克氏综合征睾丸体积大小与性激素的相关性及睾丸组织超微结构的研究

目的探讨克氏综合征睾丸体积大小与性激素的相关性及造成克氏综合征男性不育的发病机理。方法对20例克氏综合征患者和10例正常对照组血清进行性激素测定，同时作睾丸组织活检进行病理切片及电镜超薄切片观察。结果克氏综合征与正常对照组睾丸体积、生精小管直径和管壁厚度及血清FSH、LH、T之间均有极显著的差异（P〈0．001），患者睾丸体积大小与FSH和LH值呈负相关性，与T值呈正相关性；睾丸组织超微结构观察结果表明生精小管界膜有不同程度的显著异常变化，主要表现为界膜增厚及纤维化增生，基膜增厚及纤维化增生，肌样细胞的空泡状变性或去分化增生。支持细胞病理变化呈现多样性特征，胞质内有大量内质网呈空泡状变性，部分线粒体扩张。间质内血管壁明显增厚及血管内皮细胞肿胀，基膜及血管腔内大量胶原纤维增生。结论推导出患者睾丸体积大小与FSH、LH、T的多重相关回归方程；同时认为克氏综合征睾丸组织结构发生严重的纤维化增生，促使其生精细胞形成过程发生早期的、程度严重的障碍和病理学变化，这是造成其男性不育的主要原因。

CORRELATION BETWEEN TESTICULAR VOLUME AND SEX HORMONE AND THE ULTRASTRUCTURAL STUDY OF THE TESTICULAR TISSUE IN KLINEFELTER SYNDROME

Objective To investigate the correlation between testicular volume and sex hormone and the pathogenesis of male sterility in Klinefelter syndrome.Methods The sex hormones of the Klinefelter syndrome group(n=20) and control group(n=10) were determined by radioimmunassay.The biopsy of testicular tissues were pathologically sectioned and ultra-thin sections were examined by electron-microscopy.Results There was a significant deference(P<0.001) in the testicular volume,the diameter of the seminiferous tubule,wall thickness and serum FSH,LH and T between Klinefelter syndrome group(n=20) and normal group.The testicular volume of patients was negatively correlated to FSH and LH,while it was positively correlated to T.The ultrastructural observations of the testicular tissue showed that the limiting membrane of the convoluted seminiferous tubules varied to an unusually great extent,mainly suggesting that limiting membrane thickened and fibers proliferated,basilemma thickened and fibers proliferated,vacuoles of myoid cells degenerated or de-differentiation proliferated;These were vesicular degeneration in lots of endoplasmic reticula,and some mitochondrial dilatation in the cytoplasma of the Sertoli's cells.Interstitial vascular walls were also found to thicken and endothelical cells to swell and collagen fibers to proliferate in the basilemma and tubular lumens.Conclusions It may follow that testicular volume has the multi-correlation of regression equation with FSH,LH and T in the serum.It is also believed that a serious fibre proliferation of testicular tissues in Klinefelter syndrome can contribute to early,serious obstruction and pathogensis in the process of sperm-producing cell formation,thus causing male sterility.