0.81). In the multivariate regression analysis the successful testicularsperm extraction showed the closest relationship to the maximum score. The testicular volume correlated significantlywith the mean Johnsen score ( r = 0.64, P < 0. 001), and the basal serum FSH concen