无精子症的临床及微生态研究

发布时间：2018-03-20 04:34

  本文选题：无精子症　切入点：临床特征　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析比较梗阻性无精子症(OA)和非梗阻性无精子症(NOA)临床指标的差异。探讨显微外科手术治疗OA的效果。研究无精子症患者精液微生态的菌群特征,并探究与健康人群之间的差异。方法:纳入2015年7月至2017年2月期间在浙江大学附属第一医院、杭州仁育医院泌尿外科和男科就诊的无精子症患者60例。行附睾或睾丸活检,根据活检结果将60例无精子症患者分为OA(A组,N=30)和NOA(B组,N=30)两大类。完善相关临床检查,比较两组临床指标的差异。30例OA患者,其中20例行显微外科手术治疗,术后定期复查精液常规,随访精道再通率及配偶孕育情况共1—20个月。60例无精子症患者,其中27例采集了精液样品,另外留取24例精液参数正常的健康志愿者的精液样品,通过DNA提取、PCR扩增及测序等实验方法,对27例无精子症患者及24例健康志愿者精液的微生态菌群结构特征进行详尽的分析,比较两者精液微生态的菌群结构差异。结果:两组无精子症患者病因各不相同。A组左侧和右侧睾丸容积均显著大于B组(P0.01)。A组FSH、LH水平均显著小于B组(P0.01),而睾酮水平则显著大于B组(P0.01)。A组精浆果糖、中性α-葡糖甘酶水平均显著小于B组(P0.01)。双侧输精管-附睾吻合、单侧输精管-附睾吻合、双侧输精管-输精管吻合、单侧输精管-输精管吻合术后精道再通率分别为46.2%(6/13)、0%(0/1)、100%(2/2)、0%(0/1)。双侧输精管-附睾吻合术后精子浓度平均为25.6±22.8百万/ml,精子活率平均为12.9%±16.1%,精子活力(PR级)平均为8.1%±13.7%。无精子症患者精液具有独特的微生态菌群结构,其多样性降低。与健康人群相比,无精子症患者精液中存在一些关键功能菌可以作为生物标志物。结论:引起OA和NOA的病因各不相同。OA患者的睾丸容积大于NOA患者。OA患者的FSH、LH、睾酮、PRL水平均正常,而NOA患者分为高促性腺激素性功能减退症和低促性腺激素性功能减退症两大类,前者FSH、LH水平升高,后者FSH、LH水平下降,两者睾酮水平均有不同程度下降。显微外科手术可以有效治疗输精管梗阻和附睾梗阻,且双侧吻合相比于单侧吻合来说,术后精道再通的几率可能更大。人类精液中存在特定的微生物菌群。与健康人群相比,无精子症患者精液的微生态菌群多样性降低,而且其中存在一些关键功能菌可能可以作为无精子症的生物标志物。
[Abstract]:Objective: to compare the clinical indexes of obstructive azoospermia (OAA) and non-obstructive azoospermia (NOAA), to explore the effect of microsurgery on OA, and to study the microecological characteristics of semen microecology in patients with azoospermia. Methods: from July 2015 to February 2017, 60 patients with azoospermia were enrolled in the first affiliated Hospital of Zhejiang University, Department of Urology and Department of andrology, Hangzhou Renyu Hospital, and underwent epididymal or testicular biopsy. According to the results of biopsy, 60 patients with azoospermia were divided into two groups: OA(A group (n = 30) and NOA(B group (n = 30). The semen routine was reviewed regularly after operation. The rate of spermatozoa recanalization and spousal gestation were followed up for 1-20 months. Among them, 27 semen samples were collected, and 24 healthy volunteers with normal semen parameters were collected. The microecological microflora structure of semen of 27 patients with azoospermia and 24 healthy volunteers was analyzed by DNA extraction PCR amplification and sequencing. Results: the causes of azoospermia were different between the two groups. The left and right testicular volume in group A was significantly larger than that in group B (P 0.01). The level of FSHLH in group A was significantly lower than that in group B (P 0. 01), while testosterone in group A was significantly lower than that in group B (P 0. 01). Fructose in seminal plasma of group B was significantly higher than that of group B (P 0.01). The level of neutral 伪 -glucosaminidase was significantly lower than that in group B (P 0.01). Bilateral vasovasal-epididymal anastomosis, unilateral vasovasal-epididymal anastomosis, bilateral vasectomy and vasovasal anastomosis were observed. The rate of recanalization of spermatozoa after unilateral vasostomy was 46.20.The average sperm concentration in patients with azoospermia was 8.1% 卤13.7. the average sperm concentration was 25.6 卤22.8 million / ml, the average sperm motility was 12.9% 卤16.1m / ml, and the average sperm motility was 8.1% 卤13.7in azoospermic patients. Semen has a unique microecological microflora structure. Its diversity is lower. Compared with healthy people, Conclusion: the testicular volume of patients with OA and NOA is larger than that of patients with NOA. The patients with NOA were divided into two groups: hypergonadotropin hypogonadism and hypogonadotropin hypogonadism. Microsurgery can effectively treat obstruction of the vas deferens and epididymis, and bilateral anastomosis is more effective than unilateral anastomosis. The possibility of recanalization of spermatozoa may be higher after operation. There is a specific microflora in human semen. The microecological microflora diversity of semen of azoospermia patients is lower than that of healthy people. Moreover, some key functional bacteria may be used as biomarkers of azoospermia.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R698.2
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本文编号：1637549