Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Lodz, Poland.
Folia Histochem Cytobiol. 2020;58(2):73-82. doi: 10.5603/FHC.a2020.0008. Epub 2020 Jun 3.
There is evidence that disturbed spermatogenesis is associated with impaired Leydig cell function and that it may be the result of testicular dysgenesis during fetal/infant development. Sertoli cell-only syndrome (SCOS) is defined by complete lack of germ cells in the seminiferous epithelium. The pathogenesis of SCOS is still not well understood. The aim of the study is to evaluate testes with SCOS focusing on morphometric signs of testicular dysgenesis and markers of Leydig cell (LC) function in relation to hormonal status of studied infertile men.
Forty-nine testicular biopsies of patients with SCOS and 15 controls with normal spermatogenesis (NOR) were studied. In each biopsy the seminiferous tubule diameter (STD), thickness of tubular membrane (TM), area fraction of intertubular space (AFIS) were measured and semi-quantitative assessment of the LC number was performed (LC-score). The results of histological examination were correlated with serum levels of FSH, LH, testosterone (T) and T/LH ratio.
In SCOS group testicular volume (median [M]: 16.0 vs. 29.5; p < 0.001) and STD (M: 141.7 vs. 190.2; p < 0.001) were lower, while TM (M: 9.8 vs. 6.4; p < 0.001) and AFIS (M: 47.6 vs. 27.6; p < 0.001) were significantly higher in comparison to NOR group. LC-score was higher in SCOS than in NOR group (M: 2.2 vs. 1.1; p < 0.001). Abnormal AFIS and STD were present in 43% of SCOS biopsies and among them in 81% the increased LC-score was found. In SCOS group, the subjects had significantly higher levels of both gonadotropins (FSH, M: 19.9 vs. 3.4; p < 0.001; LH, M: 7.1 vs. 4.2; p < 0.001). Total serum testosterone level did not differ between studied groups; however, T/LH ratio was significantly lower in SCOS group (M: 2.3 vs. 3.8; p < 0.001). Negative correlation between LC-score and STD was observed in SCOS group (r = -0.48; p < 0.001). AFIS correlated positively with serum FSH level in NOR (r = 0.53; p < 0.05) and SCOS (r = 0.41; p < 0.05) group, while with LH, and negatively with T/LH ratio, only in SCOS (LH, r = 0.37; p < 0.05; T/LH, r = -0.36; p < 0.05) group.
We have shown that substantial number of testes from subjects with SCOS presented abnormal morphometric features, which are recognized as the signs of testicular dysgenesis. Additionally, an increased number of Leydig cells simultaneously with abnormal T/LH ratio were found, which suggests an impaired function of these cells. Increased serum levels of LH and also FSH, may reflect dysfunction of Leydig cells. It seems that reproductive hormones levels reflect also the condition of testicular structure, and that FSH may be related to the changes in intertubular space area independently of impaired Leydig cell function.
有证据表明，精子发生障碍与睾丸间质细胞功能受损有关，而睾丸间质细胞功能受损可能是胎儿/婴儿发育过程中睾丸发育不良的结果。唯支持细胞综合征（SCOS）的定义是曲细精管上皮完全缺乏生殖细胞。SCOS 的发病机制仍不完全清楚。本研究的目的是评估具有 SCOS 的睾丸，重点关注睾丸发育不良的形态学特征和与研究性不育男性激素状态相关的睾丸间质细胞（LC）功能的标志物。
研究了 49 例 SCOS 患者和 15 例正常生精（NOR）对照组的睾丸活检。在每个活检中，测量了曲细精管直径（STD）、管状膜厚度（TM）、间质空间面积分数（AFIS），并进行了 LC 数量的半定量评估（LC 评分）。组织学检查结果与血清 FSH、LH、睾酮（T）和 T/LH 比值相关。
在 SCOS 组中，睾丸体积（中位数 [M]：16.0 比 29.5；p < 0.001）和 STD（M：141.7 比 190.2；p < 0.001）较低，而 TM（M：9.8 比 6.4；p < 0.001）和 AFIS（M：47.6 比 27.6；p < 0.001）则较高。与 NOR 组相比，SCOS 组的 LC 评分较高（M：2.2 比 1.1；p < 0.001）。43%的 SCOS 活检显示异常的 AFIS 和 STD，其中 81%发现 LC 评分增加。在 SCOS 组中，受试者的两种促性腺激素（FSH，M：19.9 比 3.4；p < 0.001；LH，M：7.1 比 4.2；p < 0.001）水平显著升高。两组血清总睾酮水平无差异；然而，SCOS 组的 T/LH 比值显著降低（M：2.3 比 3.8；p < 0.001）。在 SCOS 组中观察到 LC 评分与 STD 呈负相关（r = -0.48；p < 0.001）。在 NOR（r = 0.53；p < 0.05）和 SCOS 组（r = 0.41；p < 0.05）中，AFIS 与血清 FSH 水平呈正相关，而与 LH 呈负相关，仅在 SCOS 组（LH，r = 0.37；p < 0.05；T/LH，r = -0.36；p < 0.05）中。
我们表明，大量来自 SCOS 患者的睾丸表现出异常的形态特征，这些特征被认为是睾丸发育不良的标志。此外，还发现了同时伴有异常 T/LH 比值的大量睾丸间质细胞，这表明这些细胞的功能受损。LH 和 FSH 血清水平升高可能反映了睾丸间质细胞的功能障碍。似乎生殖激素水平也反映了睾丸结构的状况，并且 FSH 可能与受损的睾丸间质细胞功能无关，与间质空间面积的变化有关。
