来曲唑在非梗阻性无精子症中应用效果研究

目的探讨来曲唑在治疗非梗阻性无精子症(NOA)患者中的应用效果。方法收集2009年8月至2016年7月在我院接受来曲唑治疗的184例NOA患者为研究对象,根据睾丸体积不同分为3组:A组(81例)(睾丸体积≥12ml),B组(63例)6ml≤睾丸体积12ml,C组(40例)睾丸体积6ml。比较各组患者用药前后的睾丸体积、精液质量、性激素水平变化及睾丸活检组织病理情况。结果 184例NOA患者在规律用药后,所有患者精液标本离心沉淀后镜检未见精子。睾丸体积和体重指数在用药前后无显著性差异(P0.05)。各组用药后睾丸活检未见生精功能活跃的病理表现。各组患者用药前后催乳素(PRL)无显著性差异(P0.05)。用药第7天,3组的FSH和LH显著上升(P0.05),A组和B组的E_2显著下降(P0.05),3组的T值较用药前显著上升(P0.05)。用药第14天,3组的FSH和LH继续上升,A组和B组的T值继续上升,均显著高于用药第7天(P0.05)。最后一次活检前,A、B组的FSH和LH较用药第14天上升减缓(P0.05),C组的FSH和LH则显著下降(P0.05),3组的T值较第14天有所下降(P0.05)。结论来曲唑在治疗NOA患者中未见明显优势,或许需要多中心、大样本数据对这一结论加以验证。

Application of letrozole in patients with non-obstructive azoospermia

Objective:To evaluate the value of aromatase inhibitor letrozole in the treatment of patients with non-obstructive azoospermia(NOA).Methods:A total of 184 patients with NOA in our hospital from Aug.2009 to Jul.2016 were recruited in this study.The patients were divided into three groups according to testicular volume:81 patients'volume≥12 ml in group A,63 patients'volume 6 ml≤and＜12 ml in group B,and 40 patients'volume＜6 ml in group C.The testicular volume,body mass index(BMI),semen quality,sexual hormones and testicular biopsy histopathology before and after treatment were compared among the groups.Results:The semen samples after centrifugal sedimentation had no sperm to be observed in all 184 patients in regular medication.There was no significant difference in testicular volume and BMI before and after treatment (P ＞ 0.05).All the patients had no active spermatogenesis in testicular pathology examination after treatment.The PRL levels were not significantly different before and after treatment (P＞0.05).On the 7th day,FSH,LH & testosterone levels were significantly increased in the three groups (P＜0.05),and E2 levels were significantly decreased in group A and B(P＜0.05).On the 14th day after treatment,FSH and LH levels were continuously increased in the three groups,and testosterone levels were continuously increased and significantly higher than those on 7th day in group A and B(P＜0.05).The FSH and LH levels were slowly increased prior to the last biopsy in group A and B(P＞0.05),and FSH and LH levels were significantly decreased in group C (P ＜ 0.05).Testosterone levels were decreased compared with the 14th day in the three groups(P＞0.05).Conclusions:Letrozole has no obvious advantage in treatment of patients with NOA.Maybe multi-center and large sample data are needed to validate this process.