生物学或临床参数能否预测47，XXY克氏综合征患者的睾丸精子恢复情况？

Can biological or clinical parameters predict testicular sperm recovery in 47,XXY Klinefelter's syndrome patients?

作者信息

Vernaeve V, Staessen C, Verheyen G, Van Steirteghem A, Devroey P, Tournaye H

机构信息

Centre For Reproductive Medicine, University Hospital, Dutch-speaking Brussels Free University (Vrije Universiteit Brussel), Laarbeeklaan 101, B-1090, Belgium.

出版信息

Hum Reprod. 2004 May;19(5):1135-9. doi: 10.1093/humrep/deh253. Epub 2004 Apr 7.

DOI:10.1093/humrep/deh253

PMID:15070870

Abstract

BACKGROUND

Contradictory results are available regarding prediction of testicular sperm extraction in 47,XXY patients. This study, therefore, aimed at assessing the availability of testicular sperm and evaluates clinical parameters predicting successful sperm retrieval in azoospermic 47,XXY Klinefelter's syndrome patients.

METHODS

Sperm recovery procedures were performed in 50 non-mosaic azoospermic Klinefelter patients. The facial hair pattern and the presence of gynaecomastia in men with successful and unsuccessful sperm recovery were compared using Fisher's exact test. The predictive value of clinical parameters such as age, testicular volume, FSH, FSH:LH ratio, testosterone and androgen sensitivity index (LH x testosterone) for successful testicular sperm retrieval was evaluated using the receiver operating characteristics (ROC) curve analysis.

RESULTS

In 24 patients (48%) testicular sperm were recovered. Ninety-four per cent of the men in whom sperm was found had a normal facial hair pattern compared to 93% in whom no sperm was recovered (not significant, NS). Seventeen percent of the men with successful testicular sperm extraction had gynaecomastia compared to 31% of the men with failed testicular sperm extraction (NS). The mean testicular volume of the largest testis in patients with sperm found was 4.2 ml compared to 3.6 ml in patients with no sperm found (NS). The mean FSH and testosterone values in patients with sperm recovered were 31.2 IU/l and 3.1 ng/ml versus 40.4 IU/l (P = 0.04) and 3.2 ng/ml (NS) in patients without sperm recovered. All examined clinical and biological parameters failed to predict the outcome of the testicular sperm extraction using ROC curve analysis.

CONCLUSION

As in the general population of men with non-obstructive azoospermia, there are currently no clinical parameters predicting successful sperm retrieval in the subpopulation of patients with non-mosaic Klinefelter syndrome.

摘要

背景

关于47,XXY患者睾丸精子提取的预测结果相互矛盾。因此，本研究旨在评估睾丸精子的可用性，并评估预测无精子症47,XXY克氏综合征患者成功获取精子的临床参数。

方法

对50例非嵌合型无精子症克氏综合征患者进行精子回收程序。使用Fisher精确检验比较精子回收成功和失败的男性的面部毛发模式和男性乳房发育情况。使用受试者工作特征（ROC）曲线分析评估年龄、睾丸体积、卵泡刺激素（FSH）、FSH:LH比值、睾酮和雄激素敏感性指数（LH×睾酮）等临床参数对成功睾丸精子提取的预测价值。

结果

24例患者（48%）回收了睾丸精子。找到精子的男性中有94%面部毛发模式正常，而未回收精子的男性中这一比例为93%（无显著性差异，NS）。睾丸精子提取成功的男性中有17%患有男性乳房发育，而睾丸精子提取失败的男性中这一比例为31%（无显著性差异）。找到精子的患者中最大睾丸的平均体积为4.2毫升，未找到精子的患者中为3.6毫升（无显著性差异）。回收精子的患者的平均FSH和睾酮值分别为31.2 IU/l和3.1 ng/ml，而未回收精子的患者中分别为40.4 IU/l（P = 0.04）和3.2 ng/ml（无显著性差异）。使用ROC曲线分析，所有检查的临床和生物学参数均未能预测睾丸精子提取的结果。