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伴有精索静脉曲张的非梗阻性无精子症患者行显微精索静脉结扎术后精子恢复的预测因素

山大生殖许超医生2018-08-13 15:01:14

J Urol. 2017 Feb;197(2):485-490. doi: 10.1016/j.juro.2016.08.085. Epub 2016 Aug18.

Predictive Factors for Sperm Recovery after Varicocelectomy in Men with Nonobstructive Azoospermia.

ShiraishiK, Oka S, Matsuyama H.

 

摘要

 

研究目的

本文探讨睾丸组织病理对预测非梗阻性无精子症患者行显微精索静脉结扎成效的作用。我们采用新一代测序仪比较精索静脉曲张术有效及无效的睾丸转录物,以明确可以预测精液中出现精子的各种因素。

研究方法

共有83位患有左侧精索静脉曲张的无精子症患者在行显微精索静脉结扎术的同时进行睾丸活检手术。分析转录组的结果。对来源于精子成熟阻滞男性的组织样本进行增殖细胞核抗原的免疫组化分析。通过患者年龄、睾丸体积、精索静脉曲张分级、FSH水平及睾丸组织学结果对精子恢复情况进行评估。

研究结果

患者平均年龄为34岁,FSH平均为12.3IU/l。有20例患者在精索静脉曲张手术后的12个月内出现精子恢复,43例唯支持细胞质综合征患者中1例恢复、27例精子成熟障碍10例恢复、13例生精功能下降9例恢复。在发生精子成熟障碍的男性精液中,本研究比较了有精子及无精子组患者的23003个基因,发现在精子恢复的男性中一些细胞周期相关基因发生上调,而一些抗氧化基因发生下调。在10例精索静脉曲张手术反应良好的患者,其增殖细胞核抗原的表达显著高于17例反应较差的患者。

研究结论

对于精子成熟障碍的转录组分析显示,细胞周期调控基因转录组的差异表现在对精索静脉曲张手术反应的不同。细胞周期评估可以预测精子恢复情况,并可以提高我们对精索静脉曲张病理生理的认识。

 

 

一句话总结:对伴有精索静脉曲张的无精子症患者,细胞周期调控基因及抗氧化基因也许可以作为精索静脉曲张手术后精子恢复情况的预测指标。

 

 

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PURPOSE:

The ability of testicular histopathology to predict the success of microsurgical varicocelectomy in patients with nonobstructive azoospermia was investigated. We used a next generation sequencer to compare the transcriptomes of varicocelectomy responsive and nonresponsive testes to identify the factors that predict sperm in the ejaculate.

MATERIALS AND METHODS:

A total of 83 men with nonobstructive azoospermia and left varicocele underwent microsurgical varicocelectomy with simultaneous testicular biopsy. Transcriptome results using the Illumina® platform were expressed as the number of fragments per kb. Immunohistochemistry for proliferating cell nuclear antigen was performed on tissue samples from men with maturation arrest. Sperm recovery was evaluated with respect to patient age, testicular volume, varicocele grade, follicle-stimulating hormone level and testicular histology.

RESULTS:

Mean age was 34 years and the mean follicle-stimulating hormone level was 12.3 IU/l. Sperm recovery was confirmed in 20 patients (24%) within 12 months after varicocelectomy, including 1 of 43 (2%) with Sertoli cell only, 10 of 27 (37%) with maturation arrest and 9 of 13 (69%) with hypospermatogenesis. Comparisons of 23,003 genes between the groups with and without sperm in the ejaculate of men with maturation arrest revealed a numberof cell cycle related genes that were up-regulated and several antioxidant genes that were down-regulated in men with sperm recovery. Proliferating cell nuclear antigen expression was significantly higher in the 10 varicocelectomy responsive men than in the 17 nonresponsive men.

CONCLUSIONS:

Transcriptome analysis of patients with maturation arrest revealed a distinct difference in the transcription of cell cycle regulation genes between varicocelectomy responsive and nonresponsive patients. Cell cycle assessment can predict sperm  recovery and could improve our understanding of varicocele pathophysiology.

 


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