Bozhedomov V A, Teodorovich O V
Urologiia. 2005 Jan-Feb(1):35-44.
To study epidemiology and etiopathogenesis of male autoimmune infertility, we examined ejaculate samples from 3660 males of reproductive age, clinico-laboratory data on 560 males from infertile couples with antispermal antibodies (ASAB), 647 males without ASAB and 40 fertile males. Ejaculate was tested according to WHO recommendations, ASAB were identified by mixed agglutination reaction (MAR) and flow cytofluorometry (FCFM), infections of the reproductive tract (IRT)--by polymerase chain reaction (PCR). Experiments were made on 136 white non-inbred mature male rats and 40 mature female rats: 1/3 of the only testis was removed in male rats, then morphology of the operated on testis was studied as well as real fertility. ASAB were detected in 18% males of reproductive age. Factors of risk of antispermal immunity are the following: IRT (52%), varicocele (35%), blunt scrotal injuries without orchitis (21%) and previous epididymoorchitis (6%), obstruction (3%), cryptorchism and anejaculation (1%). Absolute risk of immune infertility makes up 67% after orchitis and epididymoorchitis, 66% after blunt scrotal injuries without clinical orchitis, 39-43% in clinical and previously operated varicocele, 32% after IRT. Combination of the risk factors raises immune infertility probability 1.2-4.1 fold. The efficacy of antibiotic therapy for bacterial IRT in ASAB is described. It is shown than it is possible to preserve spermatogenesis after testicular trauma by stimulation of its regeneration. Immunological mechanisms of male autoimmune infertility are analysed. Thus, main causes of male autoimmune infertility are mechanical, infectious or other affection of the testis leading to impairment of hematotesticular barrier, varicocele increases the risk of autoimmune reactions and orchitis after traumas; cross-over interaction between antigenic determinants of sperm and IRT; obstruction of the ejaculatory tract; specific features of antiinfectious immunity.
为研究男性自身免疫性不育的流行病学和病因发病机制，我们检测了3660名育龄男性的精液样本、560名患有抗精子抗体（ASAB）的不育夫妇男性、647名无ASAB的男性以及40名有生育能力男性的临床实验室数据。精液按照世界卫生组织的建议进行检测，ASAB通过混合凝集反应（MAR）和流式细胞荧光术（FCFM）鉴定，生殖道感染（IRT）通过聚合酶链反应（PCR）检测。对136只白色非近交成熟雄性大鼠和40只成熟雌性大鼠进行了实验：切除雄性大鼠唯一睾丸的1/3，然后研究手术睾丸的形态以及实际生育能力。在18%的育龄男性中检测到ASAB。抗精子免疫的危险因素如下：IRT（52%）、精索静脉曲张（35%）、无睾丸炎的阴囊钝性损伤（21%）和既往附睾炎（6%）、梗阻（3%）、隐睾和无射精（1%）。睾丸炎和附睾炎后免疫性不育的绝对风险为６７％，无临床睾丸炎的阴囊钝性损伤后为66%，临床和既往手术治疗的精索静脉曲张为39-43%，IRT后为32%。危险因素的组合使免疫性不育的概率提高1.2-4.1倍。描述了抗生素治疗ASAB中细菌性IRT的疗效。结果表明，通过刺激睾丸再生，睾丸创伤后有可能保留精子发生。分析了男性自身免疫性不育的免疫机制。因此，男性自身免疫性不育的主要原因是睾丸的机械性、感染性或其他影响导致血睾屏障受损，精索静脉曲张增加自身免疫反应的风险以及创伤后的睾丸炎；精子和IRT抗原决定簇之间的交叉相互作用；射精管梗阻；抗感染免疫的特异性特征。
