無精子癥患者睪丸活檢定性定量評(píng)價(jià)體系的建立
發(fā)布時(shí)間：2018-12-30 10:48
【摘要】：研究背景及目的睪丸活檢組織學(xué)評(píng)價(jià)可以反映精子發(fā)生的狀態(tài),為無精子癥男性的醫(yī)療干預(yù)提供依據(jù)。然而,由于組織學(xué)診斷名稱含糊不清,定性與定量標(biāo)準(zhǔn)不明,降低了睪丸活檢的診斷價(jià)值。為了提高睪丸活檢的診斷和預(yù)測(cè)預(yù)后價(jià)值,我們建立了一個(gè)統(tǒng)一的、全面的報(bào)告系統(tǒng),定性和定量評(píng)價(jià)睪丸活檢組織。我們重新評(píng)價(jià)無精子癥患者睪丸活檢組織,探討這個(gè)評(píng)價(jià)系統(tǒng)的臨床應(yīng)用性和可行性。研究資料及方法重新分析2008年1月至2015年12月在南方醫(yī)院生殖中心就診的828例無精子癥患者的睪丸活檢組織病理學(xué)特點(diǎn)。其中226例患者行睪丸切開取精術(shù)(TESE)提取精子。觀察分析生精小管和間質(zhì)組織的改變,包括生精小管總數(shù)、生精小管直徑、成熟精子數(shù)、增厚的基底膜、間質(zhì)細(xì)胞等。睪丸活檢的組織病理學(xué)分類根據(jù)我們提供的評(píng)價(jià)方法分為10種類型:正常睪丸組織表現(xiàn)、精子發(fā)生正常、精子發(fā)生低下、精子成熟障礙、唯支持細(xì)胞綜合征、精子發(fā)生阻滯、混合型、青春期前睪丸組織、生精小管透明變性、其他類型。所有患者進(jìn)行了精液常規(guī)分析、染色體核型分析、內(nèi)分泌激素分析(卵泡刺激素(FSH)、黃體生成素(LH)和睪酮(T))。染色體核型異常及年齡大于50歲的患者不納入本研究。研究結(jié)果828例無精子癥患者睪丸活檢結(jié)果為:546例可發(fā)現(xiàn)成熟精子(65.9%);234例為精子發(fā)生正常(28.3%),305例為精子發(fā)生低下(36.8%),95例為精子成熟障礙(11.5%),142例為唯支持細(xì)胞綜合征(17.1%),8例為精子發(fā)生阻滯(1.0%),27例為混合型(3.3%),10例為生精小管纖維硬化(1.2%),7例為其他類型(0.8%)。根據(jù)平均成熟精子數(shù)多少,把精子發(fā)生低下分為3亞型,其中170例為輕度(55.7%),89例為中度(29.2%),46例為重度(15.1%)。無精子癥患者的組織學(xué)分析顯示生精功能損傷不僅表現(xiàn)在生精上皮,還與生精小管直徑、基底膜、間質(zhì)細(xì)胞增生等方面有關(guān)。根據(jù)生精小管基底膜病變特點(diǎn),分為正常、不完全纖維硬化、完全纖維硬化。根據(jù)最大簇的間質(zhì)細(xì)胞數(shù)的多少,分為5等級(jí)。不同組織病理學(xué)類型患者的生精小管直徑、生精小管完全纖維硬化的比例、間質(zhì)細(xì)胞增生程度和血清FSH水平與LH水平具有統(tǒng)計(jì)學(xué)差異(p0.05)。不同等級(jí)間質(zhì)細(xì)胞增生的FSH(p0.001)水平與LH水平(p0.001)有統(tǒng)計(jì)學(xué)差異。3種亞型精子發(fā)生低下患者的生精小管直徑有統(tǒng)計(jì)學(xué)差異,血清FSH、LH、T水平無統(tǒng)計(jì)學(xué)差異。在226例行TESE的患者中,212例成功提取精子。精子發(fā)生正常(100%)和精子發(fā)生低下患者(100%)均能成功提取精子,僅有56.5%的精子成熟障礙患者能夠成功提取精子。結(jié)論1.無精子癥患者的睪丸組織病理學(xué)改變呈多樣性。組織損傷程度與生精上皮、生精小管直徑、生精小管纖維硬化程度、間質(zhì)細(xì)胞增生程度有關(guān)。2.無精子癥患者血清FSH、LH水平能在一定程度上反映精子發(fā)生損傷程度,包括生精上皮及間質(zhì)細(xì)胞改變,但僅能作為一個(gè)參考指標(biāo)。3.睪丸活檢定性定量評(píng)價(jià)方法為病理醫(yī)生提供了一個(gè)定義清晰的、準(zhǔn)確的和全面的評(píng)價(jià)標(biāo)準(zhǔn)。4.我們建立的無精子癥患者睪丸活檢綜合報(bào)告系統(tǒng),能夠更準(zhǔn)確預(yù)測(cè)預(yù)后和指導(dǎo)臨床治療決策。
[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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R698.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
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 劉興章;唐運(yùn)革;劉晃;唐立新;文任N，
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