睾丸扭转：对自身免疫、垂体-睾丸轴的影响及其与男孩原发性性腺功能障碍的相关性。
Testicular torsion: its effect on autoimmunisation, pituitary-testis axis and correlation with primary gonadal dysfunction in boys.
机构信息
The Chair and Department of Paediatric Surgery and Traumatology, Medical University of Lublin, Lublin, Poland.
The Department of Paediatric Endocrinology and Diabetology with Endocrine-Metabolic Laboratory, Medical University of Lublin, Lublin, Poland.
出版信息
Pediatr Res. 2021 Dec;90(6):1193-1200. doi: 10.1038/s41390-021-01382-0. Epub 2021 Feb 18.
BACKGROUND
Torsion of the testis is an urgent surgical condition that endangers the viability of the gonad and the fertility of the patient. Our aim was to assess potential autoimmune processes and hormonal abnormalities in boys operated on due to that illness.
METHODS
The authors evaluated the levels of antibodies against sperm and Leydig cells, concentrations of follicle-stimulating, luteinizing and anti-Müllerian hormone, testosterone, oestradiol and vascular endothelial growth factor in the serum in 28 boys operated on due to torsion of the testis. Patients' sexual maturity was assessed according the Tanner scale (group G1, G4 and G5).
RESULTS
No antibodies against sperm or Leydig cells were found in the serum. Statistically significant differences in follicle-stimulating and anti-Müllerian hormone concentrations were observed in the G1, and they were higher in the study than in the control group. There were no statistically significant differences in luteinizing hormone, testosterone, oestradiol and vascular endothelial growth factor concentrations in the study group or control group. Testosterone concentration was unrelated to total testicular volume.
CONCLUSIONS
Results did not confirm the autoimmune process in boys with torsion of the testis. The pituitary-testis axis seems to have sufficient compensation capabilities. However, study results suggest that primary gonadal dysfunction may predispose to torsion.
IMPACT
Significant differences exist between the literature data and own results on the formation of antibodies and hormonal changes due to testicular torsion in boys. It is a novel, prospective study on antibodies against sperms and Leydig cells in the serum and on hormonal processes occurring as a result of the testicular torsion from the prenatal period to the adolescence with division into pubertal groups. The study has revealed sufficient compensation capabilities of the pituitary-testis axis and no autoimmune process in boys with torsion of the testis.
背景
睾丸扭转是一种危及性腺活力和患者生育能力的紧急手术情况。我们的目的是评估因该病接受手术的男孩中潜在的自身免疫过程和激素异常。
方法
作者评估了 28 名因睾丸扭转接受手术的男孩血清中抗精子和莱迪希细胞抗体、卵泡刺激素、黄体生成素和抗苗勒管激素、睾酮、雌二醇和血管内皮生长因子的浓度。根据 Tanner 量表评估患者的性成熟度（G1、G4 和 G5 组）。
结果
血清中未发现抗精子或莱迪希细胞抗体。在 G1 组中观察到卵泡刺激素和抗苗勒管激素浓度存在统计学显著差异，且研究组高于对照组。研究组和对照组的黄体生成素、睾酮、雌二醇和血管内皮生长因子浓度无统计学显著差异。睾酮浓度与总睾丸体积无关。
结论
结果未证实睾丸扭转男孩存在自身免疫过程。垂体-睾丸轴似乎具有足够的代偿能力。然而，研究结果表明，原发性性腺功能障碍可能易导致扭转。
影响
本研究结果与文献数据存在显著差异，涉及男孩因睾丸扭转形成的抗体和激素变化。这是一项新颖的、前瞻性研究，涉及血清中抗精子和莱迪希细胞抗体以及从产前到青春期的睾丸扭转引起的激素过程，并分为青春期组。该研究揭示了垂体-睾丸轴的充分代偿能力，以及睾丸扭转男孩不存在自身免疫过程。
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