原发性不育男性的睾丸细胞学模式：海湾战争以来有任何变化吗？

Patterns of testicular cytology in men with primary infertility: any change since the Gulf War?

作者信息

Haddad Fares H, Omari Ahmad A, Malkawi Omar M, Ajour Wijdan K, Izat Alia, Khasrof Hana, Khawaldeh Abdel Karim

机构信息

Endocrine Division, Department of Medicine, King Hussein Medical Center, Amman, Jordan.

出版信息

Acta Cytol. 2004 Nov-Dec;48(6):807-12. doi: 10.1159/000326450.

DOI:10.1159/000326450

PMID:15581166

Abstract

OBJECTIVE

To evaluate the patterns of testicular cytology in men with primary infertility, to compare the morphologic patterns between the periods 1990-1995, immediately after Gulf War II, and 1997-2001 and to determine whether there is a correlation between hormonal profile, testicular volume and morphologic pattern.

STUDY DESIGN

Retrospective study of men with primary infertility. History, complete physical examination, hormonal assay and testicular ultrasound were evaluated. A total of 545 patients had samples for testicular cytology obtained from both testes. The patient's consent was obtained in all cases. Smears were interpreted under light microscopy after treatment with Diff-Quik. A total of 104 healthy, fertile subjects were used for comparison of the hormonal profile and testicular volume.

RESULTS

The mean (+/- SD) age was 28.66 +/- 4.36 years and duration of marriage 4.4 +/- 4.36 years. There were 11.2% patients with normal cytology, 55.8% with hypospermatogenesis, 28.4% with testicular atrophy, 2.9% with Sertoli cells only and 1.7% with maturation arrest. A significant increase in hypospermatogenesis and decrease in the Sertoli cell-only pattern were noted in 1997-2001 when compared with 1990-1995. The mean left testicular volume was 10.53 +/- 5.51 mL3 in the infertile group vs. 15.2 +/- 4.97 in the fertile group (p < 0.003); right testicular volume was 10.84 +/- 4.77 vs. 15.15 +/- 5.31 (p < 0.003). The hormonal profile revealed higher luteinizing hormone and follicle-stimulating hormone levels in the infertile group vs. control group (8.53 +/- 9.03 and 16.44 +/- 19.243 vs. 6.98 +/- 4.53 and 7.37 +/- 6.63, respectively [p < 0.001]). Free testosterone was higher in the fertile group (39.69 +/- 12.76 vs. 20.28 +/- 8.5 [p < 0.000]).

CONCLUSION

The majority of infertile males in our cohort had hypospermatogenesis; testicular atrophy was the next most common disorder. There was no major change in overall absolute numbers since the Gulf War. Testicular cytology by fine needle aspiration is a safe and well-tolerated complementary investigation for unexplained male infertility.

摘要

目的

评估原发性不育男性的睾丸细胞学模式，比较1990 - 1995年（海湾战争II刚结束后）和1997 - 2001年期间的形态学模式，并确定激素水平、睾丸体积与形态学模式之间是否存在相关性。

研究设计

对原发性不育男性进行回顾性研究。评估病史、全面体格检查、激素测定和睾丸超声检查。共有545例患者从双侧睾丸获取了睾丸细胞学样本。所有病例均获得了患者的同意。涂片经Diff - Quik处理后在光学显微镜下进行解读。共有104名健康、有生育能力的受试者用于激素水平和睾丸体积的比较。

结果

平均（±标准差）年龄为28.66±4.36岁，婚姻持续时间为4.4±4.36年。细胞学正常的患者占11.2%，精子发生减少的患者占55.8%，睾丸萎缩的患者占28.4%，仅有支持细胞的患者占2.9%，成熟停滞的患者占1.7%。与1990 - 1995年相比，1997 - 2001年精子发生减少的情况显著增加，仅有支持细胞模式的情况减少。不育组左侧睾丸平均体积为10.53±5.51 mL³，而生育组为15.2±4.97 mL³（p < 0.003）；右侧睾丸体积分别为10.84±4.77 mL³和15.15±5.31 mL³（p < 0.003）。激素水平显示，不育组促黄体生成素和促卵泡生成素水平高于对照组（分别为8.53±9.03和16.44±19.243，而对照组为6.98±4.53和7.37±6.63 [p < 0.001]）。生育组游离睾酮水平更高（39.69±12.76 vs. 20.28±8.5 [p < 0.000]）。