无精子症患者睾丸活检定性定量评价体系的建立
发布时间：2018-12-30 10:48
【摘要】：研究背景及目的睾丸活检组织学评价可以反映精子发生的状态,为无精子症男性的医疗干预提供依据。然而,由于组织学诊断名称含糊不清,定性与定量标准不明,降低了睾丸活检的诊断价值。为了提高睾丸活检的诊断和预测预后价值,我们建立了一个统一的、全面的报告系统,定性和定量评价睾丸活检组织。我们重新评价无精子症患者睾丸活检组织,探讨这个评价系统的临床应用性和可行性。研究资料及方法重新分析2008年1月至2015年12月在南方医院生殖中心就诊的828例无精子症患者的睾丸活检组织病理学特点。其中226例患者行睾丸切开取精术(TESE)提取精子。观察分析生精小管和间质组织的改变,包括生精小管总数、生精小管直径、成熟精子数、增厚的基底膜、间质细胞等。睾丸活检的组织病理学分类根据我们提供的评价方法分为10种类型:正常睾丸组织表现、精子发生正常、精子发生低下、精子成熟障碍、唯支持细胞综合征、精子发生阻滞、混合型、青春期前睾丸组织、生精小管透明变性、其他类型。所有患者进行了精液常规分析、染色体核型分析、内分泌激素分析(卵泡刺激素(FSH)、黄体生成素(LH)和睾酮(T))。染色体核型异常及年龄大于50岁的患者不纳入本研究。研究结果828例无精子症患者睾丸活检结果为:546例可发现成熟精子(65.9%);234例为精子发生正常(28.3%),305例为精子发生低下(36.8%),95例为精子成熟障碍(11.5%),142例为唯支持细胞综合征(17.1%),8例为精子发生阻滞(1.0%),27例为混合型(3.3%),10例为生精小管纤维硬化(1.2%),7例为其他类型(0.8%)。根据平均成熟精子数多少,把精子发生低下分为3亚型,其中170例为轻度(55.7%),89例为中度(29.2%),46例为重度(15.1%)。无精子症患者的组织学分析显示生精功能损伤不仅表现在生精上皮,还与生精小管直径、基底膜、间质细胞增生等方面有关。根据生精小管基底膜病变特点,分为正常、不完全纤维硬化、完全纤维硬化。根据最大簇的间质细胞数的多少,分为5等级。不同组织病理学类型患者的生精小管直径、生精小管完全纤维硬化的比例、间质细胞增生程度和血清FSH水平与LH水平具有统计学差异(p0.05)。不同等级间质细胞增生的FSH(p0.001)水平与LH水平(p0.001)有统计学差异。3种亚型精子发生低下患者的生精小管直径有统计学差异,血清FSH、LH、T水平无统计学差异。在226例行TESE的患者中,212例成功提取精子。精子发生正常(100%)和精子发生低下患者(100%)均能成功提取精子,仅有56.5%的精子成熟障碍患者能够成功提取精子。结论1.无精子症患者的睾丸组织病理学改变呈多样性。组织损伤程度与生精上皮、生精小管直径、生精小管纤维硬化程度、间质细胞增生程度有关。2.无精子症患者血清FSH、LH水平能在一定程度上反映精子发生损伤程度,包括生精上皮及间质细胞改变,但仅能作为一个参考指标。3.睾丸活检定性定量评价方法为病理医生提供了一个定义清晰的、准确的和全面的评价标准。4.我们建立的无精子症患者睾丸活检综合报告系统,能够更准确预测预后和指导临床治疗决策。
[Abstract]:The study background and the histological evaluation of the target testis biopsy can reflect the status of the spermatogenesis and provide the basis for the medical intervention of the male with azoospermia. However, because the histological diagnosis name is ambiguous, the qualitative and quantitative criteria are not clear, and the diagnostic value of the testis biopsy is reduced. In order to improve the diagnostic and prognostic value of testicular biopsy, we have established a unified, comprehensive reporting system to qualitatively and quantitatively evaluate the testicular biopsy. We re-evaluate the testicular biopsy of azoospermia patients and discuss the clinical application and feasibility of this evaluation system. The pathological features of the testicular biopsy in 828 azoospermia patients from January 2008 to December 2015 were re-analyzed by the data and methods. In 226 of the patients, the sperm was extracted from the testicular incision and sperm extraction (TSE). The changes of the small tube and the interstitial tissue were observed, including the total number of the small tube, the diameter of the small tube, the number of mature sperm, the thickened basement membrane, the interstitial cells and so on. The histological classification of the testis biopsy is divided into 10 types according to the evaluation method we provide: normal testis tissue performance, normal spermatogenesis, low spermatogenesis, mature sperm obstruction, only cell syndrome, spermatogenesis block, mixed type, prepubertal testis tissue, The spermatogenic small tube is transparent and denatured, and the other types. All patients underwent semen routine analysis, chromosomal karyotype analysis, endocrine hormone analysis (follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T)). Patients with abnormal karyotype and age greater than 50 years of age were not included in this study. The results of the study on the testicular biopsy of 828 azoospermia patients were as follows: the mature sperm (65. 9%) can be found in 546 cases; In the 234 cases, the spermatogenesis was normal (32.8%), and 305 cases were sperm maturation (31.8%), and 95 cases were sperm maturation disorder (11.5%), 142 cases were cell-only syndrome (1.7%), 8 cases were spermatogenesis block (1.0%), 27 cases were mixed (30.3%), 10 of the 10 living fine-tube fiber hardening (1. 2%), and 7 cases were other types (0.8%). According to the average mature sperm count, the oligospermia was divided into 3 subtypes, of which 170 were mild (55.7%), 89 were moderate (25.2%) and 46 were severe (15.1%). The histological analysis of azoospermia showed that the functional damage of the spermatogenic function was not only in the spermatogenic epithelium but also in the aspects of the diameter of the small tube, the basement membrane, the proliferation of the interstitial cells, and so on. According to the characteristics of the basal membrane of the small tube, it can be divided into normal, incomplete fiber hardening and complete fiber hardening. The number of interstitial cells according to the maximum cluster is divided into 5 grades. There was a statistical difference between the diameter of the small tube, the diameter of the small tube of the raw fine tube, the degree of interstitial cell proliferation and the level of the serum FSH and the LH level in the patients with different histopathological types (p0.05). There was a statistical difference between the level of FSH (p0.001) and the level of LH (p0.001) in the different grade of interstitial cell proliferation. There was no statistical difference in the diameter of the small tube of the 3 sub-type of spermatogenesis, and there was no statistical difference in the serum FSH, LH and T levels. Of the 226 patients with TSE, 212 successfully extracted the sperm. Spermatogenesis (100%) and oligospermia (100%) were successful in the extraction of the sperm, with only 55.6% of the sperm mature with the ability to successfully extract the sperm. Conclusion 1. The pathological changes of the testis in patients with azoospermia were varied. The degree of tissue injury was related to the diameter of the spermatogenic epithelium, the diameter of the small tube of the raw sperm, the degree of hardening of the microtube of the raw sperm, and the degree of the proliferation of the interstitial cells. The serum FSH and LH levels in the patients with azoospermia can reflect the degree of spermatogenesis in a certain extent, including the changes of the spermatogenic epithelium and the interstitial cells, but can only be used as a reference index. The method of qualitative and quantitative evaluation of testis biopsy provides a clear, accurate and comprehensive evaluation standard for pathological doctors. The testicular biopsy comprehensive reporting system for azoospermia patients can be used to predict the prognosis and to guide the decision-making of clinical treatment more accurately.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R698.2
[Abstract]:The study background and the histological evaluation of the target testis biopsy can reflect the status of the spermatogenesis and provide the basis for the medical intervention of the male with azoospermia. However, because the histological diagnosis name is ambiguous, the qualitative and quantitative criteria are not clear, and the diagnostic value of the testis biopsy is reduced. In order to improve the diagnostic and prognostic value of testicular biopsy, we have established a unified, comprehensive reporting system to qualitatively and quantitatively evaluate the testicular biopsy. We re-evaluate the testicular biopsy of azoospermia patients and discuss the clinical application and feasibility of this evaluation system. The pathological features of the testicular biopsy in 828 azoospermia patients from January 2008 to December 2015 were re-analyzed by the data and methods. In 226 of the patients, the sperm was extracted from the testicular incision and sperm extraction (TSE). The changes of the small tube and the interstitial tissue were observed, including the total number of the small tube, the diameter of the small tube, the number of mature sperm, the thickened basement membrane, the interstitial cells and so on. The histological classification of the testis biopsy is divided into 10 types according to the evaluation method we provide: normal testis tissue performance, normal spermatogenesis, low spermatogenesis, mature sperm obstruction, only cell syndrome, spermatogenesis block, mixed type, prepubertal testis tissue, The spermatogenic small tube is transparent and denatured, and the other types. All patients underwent semen routine analysis, chromosomal karyotype analysis, endocrine hormone analysis (follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T)). Patients with abnormal karyotype and age greater than 50 years of age were not included in this study. The results of the study on the testicular biopsy of 828 azoospermia patients were as follows: the mature sperm (65. 9%) can be found in 546 cases; In the 234 cases, the spermatogenesis was normal (32.8%), and 305 cases were sperm maturation (31.8%), and 95 cases were sperm maturation disorder (11.5%), 142 cases were cell-only syndrome (1.7%), 8 cases were spermatogenesis block (1.0%), 27 cases were mixed (30.3%), 10 of the 10 living fine-tube fiber hardening (1. 2%), and 7 cases were other types (0.8%). According to the average mature sperm count, the oligospermia was divided into 3 subtypes, of which 170 were mild (55.7%), 89 were moderate (25.2%) and 46 were severe (15.1%). The histological analysis of azoospermia showed that the functional damage of the spermatogenic function was not only in the spermatogenic epithelium but also in the aspects of the diameter of the small tube, the basement membrane, the proliferation of the interstitial cells, and so on. According to the characteristics of the basal membrane of the small tube, it can be divided into normal, incomplete fiber hardening and complete fiber hardening. The number of interstitial cells according to the maximum cluster is divided into 5 grades. There was a statistical difference between the diameter of the small tube, the diameter of the small tube of the raw fine tube, the degree of interstitial cell proliferation and the level of the serum FSH and the LH level in the patients with different histopathological types (p0.05). There was a statistical difference between the level of FSH (p0.001) and the level of LH (p0.001) in the different grade of interstitial cell proliferation. There was no statistical difference in the diameter of the small tube of the 3 sub-type of spermatogenesis, and there was no statistical difference in the serum FSH, LH and T levels. Of the 226 patients with TSE, 212 successfully extracted the sperm. Spermatogenesis (100%) and oligospermia (100%) were successful in the extraction of the sperm, with only 55.6% of the sperm mature with the ability to successfully extract the sperm. Conclusion 1. The pathological changes of the testis in patients with azoospermia were varied. The degree of tissue injury was related to the diameter of the spermatogenic epithelium, the diameter of the small tube of the raw sperm, the degree of hardening of the microtube of the raw sperm, and the degree of the proliferation of the interstitial cells. The serum FSH and LH levels in the patients with azoospermia can reflect the degree of spermatogenesis in a certain extent, including the changes of the spermatogenic epithelium and the interstitial cells, but can only be used as a reference index. The method of qualitative and quantitative evaluation of testis biopsy provides a clear, accurate and comprehensive evaluation standard for pathological doctors. The testicular biopsy comprehensive reporting system for azoospermia patients can be used to predict the prognosis and to guide the decision-making of clinical treatment more accurately.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R698.2
【参考文献】
相关期刊论文 前2条
1 Taylor C Peak;Nora M Haney;William Wang;Kenneth J DeLay;Wayne J Hellstrom;;Stem cell therapy for the treatment of Leydig cell dysfunction in primary hypogonadism[J];World Journal of Stem Cells;2016年10期
2 刘兴章;唐运革;刘晃;唐立新;文任N，
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