血清卵泡刺激素水平的测定对睾丸生精功能的预测分析
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摘要
目的探讨血清促卵泡刺激素(FSH)水平的测定在少精子症、重度少精子症、隐匿性无精子症患者病因学诊断中的临床价值。方法采用化学发光仪免疫法测定血清生殖激素:FSH、促黄体生成素(LH)、泌乳素(PRL)、雌激素(E_2)和睾酮(T),测定除染色体检出异常、Y染色体微缺失、精索静脉曲张、肥胖的患者外,选取在我院行辅助生殖技术由于女方因素原因引起的不孕患者,男方各项检查未见异常的120例患者作为对照组与少精子症患者589例、重度少精子症384例、隐匿性无精子症患者347例的内分泌激素测定结果进行对比分析。考虑到无精子症影响因素较多,本临床研究范围除外无精子症的患者。结果少精子症组患者较对照组患者血清FSH水平增高(P<0.05),重度少精子症组和隐匿性无精子症组患者较对照组患者血清FSH水平明显增高(P<0.01),重度少精子症组与隐匿性无精子症组的血清FSH和LH比较,差异具统计学意义(P<0.05)。当血清FSH超过(7.61±1.94)mIU/mL时,就可能出现生精功能受损,超过(12.31±2.07)mIU/mL时,就可能出现生精功能低下,治疗效果不显著,提示血清FSH能够作为反映睾丸损伤程度的间接指标。结论男性重度少精子症、隐匿性无精子症在内分泌方面与生殖激素水平表达有密切关系。精液生精细胞的功能常决定诊疗的成败,临床医生应积极据这些指标,结合患者的症状和体征以及特殊检查,综合分析,预测患者的诊疗效果。
Objective To investigate the clinical value of serum follicle stimulating hormone level in etiological diagnosis of oligozoospermia,severe oligozoospermia and occult azoospermia.Methods Levels of serum reproductive hormones were detected by chemiluminescence immunoassay such as follicle stimulating hormone(FSH)and luteinizing hormone(LH),prolactin(PRL),estrogen(E_2),testosterone(T).The patients with chromosome detection abnormalities and Y chromosome microdeletions,varicocele,obese patients in our hospital were excluded in the study.selection of assisted reproductive technology caused by female factors cause infertility due to the man normal sperm in number and activity,the examination of 120 cases of normal patients as measured results were compared between control group and endocrine hormone in patients with azoospermia,589 cases of severe oligozoospermia and 384 Cases of occult azoospermia in 347 cases.In view of the many factors affecting azoospermia,the patients with azoospermia were excluded from the scope of the clinical study.Results The levels of FSH in oligospermatism group and severe oligozoospermia group were all increased as compared with that of the control group(P<0.05).Serum FSH levels were significantly increased in occult azoospermia patient group compared with that of the control group,(P<0.01).Serum FSH levels were significantly increased in reproductive hormone levels were found between severe oligozoospermia group and occult azoospermia group that of the control group(P<0.05).The spermatogenesis function was impaired at the level of serum FSH over(7.61±1.94)m IU/m L.The spermatogenesis function was poor at level of serum FSH over(12.31±2.07)m IU/m L,and the therapeutic effect was no significant difference.It suggests that serum FSH can be used as an indirect index to reflect the degree of testicular injury.Conclusion Endocrine and reproductive hormone levels may be associated with male severe oligospermia and azoospermia in occult.Spermatogenic cell function often determines the success or failure of treatment.According to results of these indicators,combining with the comprehensive analysis of the symptoms and signs and special examination,clinicians give an accurate prediction for outcome of the patients.
Objective To investigate the clinical value of serum follicle stimulating hormone level in etiological diagnosis of oligozoospermia,severe oligozoospermia and occult azoospermia.Methods Levels of serum reproductive hormones were detected by chemiluminescence immunoassay such as follicle stimulating hormone(FSH)and luteinizing hormone(LH),prolactin(PRL),estrogen(E_2),testosterone(T).The patients with chromosome detection abnormalities and Y chromosome microdeletions,varicocele,obese patients in our hospital were excluded in the study.selection of assisted reproductive technology caused by female factors cause infertility due to the man normal sperm in number and activity,the examination of 120 cases of normal patients as measured results were compared between control group and endocrine hormone in patients with azoospermia,589 cases of severe oligozoospermia and 384 Cases of occult azoospermia in 347 cases.In view of the many factors affecting azoospermia,the patients with azoospermia were excluded from the scope of the clinical study.Results The levels of FSH in oligospermatism group and severe oligozoospermia group were all increased as compared with that of the control group(P<0.05).Serum FSH levels were significantly increased in occult azoospermia patient group compared with that of the control group,(P<0.01).Serum FSH levels were significantly increased in reproductive hormone levels were found between severe oligozoospermia group and occult azoospermia group that of the control group(P<0.05).The spermatogenesis function was impaired at the level of serum FSH over(7.61±1.94)m IU/m L.The spermatogenesis function was poor at level of serum FSH over(12.31±2.07)m IU/m L,and the therapeutic effect was no significant difference.It suggests that serum FSH can be used as an indirect index to reflect the degree of testicular injury.Conclusion Endocrine and reproductive hormone levels may be associated with male severe oligospermia and azoospermia in occult.Spermatogenic cell function often determines the success or failure of treatment.According to results of these indicators,combining with the comprehensive analysis of the symptoms and signs and special examination,clinicians give an accurate prediction for outcome of the patients.
引文
1 Lee LK,Foo KY.Recent insights on the significance of ranscriptomic and metabolomic analysis of male factor infertility.Clin Biochem 2014;47(10-11):973-982
2常元勋主编.金属毒理学.北京:北京大学医学出版社,2008:144-146
3 Rajender S,Avery K,Agarwal A.Epigenetics,spermatogenesis and male infertility.Mutat Res 2011;727(3):62-71
4 Mahmoud A,T'Sjoen G.Male hormonal contraception:where do we stand?.Eur J Contracept Reprod Health Care2012;17(3):179-186
5 Hedger MP,Winnall WR.Regulation of activin and inhibin in the adult testis and the evidence forfunctional roles in permatogenesis and immu-noregulation.Mol Cell Endocrinol 2012;359(1-2):30-42
6 Hagiuda J,Ishikawa H,Furuuchi T,et al.Relationship between dys-lipidaemia and semen quality and serum sexhormone levels:an infertility study of 167 Japanese patients.Andrologia 2014;46(2):131-135
7 Brugh VM 3rd,Lipshultz LI.Male factor infertility:evaluation and management.Med Clin North Am 2004;88(2):367-385
8郭继梅,吕玲,宫玉环.男性不育的病因及治疗新进展.医学综述2013;19(22):4138-4141
9 Lawrence C.Layman,张桂元.引起男性不育的基因.生殖与避孕2003;23(2):95-102
10吴世木,王培书,郑金川,等.男性不育患者精浆NO水平及其与抗精子抗体的关系.生殖与避孕2001;21(5):304-306
11陈荣安,房秉仁,欧阳贵,等.不同病因无精子症的生殖激素水平.生殖与避孕2002;22(2):111-113
12 Madani AH,Falahatkar S,Heidarzadeh A,et al.Sensitivity and specificity of serum FSH and testis size in predicting the existence of spermatogenesis in azoospermic in fertile men.Andrologia 2012;44(3):205-209
13 Yang Q,Huang YP,Wang HX,et al.Folicle-stimulating hormone as a predictor for sperm retrieval rate in patients with nonobstructive azoospermia:a systematic review and meta-analysis.Asian J Androl 2015;17(2):281-284
14赵骥腾,岳长久,陈佳.无精子症患者睾丸穿刺活检与血清LH、FSH水平的相关性.中华内分泌外科杂志2016;10(1):67-70
2常元勋主编.金属毒理学.北京:北京大学医学出版社,2008:144-146
3 Rajender S,Avery K,Agarwal A.Epigenetics,spermatogenesis and male infertility.Mutat Res 2011;727(3):62-71
4 Mahmoud A,T'Sjoen G.Male hormonal contraception:where do we stand?.Eur J Contracept Reprod Health Care2012;17(3):179-186
5 Hedger MP,Winnall WR.Regulation of activin and inhibin in the adult testis and the evidence forfunctional roles in permatogenesis and immu-noregulation.Mol Cell Endocrinol 2012;359(1-2):30-42
6 Hagiuda J,Ishikawa H,Furuuchi T,et al.Relationship between dys-lipidaemia and semen quality and serum sexhormone levels:an infertility study of 167 Japanese patients.Andrologia 2014;46(2):131-135
7 Brugh VM 3rd,Lipshultz LI.Male factor infertility:evaluation and management.Med Clin North Am 2004;88(2):367-385
8郭继梅,吕玲,宫玉环.男性不育的病因及治疗新进展.医学综述2013;19(22):4138-4141
9 Lawrence C.Layman,张桂元.引起男性不育的基因.生殖与避孕2003;23(2):95-102
10吴世木,王培书,郑金川,等.男性不育患者精浆NO水平及其与抗精子抗体的关系.生殖与避孕2001;21(5):304-306
11陈荣安,房秉仁,欧阳贵,等.不同病因无精子症的生殖激素水平.生殖与避孕2002;22(2):111-113
12 Madani AH,Falahatkar S,Heidarzadeh A,et al.Sensitivity and specificity of serum FSH and testis size in predicting the existence of spermatogenesis in azoospermic in fertile men.Andrologia 2012;44(3):205-209
13 Yang Q,Huang YP,Wang HX,et al.Folicle-stimulating hormone as a predictor for sperm retrieval rate in patients with nonobstructive azoospermia:a systematic review and meta-analysis.Asian J Androl 2015;17(2):281-284
14赵骥腾,岳长久,陈佳.无精子症患者睾丸穿刺活检与血清LH、FSH水平的相关性.中华内分泌外科杂志2016;10(1):67-70