血清生殖激素及抑制素B在无精子症诊治中的临床价值

引用本文

李玉山, 冯宗刚. 血清生殖激素及抑制素B在无精子症诊治中的临床价值. 25(3): 164-166
LI Yushan, FENG Zonggang. Clinical value of serum reproductive hormones and inhibin B levels in azoospermia. Labratory Medicine, 25(3): 164-166 复制到剪切板

Permissions

《检验医学》编辑部

血清生殖激素及抑制素B在无精子症诊治中的临床价值

李玉山¹, 冯宗刚²

1.郑州大学第三附属医院人类精子库,河南郑州 450052

2.郑州大学第二附属医院生殖中心,河南郑州 450014

作者简介：李玉山,男,1966年生,硕士,副教授,主要从事生殖免疫研究。

基金:河南省医学科技攻关项目(200903070)

摘要

目的

探讨血清促卵泡成熟激素(FSH)、黄体生成素(LH)及睾酮(T)等生殖激素水平对无精子症分型以及血清抑制素B(INHB)水平对非梗阻性无精子症患者睾丸精子存在与否的预测价值。

方法

采用化学发光免疫分析法测定45例非梗阻性无精子症、40例梗阻性无精子症及40名正常生育男性血清FSH、LH及T的浓度,以双抗体夹心酶联免疫吸附试验(ELISA)测定血清INHB水平。

结果

非梗阻性无精子症患者血清的FSH、T、T/LH比值、INHB与对照组相比,差异有统计学意义( P<0.05);而梗阻性无精子症患者和对照组相比,各项指标差异均无统计学意义( P>0.05)。非梗阻性无精子症患者中,睾丸精子抽吸(TESE)获得精子者血清INHB水平显著高于TESE无精子者( P<0.05)。

结论

FSH水平是预测睾丸生精功能的可靠标志,T/LH比值可以作为早期判断间质细胞功能状态的敏感指标,血清INHB对预测TESE结局有重要的指导意义。

关键词: 无精子症; 生殖激素; 抑制素B; 睾丸精子抽吸

中图分类号:R446.62 文献标志码:A 文章编号:1673-8640(2010)03-0164-03

Clinical value of serum reproductive hormones and inhibin B levels in azoospermia

LI Yushan¹, FENG Zonggang²

1. Human Sperm Bank, the Third Affiliated Hospital of Zhengzhou University, Henan Zhengzhou 450052, China

2. Reproductive Center, the Second Affiliated Hospital of Zhengzhou University, Henan Zhengzhou 450014,China

Abstract

Objective

To evaluate the influence of serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) levels to the type of azoospermia and the predictive value of inhibin B (INHB) level as an indicator of the presence of testicular spermatozoa in patients with nonobstructive azoospermia.

Methods

45 patients with nonobstructive azoospermia, 40 patients with obstructive azoospermia and 40 healthy subjects were involved in this study. Serum FSH, LH and T levels were measured by chemiluminescence immunoassay,and serum INHB was measured by sandwich enzyme-linked immunosorbent assay (ELISA).

Results

In 45 patients with nonobstructive azoospermia, the levels of FSH and LH were higher than those in control group ( P<0.05), but the levels of INHB, T and T/LH were lower than those in control group ( P< 0.05). There were no statistical significance between the levels of FSH, LH, T and INHB in patients with obstructive azoospermia and those in control group ( P>0.05). Serum INHB level was significantly higher in patients with nonobstructive azoospermia who had spermatozoa on testicular sperm extraction (TESE) than in those who had no spermatozoa on TESE ( P<0.05).

Conclusions

FSH level is a reliable marker for testicular spermatogenic function, and T/LH is an important sensitive index for the function of Leydig cells. Serum INHB level seems to be a prediction of the end-result of TESE.

Keyword: Azoospermia; Reproductive hormone; Inhibin B; Testicular sperm extraction

Show Figures

在男性不育症中, 无精子症约占男性不育门诊的10%^[1]。无精子症可分为梗阻性无精子症和非梗阻性无精子症。睾丸生精功能主要受下丘脑-垂体-睾丸轴调控, 任何因素引起的生殖激素的改变都会影响男性的生育能力^[2]。血清抑制素B(INHB)是由睾丸产生的糖蛋白激素, 被认为是男性精子发生的血清标志物^{[3, 4]} 。目前尚无有意义的标记确定非梗阻性无精子症患者睾丸中成熟精子存在与否。本研究采用化学发光免疫分析法测定梗阻性无精子症患者和非梗阻性无精子症患者及有正常生育史的男性血清促卵泡成熟激素(FSH)、黄体生成素(LH)及睾酮(T)的浓度, 采用双抗体夹心酶联免疫吸附试验(ELISA)测定血清INHB 水平, 并对非梗阻性无精子症患者进行睾丸精子抽吸(TESE), 旨在探讨血清性激素和INHB水平预测非梗阻性无精子症患者睾丸生精上皮包括精子存在的价值。

材料和方法

一、研究对象

选择郑州大学第三附属医院2006至2008年男科门诊就诊的无精子症患者85例, 年龄24~37岁, 平均年龄30岁, 其中梗阻性无精子症40例, 非梗阻性无精子症45例, 3次以上精液常规检查并行离心沉淀物镜检均未发现精子。所有研究对象婚龄2~13年, 为女方检查正常, 婚后同居2年以上, 未采取避孕措施而未使女方受孕者。经过严格筛选, 细胞遗传学分析染色体核型正常(46, XY), 并排除Y染色体微缺失等情况, 且未进行过内分泌治疗。对照组40名, 随机选取精液指标正常的健康男性自愿者, 年龄22~35岁, 平均年龄29岁, 依据世界卫生组织(WHO)1999精液分析标准, 各项参数正常。

二、激素的测定

所有观察对象均于上午8~10时在肘静脉取血样, 分离血清, 储存于-30 ℃冰箱待测。采用化学发光免疫分析法测定血清FSH、LH及T浓度(美国ACS:180SE), 试剂盒由西门子医疗诊断设备有限公司提供。

三、INHB的测定

用双抗体夹心ELISA测定血清INHB, 试剂盒购自英国Serotec公司。

四、统计学方法

采用SPSS 12.0统计软件进行单因素方差分析及相关性分析。

结果

一、激素水平测定结果

非梗阻性无精子症组血清FSH、LH水平较对照组显著升高, 差异有统计学意义(P< 0.05), T 及T/LH 比值降低, 差异有统计学意义(P< 0.05)。梗阻性无精症组血清FSH、LH及T水平较正常对照低, 但差异无统计学意义(P> 0.05)。见表1。

表1 血清生殖激素测定结果

二、血清INHB水平测定结果

对照组、梗阻性无精子症组、非梗阻性无精子症组血清INHB水平分别为(188.49± 69.68)、(202.66± 78.36)和(83.26± 58.74) ng/L。非梗阻性无精子症组与对照组比较, 血清INHB水平较低, 差异有统计学意义(P< 0.05), 梗阻性无精子症组血清INHB与正常对照组差异无统计学意义(P> 0.05)。

三、INHB对非梗阻性无精子症患者睾丸精子获取成功的诊断结果

对45例非梗阻性无精子症患者进行TESE, 其中19例获得精子, 26例没有获得精子, TESE成功与否和血清INHB的含量高度相关, TESE获得精子者血清INHB 水平显著高于TESE无精子者(P< 0.05), TESE获得精子组和TESE未获得精子组比较, 血清FSH、LH、T差异无统计学意义。见表2。

表2 INHB对非梗阻性无精子症患者睾丸精子获取成功的诊断结果

讨论

睾丸生精功能主要受下丘脑-垂体-睾丸轴调控。FSH主要作用于精子成熟的初始阶段, 促进次级精母细胞发育为精子细胞和精子, FSH受支持细胞分泌的抑制素的负反馈调节。LH 促进睾丸的间质细胞生长, 促进其合成和分泌T, 促进T扩散入曲细精管, 供精子生成所需 ^[2]。FSH升高提示睾丸生精功能障碍, 如同时伴有T、T/LH 比值明显降低, 说明睾丸间质细胞功能也受到损害^[4]。如睾丸体积小, 伴FSH明显升高, 且T/LH的比值明显降低, 提示睾丸间质细胞同时受到损害^{[5, 6]}。本研究中非梗阻性无精子症患者血清FSH、LH水平与对照组比较显著升高, T及T/LH比值降低, 差异有统计学意义; 梗阻性无精症组与正常对照组相比, 血清FSH、LH及T水平较低, 但差异无统计学意义, 与先前的报道相一致^[4~11]。提示FSH水平是预测睾丸生精功能的可靠标志, T/LH比值可以作为早期判断间质细胞功能状态的敏感指标。

近年来发现血清INHB与睾丸精子发生密切相关, 是非梗阻性无精子症患者在治疗时行TESE成功与否的一种有效的预测指标^[7~11]。有学者认为INHB水平反映了整个睾丸组织的功能, 在区分正常和受损的精子发生时, INHB的测定可能取代睾丸活检^[8]。本研究结果显示, 非梗阻性无精子症组与对照组比较, 血清INHB水平降低, TESE成功与否和血清INHB的含量高度相关, TESE获得精子者血清INHB水平显著高于TESE未获得精子者, 而FSH、LH、T水平无显著差异。这些结果与国内外一些学者的类似研究结果相似^[7~9], 提示INHB水平的检测对非梗阻性无精子症患者睾丸精子存在与否具有预测价值。

上述研究结果表明, 血清性激素测定是鉴别非梗阻性与梗阻性无精子症的重要指标, 非梗阻性无精子症患者行TESE前检测INHB水平, 可有效预测睾丸中精子的存在与否, 可提高TESE获得精子的成功率。

The authors have declared that no competing interests exist.

参考文献

View Option

[1]	Zopfgen A, Priem F, Sudhoff F, et al. Relationship between semen quality and the seminal plasma components carnitine, alpha-glucosidase, fructose, citrate and granulocyte elastase in infertile men compared with a normal population[J]. Hum Rep-rod, 2000, 15(4): 840-845. [本文引用:1]
[2]	刘锋, 邹彦, 邓志华, 等. 人类无精子症研究现状[J]. 广西医学, 2003, 25(3): 376-379. [本文引用:2]
[3]	Goulis DG, Polychronou P, Mikos T, et al. Serum inhibin-B and follicle stimulating hormone as predictors of the presence of sperm in testicular fine needle aspirate in men with azoospermia[J]. Hormones (Athens), 2008, 7(2): 140-147. [本文引用:1] [JCR: 2.013]
[4]	吕晓婷, 陈道桢. 抑制素B与男性不育[J]. 中国生育健康杂志, 2008, 19(5): 275-277. [本文引用:3]
[5]	熊文琴, 张文权. 无精子症患者生殖激素水平状况分析[J]. 实用医技杂志, 2007, 14(6): 685-687. [本文引用:1]
[6]	Kolettis PN, Sabanegh ES, D'amico AM, et al. Outcomes for vasectomy reversal performed after obstructive intervals of at least 10 years[J]. Urology, 2002, 60(5): 885-888. [本文引用:1] [JCR: 2.424]
[7]	Nowroozi MR, Radkhah K, Ayati M, et al. Serum inhibin B concentration as a prognostic factor for prediction of sperm retrieval in testis biopsy of patients with azoospermia[J]. Arch Iran Med, 2008, 11(1): 54-56. [本文引用:2] [JCR: 1.222]
[8]	刘运初, 蔡志明, 李贤新, 等. 血清抑制素B对非阻塞性无精子症睾丸精子存在的预测价值[J]. 中华男科学杂志, 2006, 12(5): 410-412. [本文引用:1]
[9]	Ziaee SA, Ezzatnegad M, Nowroozi M, et al. Prediction of successful sperm retrieval in patients with nonobstructive azoospermia[J]. Urol J, 2006, 3(2): 92-96. [本文引用:1] [JCR: 0.559]
[10]	Duvilla E, Lejeune H, Trombert-Paviot B, et al. Signi-ficance of inhibin B and anti-Müllerian hormone in seminal plasma: a preliminary study[J]. Fertil Steril, 2008, 89(2): 444-448. [本文引用:1] [JCR: 4.174]
[11]	Kumanov P, Nand ipati K, Tomova A, et al. Inhibin B is a better marker of spermatogenesis than other hormones in the evaluation of male factor infertility[J]. Fertil Steril, 2006, 86(2): 332-338. [本文引用:2] [JCR: 4.174]

2000

0.0

... 在男性不育症中,无精子症约占男性不育门诊的10%^[1] ...

2003

0.0

... 睾丸生精功能主要受下丘脑-垂体-睾丸轴调控,任何因素引起的生殖激素的改变都会影响男性的生育能力^[2] ...

... LH 促进睾丸的间质细胞生长,促进其合成和分泌T,促进T扩散入曲细精管,供精子生成所需 ^[2] ...

2008

2.013

0.0

... 血清抑制素B(INHB)是由睾丸产生的糖蛋白激素,被认为是男性精子发生的血清标志物^[3,4] ...

2008

0.0

... 血清抑制素B(INHB)是由睾丸产生的糖蛋白激素,被认为是男性精子发生的血清标志物^[3,4] ...

... FSH升高提示睾丸生精功能障碍,如同时伴有T、T/LH 比值明显降低,说明睾丸间质细胞功能也受到损害^[4] ...

... 梗阻性无精症组与正常对照组相比,血清FSH、LH及T水平较低,但差异无统计学意义,与先前的报道相一致^[4~11] ...

2007

0.0

... 如睾丸体积小,伴FSH明显升高,且T/LH的比值明显降低,提示睾丸间质细胞同时受到损害^[5,6] ...

2002

2.424

0.0

... 如睾丸体积小,伴FSH明显升高,且T/LH的比值明显降低,提示睾丸间质细胞同时受到损害^[5,6] ...

2008

1.222

0.0

... 近年来发现血清INHB与睾丸精子发生密切相关,是非梗阻性无精子症患者在治疗时行TESE成功与否的一种有效的预测指标^[7~11] ...

... 这些结果与国内外一些学者的类似研究结果相似^[7~9],提示INHB水平的检测对非梗阻性无精子症患者睾丸精子存在与否具有预测价值 ...

2006

0.0

... 有学者认为INHB水平反映了整个睾丸组织的功能,在区分正常和受损的精子发生时,INHB的测定可能取代睾丸活检^[8] ...

2006

0.559

0.0

... 这些结果与国内外一些学者的类似研究结果相似^[7~9],提示INHB水平的检测对非梗阻性无精子症患者睾丸精子存在与否具有预测价值 ...

2008

4.174

0.0

. 2008, 89(2):444-448 DOI:10.1016/j.fertnstert.2007.03.032

Signi-ficance of inhibin B and anti-M#cod#x000fc;llerian hormone in seminal plasma: a preliminary study

Objective To evaluate the predictive value of seminal inhibin B and anti-Müllerian hormone (AMH) on the outcome of testicular sperm extraction (TESE) in patients with nonobstructive azoospermia. Design Prospective study. Setting Reproductive biology department. Patient(s) Forty-seven normospermic, 28 oligozoospermic, and 68 azoospermic patients. Intervention(s) Testicular sperm extraction. Main Outcome Measure(s) Seminal inhibin B and AMH measure. Result(s) The seminal values of inhibin B and AMH are widely dispersed. Both inhibin B and AMH seminal values are significantly different between the three groups. The average rates of seminal AMH (not inhibin B) differ significantly according to the etiology of the azoospermia. Both seminal markers are correlated. A significant positive correlation could be observed between the seminal inhibin B and the sperm count, but not for AMH. A significant correlation also exists between seminal and serum inhibin B. The predictive value for TESE outcome of each parameter is rather low. Conversely, a logistic regression combining serum FSH, seminal inhibin B, and AMH produced a satisfying area under the curve of 0.985. Conclusion(s) Seminal inhibin B and AMH values are proposed. Separately, seminal markers are poor predictors of TESE outcome. A logistic regression model led to a satisfying area under the curve of 0.985.

2006

4.174

0.0

. 2006, 86(2):332-338 DOI:10.1016/j.fertnstert.2006.01.022

Inhibin B is a better marker of spermatogenesis than other hormones in the evaluation of male factor infertility

Objective To assess the role of inhibin B in the evaluation of male factor infertility. Design Prospective study. Setting Reproductive endocrinology clinic. Patient(s) Seventy-five patients with infertility problems (mean age 31.2 ± 7.5 years) and 12 controls (32.1 ± 8.8 years) with proven fertility. Intervention(s) None. Main Outcome Measure(s) Semen analysis was performed according to World Health Organization guidelines. Testicular volume was assessed with the Prader’s orchidometer. Serum levels of inhibin B (pg/mL), LH (mIU/mL), FSH (mIU/mL), prolactin (micro IU/mL), and testosterone (nmol/L) were assessed. Result(s) The mean ± SEM inhibin B and testosterone levels were significantly lower in the patients than in the controls (inhibin B: 116.4 ± 11.7 vs. 181.2 ± 20.9, P =.008; testosterone: 13.6 ± 0.9 vs. 25.1 ± 2.9, P =.008). In general, sperm count and testicular volume in the patients were significantly and positively correlated with inhibin B (sperm count: r = 0.476, P P =.0001; left: r = 0.53, P =.0001); the inhibin B-FSH index was negatively correlated with FSH. Inhibin B was more strongly correlated with testicular volume and semen parameters than FSH. Inhibin B in the patients was negatively correlated with FSH (r = −0.723, P =.0001) and LH (r = −0.52, P =.0001) and was positively correlated with testosterone (r = 0.4, P =.0013). Conclusion(s) Inhibin B measurement is a better marker of fertility status than FSH and LH. Concentration of inhibin B in patients with infertility may provide useful information on spermatogenesis and possibly serve as a more direct marker of spermatogenesis than FSH.

... 梗阻性无精症组与正常对照组相比,血清FSH、LH及T水平较低,但差异无统计学意义,与先前的报道相一致^[4~11] ...

... 近年来发现血清INHB与睾丸精子发生密切相关,是非梗阻性无精子症患者在治疗时行TESE成功与否的一种有效的预测指标^[7~11] ...