本文選題：無精子癥　切入點：臨床特征　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析比較梗阻性無精子癥(OA)和非梗阻性無精子癥(NOA)臨床指標(biāo)的差異。探討顯微外科手術(shù)治療OA的效果。研究無精子癥患者精液微生態(tài)的菌群特征,并探究與健康人群之間的差異。方法:納入2015年7月至2017年2月期間在浙江大學(xué)附屬第一醫(yī)院、杭州仁育醫(yī)院泌尿外科和男科就診的無精子癥患者60例。行附睪或睪丸活檢,根據(jù)活檢結(jié)果將60例無精子癥患者分為OA(A組,N=30)和NOA(B組,N=30)兩大類。完善相關(guān)臨床檢查,比較兩組臨床指標(biāo)的差異。30例OA患者,其中20例行顯微外科手術(shù)治療,術(shù)后定期復(fù)查精液常規(guī),隨訪精道再通率及配偶孕育情況共1—20個月。60例無精子癥患者,其中27例采集了精液樣品,另外留取24例精液參數(shù)正常的健康志愿者的精液樣品,通過DNA提取、PCR擴(kuò)增及測序等實驗方法,對27例無精子癥患者及24例健康志愿者精液的微生態(tài)菌群結(jié)構(gòu)特征進(jìn)行詳盡的分析,比較兩者精液微生態(tài)的菌群結(jié)構(gòu)差異。結(jié)果:兩組無精子癥患者病因各不相同。A組左側(cè)和右側(cè)睪丸容積均顯著大于B組(P0.01)。A組FSH、LH水平均顯著小于B組(P0.01),而睪酮水平則顯著大于B組(P0.01)。A組精漿果糖、中性α-葡糖甘酶水平均顯著小于B組(P0.01)。雙側(cè)輸精管-附睪吻合、單側(cè)輸精管-附睪吻合、雙側(cè)輸精管-輸精管吻合、單側(cè)輸精管-輸精管吻合術(shù)后精道再通率分別為46.2%(6/13)、0%(0/1)、100%(2/2)、0%(0/1)。雙側(cè)輸精管-附睪吻合術(shù)后精子濃度平均為25.6±22.8百萬/ml,精子活率平均為12.9%±16.1%,精子活力(PR級)平均為8.1%±13.7%。無精子癥患者精液具有獨特的微生態(tài)菌群結(jié)構(gòu),其多樣性降低。與健康人群相比,無精子癥患者精液中存在一些關(guān)鍵功能菌可以作為生物標(biāo)志物。結(jié)論:引起OA和NOA的病因各不相同。OA患者的睪丸容積大于NOA患者。OA患者的FSH、LH、睪酮、PRL水平均正常,而NOA患者分為高促性腺激素性功能減退癥和低促性腺激素性功能減退癥兩大類,前者FSH、LH水平升高,后者FSH、LH水平下降,兩者睪酮水平均有不同程度下降。顯微外科手術(shù)可以有效治療輸精管梗阻和附睪梗阻,且雙側(cè)吻合相比于單側(cè)吻合來說,術(shù)后精道再通的幾率可能更大。人類精液中存在特定的微生物菌群。與健康人群相比,無精子癥患者精液的微生態(tài)菌群多樣性降低,而且其中存在一些關(guān)鍵功能菌可能可以作為無精子癥的生物標(biāo)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 偽 -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% 鹵13.7. the average sperm concentration was 25.6 鹵22.8 million / ml, the average sperm motility was 12.9% 鹵16.1m / ml, and the average sperm motility was 8.1% 鹵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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R698.2
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本文編號：1637549