血清抑制素B对非梗阻性无精子症患者精子获取结果的预测价值

发布时间：2018-07-06 13:36

本文选题：非梗阻性无精子症 + 血清抑制素B　；参考：《山东大学》2017年硕士论文

【摘要】：一.研究目的:通过睾丸活检取精术(testicular sperm extraction,TESE)取得精子行卵泡浆内单精子注射(intracytoplasmic sperm injection,ICSI)使不育症患者,尤其是严重少精子症和无精子症患者拥有得到血亲后代的机会。TESE甚至可以在睾丸仅存在局灶性精子发生的情况下取得精子。然而,TESE在非梗阻性无精子症(non-obstructive azoospermia,NOA)患者中的成功率不足50%,这给患者及其家庭带来心理和经济上的双重压力,甚至患者的睾丸功能也有可能因TESE手术并发症(血肿、感染、睾丸组织纤维化、睾丸萎缩等)而进一步受损。因此,在行睾丸活检取精术前,一个用来预测精子是否存在的非侵入性指标是十分有必要的。血清抑制素B(serum inhibin B,INHB)和卵泡刺激素(follicle stimulating hormone,FSH)则是目前最有应用价值的两个指标。本研究中,我们通过检测NOA患者血清抑制素B与卵泡刺激素水平,来评估其单独或联合使用预测NOA患者睾丸精子发生存在的诊断准确率。二.研究方法:测定291例非梗阻性无精子症患者血清抑制素B、卵泡刺激素、黄体生成素及睾酮水平,并测量其睾丸体积(以单侧计算),睾丸活检取精术取得睾丸组织送检,以证实精子是否存在,并使用睾丸病理Johnsen评分法对精曲小管生精能力进行评价。依据血清卵泡刺激素水平和睾丸活检组织病理结果将患者进行分组,比较组间各项指标差异。采用受试者工作特征曲线比较不同指标单独或联合预测NOA患者睾丸精子发生存在的诊断准确率。三.研究结果:在291名NOA患者中,137人(47.08%)通过睾丸活检成功取到精子,血清INHB浓度在有精子组(TESE+)中均显著高于无精子组(TESE-)(P0.05)。在总体及FSH正常组,血清FSH浓度在TESE-组中均显著高于TESE+组(P0.05)。INHB水平随生精能力损伤程度加重而降低。受试者工作特征曲线(Receiver operating characteristic curve,ROC curve)分析显示,在FSH增高组中,INHB对睾丸活检结果的预测价值明显优于FSH(P0.05)。四.研究结论:血清INHB对睾丸活检结果的预测价值在血清FSH增高的患者中优于血清FSH;INHB是评价睾丸生精功能直接而有效的血清标志物,对于判定患者是否应接受睾丸组织检查具有重要的指导意义。由于受所用外科取精技术的限制,其价值高低仍需进一步探讨。
[Abstract]:I. Objective: to obtain spermatozoa by testicular biopsy (testicular sperm extraction) and intracytoplasmic sperm injection (intracytoplasmic sperm injection) for infertile patients. Especially the patients with severe oligozoospermia and azoospermia have the chance to get blood relatives. TESE can even obtain spermatozoa in the presence of only focal spermatogenesis in the testis. However, the success rate of Tese in patients with non-obstructive azoospermia (non-obstructive) is less than 50%, which brings psychological and economic stress to patients and their families, and even the testicular function of patients may be due to complications (hematoma, infection) of Tese surgery. Testicular fibrosis, testicular atrophy, etc.) and further damage. Therefore, it is necessary to predict the existence of spermatozoa by a noninvasive index before testicular biopsy. Serum inhibin B (serum inhibin and follicle stimulating hormone (follicle stimulating are the two most valuable markers. In this study, serum inhibin B and follicle stimulating hormone (FSH) levels were measured in patients with NOA to evaluate their diagnostic accuracy in predicting testicular spermatogenesis in patients with NOA alone or in combination. II. Methods: serum inhibin B, follicle stimulating hormone, luteinizing hormone and testosterone were measured in 291 patients with non-obstructive azoospermia, and testicular volume was measured. Testicular tissue was obtained by testicular biopsy. To confirm the existence of spermatozoa and to evaluate the spermatogenic ability of seminiferous tubules by testicular pathological Johnsen score. The patients were divided into groups according to serum follicle stimulating hormone level and testicular biopsy results. The diagnostic accuracy of testicular spermatogenesis in NOA patients was compared by using the operating characteristic curve. Three Results: 137 (47.08%) of 291 patients with NOA obtained sperm by testicular biopsy. The concentration of serum INHB in the spermatozoa group (TESE) was significantly higher than that in the azoospermic group (TESE-) (P0.05). In general and FSH normal group, serum FSH concentration in TESE- group was significantly higher than that in TESE group (P0.05) .INHB level decreased with the severity of spermatogenic ability injury. The analysis of receiver operating characteristic curve (ROC curve) showed that the predictive value of operating characteristic in testicular biopsy was significantly better than that of FSH (P0.05). four Conclusion: the predictive value of serum INHB in testicular biopsy is better than that in serum FSH in patients with testicular biopsy. It is a direct and effective serum marker for evaluating testicular spermatogenic function. It is of great significance to determine whether the patient should undergo testicular tissue examination. Due to the limitation of surgical sperm extraction, its value should be further discussed.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R698.2

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