克氏综合征嵌合型与非嵌合型病例中显微睾丸精子提取术成功获取精子的预测因素评估：一项前瞻性病例系列研究。

Evaluation of the predictors of successful sperm retrieval of micro-TESE in cases with mosaic Klinefelter versus cases with non-mosaic Klinefelter: a prospective case series study.

作者信息

Elahwany Amr, Elrefaey Fatma A, Alahwany Hisham, Torad Hesham, GamalEl Din Sameh Fayek, Dawood Rashad Mohammed Saeed, Ragab Mohamed Wael, Megawer Ahmed Fawzy

机构信息

Department of Andrology and STDs Kasr Al-Ainy, Faculty of Medicine Cairo University, Al-Saray Street, El Manial, Cairo, 11956, Egypt.

Nile IVF Center, Cairo, Egypt.

出版信息

Basic Clin Androl. 2025 May 19;35(1):18. doi: 10.1186/s12610-025-00265-2.

DOI:10.1186/s12610-025-00265-2

PMID:40389812

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12087168/

Abstract

BACKGROUND

We evaluated the predictors of eventful microsurgical testicular sperm extraction (micro-TESE) from infertile men with Klinefelter syndrome (KS).

RESULTS

The mean age of the patients was 32.4 ± 6.3 years. The mean serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), estradiol (E2) and prolactin were 34.38 ± 14.66, 18.92 ± 6.54, 3.18 ± 2.08, 28.2 ± 10, 11.56 ± 5.09, respectively. The mean right (Rt) testicular and left (Lt) testicular volumes were 2.17 ± 0.83 ml, 2.2 ± 0.89 ml, respectively. Mosaic KS patients showed highly significant TT compared to non-mosaic KS patients. Twenty-six patients out of 50 patients (52%) showed mature sperm in wet preparation, whereas the sperm retrieval rate (SRR) of the patients with mosaic and non-mosaic KS was (57.1) % and (32.1) %, respectively. SR was significantly associated with testicular volume > 2 ml, total testicular volume > 5 ml and LH < 21.29 IU/L (p 0.007, 0.005, 0.044, respectively). FISH testing results showed that higher 46xy and lower 47xxy were significantly associated with successful sperm retrieval (p 0.014, 0.015, respectively). Rt and Lt testicular volumes, total testicular volume, LH and FISH could significantly predict successful SR. No statistically significant correlations were found between micro-TESE and age, serum FSH, serum TT, E2, prolactin. Further, receiver operation characteristic (ROC) curve showed Rt and Lt testicular volumes and total testicular volume and LH level and 46xy could significantly predict successful SR with p 0.007, 0.007, 0.005 and 0.044 and 0.015, respectively. Moreover, the cutoff point and sensitivity and specificity and positive and negative predictive values for Rt and Lt testicular volumes were as follows 2 ml, 73.1%, 61.4%, 52.78, 79.41, 2 ml, 76.9%, 57.8%, 51.28 and 80.65, respectively. While these values for total testicular volume were as follows 5.255 ml, 61.5, 75, 59.26 and 76.74, respectively. Furthermore, these values for LH and 46xy were as follows 17 IU/l, 73.1%, 50%, 46.34, 75.86, 16.35, 84.6, 50, 50 and 84.6, respectively.

CONCLUSIONS

Patients with mosaic KS had higher rates of SRR compared to non-mosaic KS.

摘要

背景

我们评估了克氏综合征（KS）不育男性患者进行显微外科睾丸精子提取术（micro-TESE）时发生不良事件的预测因素。

结果

患者的平均年龄为32.4±6.3岁。促卵泡生成素（FSH）、促黄体生成素（LH）、总睾酮（TT）、雌二醇（E2）和催乳素的平均血清水平分别为34.38±14.66、18.92±6.54、3.18±2.08、28.2±10、11.56±5.09。右侧（Rt）睾丸和左侧（Lt）睾丸的平均体积分别为2.17±0.83ml、2.2±0.89ml。与非嵌合型KS患者相比，嵌合型KS患者的TT水平具有高度显著性差异。50例患者中有26例（52%）在湿片检查中发现成熟精子，而嵌合型和非嵌合型KS患者的精子获取率（SRR）分别为（57.1）%和（32.1）%。SR与睾丸体积>2ml、总睾丸体积>5ml以及LH<21.29IU/L显著相关（p分别为0.007、0.005、0.044）。荧光原位杂交（FISH）检测结果显示，较高的46xy比例和较低的47xxy比例与成功获取精子显著相关（p分别为0.014、0.015）。Rt和Lt睾丸体积、总睾丸体积、LH以及FISH能够显著预测SR成功。未发现micro-TESE与年龄、血清FSH、血清TT、E2、催乳素之间存在统计学显著相关性。此外，受试者工作特征（ROC）曲线显示，Rt和Lt睾丸体积、总睾丸体积、LH水平以及46xy比例能够显著预测SR成功，p分别为0.007、0.007、0.005、0.044和0.015。而且，Rt和Lt睾丸体积的截断点、敏感性、特异性以及阳性和阴性预测值如下：分别为2ml、73.1%、61.4%、52.78、79.41；2ml、76.9%、57.8%、51.28和80.65。而总睾丸体积的这些值如下：分别为5.255ml、61.5%、75%、59.26和76.74%；LH和46xy比例的这些值如下：分别为17IU/l、73.1%、50%、46.34、75.86；16.35、84.6%、50%、50和84.6%。