早期与晚期成熟阻滞：睾丸衰竭的生殖结局。
Early versus late maturation arrest: reproductive outcomes of testicular failure.
机构信息
Scott Department of Urology, Baylor College of Medicine, Baylor Clinic, Houston, TX 77030, USA.
出版信息
J Urol. 2011 Aug;186(2):621-6. doi: 10.1016/j.juro.2011.03.156.
PURPOSE
There is a paucity of data characterizing infertile men with maturation arrest. We hypothesized that men with early stage maturation arrest could be clinically distinguished from men with late maturation arrest and would have worse reproductive outcomes.
MATERIALS AND METHODS
We retrospectively reviewed the records of all patients with nonobstructive azoospermia and cryptozoospermia who underwent testis mapping and sperm extraction from 2002 to 2009 and for whom histopathological findings were available. Patients had uniform maturation arrest if multiple biopsies revealed maturation arrest at the spermatogonia/spermatocyte (early maturation arrest) or the spermatid (late maturation arrest) stage. Clinical parameters and pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection were examined. Statistical analysis consisted of univariate and multivariate analysis.
RESULTS
Uniform maturation arrest was identified in 49 of 219 men (22.3%) undergoing testicular sperm extraction. On multivariate analysis men with maturation arrest had significantly larger testes (p=0.01), decreased follicle-stimulating hormone (p=0.05) and more detectable genetic abnormalities (p=0.01) than men with other histopathological conditions. Men with late maturation arrest had decreased follicle-stimulating hormone (p=0.02), increased testosterone (p=0.03) and a higher sperm retrieval rate at testicular sperm extraction (p=0.01) than men with early maturation arrest. Predictors of successful sperm retrieval were larger testes, cryptozoospermia, late maturation arrest and hypospermatogenesis (each p≤0.05). Pregnancy outcomes for men with maturation arrest were not significantly different from those for men with other histopathological conditions.
CONCLUSIONS
Maturation arrest is a common, diverse histopathological subtype of severe male infertility. Compared to men with late maturation arrest those with early maturation arrest have increased follicle-stimulating hormone, decreased testosterone and a decreased probability of mature spermatozoa. In vitro fertilization/intracytoplasmic sperm injection outcomes were similar when spermatozoa were discovered during testicular sperm extraction.
目的
关于精子发生阻滞的不育男性，相关数据资料较为匮乏。我们假设，早期精子发生阻滞患者与晚期精子发生阻滞患者在临床上可以被区分，且前者的生殖结局较差。
材料与方法
我们对 2002 年至 2009 年期间接受睾丸组织学检查和精子提取术的所有非梗阻性无精子症和隐匿性精子症患者的病历进行了回顾性分析，这些患者的组织病理学检查结果均可用。如果多次活检均显示精母细胞/精原细胞（早期精子发生阻滞）或精子细胞（晚期精子发生阻滞）阶段存在精子发生阻滞，则认为患者存在均匀性精子发生阻滞。我们检查了体外受精/胞浆内单精子注射的临床参数和妊娠结局。统计分析包括单变量和多变量分析。
结果
在 219 名接受睾丸精子提取术的男性中，有 49 名（22.3%）被诊断为均匀性精子发生阻滞。多变量分析显示，与其他组织病理学类型的男性相比，精子发生阻滞患者的睾丸体积更大（p=0.01），促卵泡激素（FSH）水平更低（p=0.05），可检测到的遗传异常更多（p=0.01）。与早期精子发生阻滞患者相比，晚期精子发生阻滞患者的 FSH 水平更低（p=0.02），睾酮水平更高（p=0.03），睾丸精子提取术的精子提取率也更高（p=0.01）。成功提取精子的预测因素包括更大的睾丸体积、隐匿性精子症、晚期精子发生阻滞和少精子症（p 值均≤0.05）。精子发生阻滞患者的妊娠结局与其他组织病理学类型患者的妊娠结局无显著差异。
结论
精子发生阻滞是严重男性不育症的一种常见、多样化的组织病理学亚型。与晚期精子发生阻滞患者相比，早期精子发生阻滞患者的 FSH 水平更高，睾酮水平更低，成熟精子的出现概率更低。在睾丸精子提取术时发现精子的情况下，体外受精/胞浆内单精子注射的结局相似。
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