锌生殖激素检测在男性不育无精子症中的诊断作用

对我院男性门诊１３０ 例男性不育者及４０ 例无精子症者进行了精浆锌、血清生殖ＦＳＨ、ＬＨ、Ｔ、ＰＲＬ检测,睾丸活检、睾丸容积、精液常规检查。结果显示：精浆锌含量下降、血清ＦＳＨ升高、Ｔ／ＬＨ比值下降,睾丸容积减少、表示睾丸功能损伤、间质细胞功能受损、生精上皮不同程度的损伤,血清ＦＳＨ含量在鉴别睾丸原发性与梗阻性无精子症中是非常重要的指标,精浆锌及血清生殖激素的检测在男性不育无精子症诊断中,在判定睾丸功能的损伤程度中具有重要作用。     

308例唯支持细胞综合征患者睾丸生精功能与生殖激素的相关性分析

目的分析生殖激素的比值在评估睾丸生精功能上的应用价值。方法回顾性分析308例在外院诊断为非梗阻性无精子症,睾丸病理为唯支持细胞综合征且来我院要求供精人工授精的临床资料。按照体外射出精液是否有精子,分为隐匿精子组和无精子组,比较两组间的生殖激素水平和遗传学指标差异,分析这些指标对评估唯支持细胞综合征患者的睾丸生精功能的价值。结果研究对象FSH/LH比值均值为2.4,其中隐匿精子组2.0,无精子组2.5,两者差异有统计学意义(P=0.001),而两组FSH、LH、PRL、T、FSH/T比值以及LH/T比值比较无显著差异。两组染色体和AZF基因比较有显著统计学差异(P0.001)。结论 FSH/LH比值联合染色体和AZF基因等指标在评估唯支持细胞综合征患者的睾丸生精功能上比睾丸体积、精液量、精液PH值、FSH、LH、PRL、T、FSH/T比值以及LH/T比值更具有参考价值。     

治疗不孕不育新技术

正显微取精术无精症患者,还能生育自己的孩子吗?事实上,无精症分为两类,梗阻性无精症与非梗阻性无精症。梗阻性无精症患者的附睾睾丸内有精子存在,由于输精管阻塞,精子无法排出体外而导致不孕不育。在治疗上,可以通过附睾睾丸穿刺提取精子做试管婴儿的方式生育孩子,还可以通过显微吻合手术恢复输精管     

非嵌合Klinefelter综合征精液生精细胞学检查和Y染色体微缺失分析

目的:分析Klinefelter综合征(Klinefelter syndrome,KS)患者精液生精细胞学检查结果和Y染色体无精症基因(Azoospermia factor,AZF)微缺失情况。方法:对27例非嵌合KS患者及对照组27例生育正常男性进行血清卵泡刺激素(FSH)、黄体生成激素(LH)、睾酮(T)浓度测定和染色体核型检查,并对其精液进行生精细胞学检查。采用多重PCR筛查Y染色体微缺失。结果:非嵌合KS患者血清FSH和LH浓度明显高于对照组,T浓度低于对照组。生精细胞学检查显示:非嵌合KS患者中1例属于精子阶段;1例初级精母细胞阶段;8例偶见精子;其余17例未见精子及各级生精细胞。对照组均可见精子及各级生精细胞。27例非嵌合KS患者与对照组均未检出AZF微缺失。结论:精液细胞学检查能很好地反映非嵌合KS患者生精功能,可作为辅助生殖前参考诊断;Y染色体AZF缺失可能不是引起非嵌合KS患者生精障碍的遗传因素,AZF缺失与KS之间存在不确定的关系。     

经皮附睾穿刺取精术在梗阻性无精子症诊断中的应用

目的 探讨经皮附睾穿刺取精术(PESA)在梗阻性无精子症患者中的诊断价值.方法 采用PESA对94例无精子症患者进行诊断性穿刺,观察穿刺效果.有精子者为PESA穿刺阳性.结果 无精子症患者的PESA穿刺阳性率为77.7％,睾丸体积≥12 mL患者PESA穿刺阳性率高于睾丸体积＜12 mL患者(p＜0.01)；FSH≤1...     

梗阻性无精子症患者应用附睾、睾丸精子助孕的结局比较

目的比较梗阻性无精子症患者应用附睾、睾丸精子助孕的结局差异。方法梗阻性无精子症患者54例,其中经皮附睾穿刺抽吸术取精者29例(PESA),睾丸精子抽提术取精者25例(TESE)。辅助生殖采用卵胞浆内单精子注射技术(ICSI),对其正常受精率、胚胎种植率、人绒毛膜促性腺激素(HCG)阳性率及临床妊娠率进行比较。结果不同取精组的正常受精率无统计学差异(P>0.05),而PESA组的胚胎种植率、HCG阳性率及临床妊娠率均高于TESE组(P<0.05)。结论梗阻性无精子症患者附睾、睾丸穿刺取精简单易行,创伤小,并发症少,获精率高,ICSI妊娠结局满意;附睾取精避免了睾丸损伤,且助孕结局可能优于睾丸取精。     

想做爸爸的你为什么没有“种子”?

<正>男人无精症,有的是精子"无路可走",有的是睾丸本无生精功能。专家提醒,男孩进入青春期,家长要注意孩子的睾丸发育是否正常,是否有遗精现象。梗阻性无精症:精子"无路可走"23岁的小周结婚两年,妻子一直不怀孕,到医院化验精液,才发现小周没有精子。根据小周的病历记载,他的精液量只有0.5毫升,而且像稀米汤一样,没有凝固状态,不像正常精液那样黏稠。医生检查,居然摸不到小周的输精管,B超检查也看不到精囊腺。医生说,小周的输精管先天缺失,睾丸产生的精子没有外出的通道,所以精液中也就没有精子,这种情况叫做梗阻性无精症。由于输精管和精囊腺在胚胎时期共同发育而来,二者的存在是相辅相成的,没有输精管也就没有精囊腺。     

无精子症精确诊断分型的临床应用分析

目的明确无精子症精确诊断分型的临床应用情况。方法收集上海交通大学医学院附属仁济医院泌尿男科门诊就诊的无精子症患者356例。完成病史收集、体格检查、精液分析、性激素及抑制素B检测、染色体核型分析、AZF检测、超声检测等。依据2013版《中国男科疾病诊断治疗指南-男性不育诊疗指南》无精子症的精确诊断分型,将患者分为:梗阻性无精子症(obstructive azoospermia,OA)组(128例)、非梗阻性无精子症(NOA non-obstructive azoospermia,NOA)组(166例)以及混合型无精子症(combined azoospermia,CA)组(62例),针对不同分型采用不同治疗方法 ,观察治疗结果。结果 OA组中,先天性双侧输精管缺如(congenital bilateral absence of the vas deferens,CBAVD)患者49例,均进行诊断性经皮附睾精子抽吸术(percutaneous epididymal sperm aspiration,PESA),找到精子后进行卵胞浆内单精子注射(intracytolasmic sperm injection,ICSI)治疗;其余79例患者,63例选择生殖道重建术,16例选择直接PESA后ICSI治疗。NOA组中,染色体异常40例,其中47,XYY克氏综合征23例、AZFa/b缺失12例,直接建议患者进行供精人工授精(artifical insemination by dornor,AID)治疗;5例为AZFc缺失,行睾丸活检后均未找到精子;其余126例患者为特发性NOA。26例患者选择接受精索内静脉显微结扎术联合睾丸活检术,选择经验性治疗61例,选择直接睾丸活检者44例。CA组中,进行PESA找到精子23例,睾丸精子抽吸术(testicular sperm aspiration,TESA)找到精子14例,TESA未找到精子者后续进行睾丸活检病理组织找到精子5例,其余20例睾丸活检也未能找到精子。结论按无精子症精确诊断分型,有助于避免过度诊断,加速临床诊断速度,提高诊断效率。根据分型进行治疗选择,有助于临床无精子症的诊治。     

抗苗勒管激素与男性生殖相关疾病的研究进展

抗苗勒管激素(anti-Mullerian hormone,AMH),又名苗勒管抑制素(Mullerian inhibiting substance,MIS),最早发现于男性胎儿,因抑制其苗勒管的发育而命名,对男性性分化具有重要作用。目前研究发现AMH在男性生殖相关领域有更加广泛的临床应用,主要体现在5个方面:(1)诊断两性畸形患者是否存在男性性腺,血清AMH比Y染色体敏感度更高,且是青春期评估睾丸功能较好的标志物;(2)与血清AMH水平比较,精浆AMH与睾丸生精功能显著相关,与精液质量呈正相关,是鉴别梗阻性、非梗阻性无精子症特异性较高的标志物;(3)精浆AMH是目前预测严重少、弱精子症患者精液冷冻-复苏率较好的指标;(4)精浆AMH水平可预测重组人卵泡刺激素(rh FSH)治疗特发性少、弱精子症的疗效;(5)对生育期需接受放化疗的男性肿瘤患者生育力的评估,精浆AMH是目前特异性最高的生物标志物。     

无精症有对策吗

<正>【专家说病】何为无精症,通俗的说就是精液中没有精子。医学上定义为"在所射出的精液中连续3次找不到一个精子,称为无精症"。是男性不育中最严重、最难治愈的疾病之一。无精症约占男性不育症患者的15%~20%。其病因复杂,根据其病因可概括为两大类:一是睾丸产生精子的功能受损,就是睾丸本身不能产生精子,称为非梗阻性无精症;另一类为睾丸可正常产生精     

Testicular Biopsy in Azoospermia and Severe Oligozoospermia

The continued experience of testicular biopsy application in 861 cases of azoospermia and 152 cases of severe oligospermia is reported adding to the previously published cases of 1075 patients with azoospermia. The most common finding in the whole series was that of normal testis denoting obstruction (48%), while among cases of functional azoospermia, Sertoli cell only and spermatogenic arrest were the most frequent (66%).     

抑制素B对精子发生障碍的诊断参考价值

抑制素B是睾丸分泌的一种糖蛋白激素,受垂体卵泡刺激素(FSH)特异调控,具有昼夜分泌节律性并随年龄增加而变化。成年男性抑制素B几乎全部来自于睾丸,且其组装过程大部分在生精细胞内完成,而后释放到循环和精浆,因此血清和精浆抑制素B水平与精子发生同步。由于使用高特异性抗体,酶联免疫吸附法（双抗体夹心ELISA法）可精确测定具有生物活性的抑制素B,满足科研和临床的需要。抑制素B的浓度在精子发生障碍时会出现变化,通过测定其浓度可对精子发生状态作出评估,在鉴别梗阻性与非梗阻性无精子症方面也具有较高的特异性与敏感性。     

血清抑制素B在非梗阻性无精子症中的应用

目的:探讨血清抑制素B(INHB)在非梗阻性无精子症中的应用及对睾丸精子抽吸结局的预测作用。方法:用回顾性分析方法对52例非梗阻性无精子症(NOA)、12例梗阻性无精子症(OA)及20例正常生育男性,采用双抗夹心ELISA法测定各组血清中INHB水平;采用化学发光法测定各组血清中卵泡刺激素(FSH)、黄体生成素(LH)和睾酮(T)水平。结果:NOA组血清INHB水平明显低于正常生育男性组和OA组,其差异均有统计学意义(P<0.01);血清FSH和LH水平明显高于OA组和正常生育男性组(P<0.01)。NOA组行睾丸抽吸(TESE)获得精子的患者,其血清INHB水平明显高于未获得精子者,其差异有统计学意义(P<0.01);而NOA组行TESE未获得精子的患者,其血清FSH水平明显高于获得精子者,其差异有统计学意义(P<0.01)。比较两组血清中LH和T水平,其差异均无统计学意义(P>0.05)。结论:血清INHB水平可反映睾丸精子发生的情况,能准确预测TESE获取精子的结局。     

微创睾丸穿刺活检术的配合及护理

目的提高微创睾丸穿刺术的护理技术水平,减少并发症。方法从2007年7月～2009年10月共210例无精子症患者应用微创睾丸穿刺活检取曲细精管。结果210例患者均成功取出曲细精管。结论做好心理护理、术前准备、术中密切配合、术后的健康宣教,能有效地预防微创睾丸穿刺活检术后并发症的发生。     

抑制素B对精子发生障碍的诊断参考价值

抑制素B是睾丸分泌的一种糖蛋白激素，受垂体卵泡刺激素（FSH）特异调控，具有昼夜分泌节律性并随年龄增加而变化。成年男性抑制素B几乎全部来自于睾丸，且其组装过程大部分在生精细胞内完成，而后释放到循环和精浆，因此血清和精浆抑制素B水平与精子发生同步。由于使用高特异性抗体，酶联免疫吸附法（双抗体夹心ELISA法）可精确测定具有生物活性的抑制素B，满足科研和临床的需要。抑制素B的浓度在精子发生障碍时会出现变化，通过测定其浓度可对精子发生状态作出评估，在鉴别梗阻性与非梗阻性无精子症方面也具有较高的特异性与敏感性。     

高压氧对精索静脉曲张家兔生殖激素水平影响的实验研究

目的研究高压氧(HBO)对精索静脉曲张(VC)家兔生殖激素水平的影响,进一步探讨精索静脉曲张致男性不育的机制。方法采用HBO干预精索静脉曲张家兔模型,对睾丸重量、体积,精液参数及外周血浆生殖激素(FSH、LH)水平进行研究。结果与VC模型组比较,HBO干预VC模型组精液质量改善,睾丸重量增加,血浆FSH、LH水平下降(P=0.0215,P=0.0492),T水平增高(P<0·0001)。结论VC可导致睾丸间质损害,并引起生殖激素水平平衡失调,从而加重睾丸生精功能及附睾精子成熟功能的损害。主要机制为VC时睾丸缺血,缺氧及其微循环灌注障碍;HBO可有效抑制VC致睾丸间质细胞损害进程,改善睾丸间质细胞生存的微循环,维持生殖内分泌激素水平平衡。     

Causes of azoospermia and their management

Azoospermia may occur because of reproductive tract obstruction (obstructive azoospermia) or inadequate production of spermatozoa, such that spermatozoa do not appear in the ejaculate (non-obstructive azoospermia). Azoospermia is diagnosed based on the absence of spermatozoa after centrifugation of complete semen specimens using microscopic analysis. History and physical examination and hormonal analysis (FSH, testosterone) are undertaken to define the cause of azoospermia. Together, these factors provide a >90% prediction of the type of azoospermia (obstructive v. non-obstructive). Full definition of the type of azoospermia is provided based on diagnostic testicular biopsy. Obstructive azoospermia may be congenital (congenital absence of the vas deferens, idiopathic epididymal obstruction) or acquired (from infections, vasectomy, or other iatrogenic injuries to the male reproductive tract). Couples in whom the man has congenital reproductive tract obstruction should have cystic fibrosis (CF) gene mutation analysis for the female partner because of the high risk of the male being a CF carrier. Patients with acquired obstruction of the male reproductive tract may be treated using microsurgical reconstruction or transurethral resection of the ejaculatory ducts, depending on the level of obstruction. Alternatively, sperm retrieval with assisted reproduction may be used to effect pregnancies, with success rates of 25-65% reported by different centres. Non-obstructive azoospermia may be treated by defining the cause of low sperm production and initiating treatment. Genetic evaluation with Y-chromosome microdeletion analysis and karyotype testing provides prognostic information in these men. For men who have had any factors potentially affecting sperm production treated and remain azoospermic, sperm retrieval from the testis may be effective in 30-70% of cases. Once sperm are found, pregnancy rates of 20-50% may be obtained at different centres with in vitro fertilisation and intracytoplasmic sperm injection.     

Effects on rat testis of 1.95-GHz W-CDMA for IMT-2000 cellular phones

In recent years concern has arisen whether carrying a cellular phone near the reproductive organs such as the testes may cause dysfunction and particularly decrease in sperm development and production, and thus fertility in men. The present study was performed to investigate the effects of a 1.95 GHz electromagnetic field on testicular function in male Sprague-Dawley rats. Five week old animals were divided into 3 groups of 24 each and a 1.95-GHz wide-band code division multiple access (W-CDMA) signal, which is used for the freedom of mobile multimedia access (FOMA), was employed for whole body exposure for 5 hours per day, 7 days a week for 5 weeks (the period from the age of 5 to 10 weeks, corresponding to reproductive maturation in the rat). Whole-body average specific absorption rates (SAR) for individuals were designed to be 0.4 and 0.08 W/kg respectively. The control group received sham exposure. There were no differences in body weight gain or weights of the testis, epididymis, seminal vesicles, and prostate among the groups. The number of sperm in the testis and epididymis were not decreased in the electromagnetic field (EMF) exposed groups, and, in fact, the testicular sperm count was significantly increased with the 0.4 SAR. Abnormalities of sperm motility or morphology and the histological appearance of seminiferous tubules, including the stage of the spermatogenic cycle, were not observed. Thus, under the present exposure conditions, no testicular toxicity was evident.     

Effects on rat testis of 1.95-GHz W-CDMA for IMT-2000 cellular phones

In recent years concern has arisen whether carrying a cellular phone near the reproductive organs such as the testes may cause dysfunction and particularly decrease in sperm development and production, and thus fertility in men. The present study was performed to investigate the effects of a 1.95?GHz electromagnetic field on testicular function in male Sprague-Dawley rats. Five week old animals were divided into 3 groups of 24 each and a 1.95-GHz wide-band code division multiple access (W-CDMA) signal, which is used for the freedom of mobile multimedia access (FOMA), was employed for whole body exposure for 5 hours per day, 7 days a week for 5 weeks (the period from the age of 5 to 10 weeks, corresponding to reproductive maturation in the rat). Whole-body average specific absorption rates (SAR) for individuals were designed to be 0.4 and 0.08 W/kg respectively. The control group received sham exposure. There were no differences in body weight gain or weights of the testis, epididymis, seminal vesicles, and prostate among the groups. The number of sperm in the testis and epididymis were not decreased in the electromagnetic field (EMF) exposed groups, and, in fact, the testicular sperm count was significantly increased with the 0.4 SAR. Abnormalities of sperm motility or morphology and the histological appearance of seminiferous tubules, including the stage of the spermatogenic cycle, were not observed. Thus, under the present exposure conditions, no testicular toxicity was evident.