不育男性血清和精浆抑制素B水平与生精功能的关系

摘要

Objective:To explore the relationship between spermatogenic status and inhibin B(INH-B)in serum or seminal plasma in men suffering sub-fertility or infertility.Methods:The data of 141 men with sub-fertility or infertility in Shenzhen Zhongshan Urology Hospital with different spermatogenic status were retrospectively analyzed.According to the seminal parameters,the patients were divided into 5 groups:normospermia (Group A,n =43),moderate oligospermia (Group B,n =40),oligozoospermia (Group C,n =27),obstructive azoospermia (Group OA,n =9)and non-obstructive azoospermia(Group NOA,n=22)groups.Seventeen patients with NOA underwent the testicular sperm aspiration (TESA),and they were subgroup into successful group (n =13) and failure group(n=4)based on the surgical outcomes.Seminal parameters including total sperm counts and sperm concentration and sperm motility as well as INH-B levels in serum or seminal plasma,FSH,LH,PRL,progesterone(P),testosterone(T)and estradiol(E2)levels in serum were detected and compared among the groups.The relationship among reproductive hormone,INH-B and semen parameters was analyzed.Results:Total testicular volume in Group A and B were significantly higher than that in Group OA an NOA(P＜0.05).INH-B in serum of Group C and NOA were statistically lower than Group A and NOA,while INH-B in seminal plasma in Group A was significantly higher than in Group C,OA and NOA (all P＜0.05).In the men with different spermatogenic status,INH-B in serum were significantly negatively correlated with FSH,LH and PRL in serum(P＜0.05),and positively correlated with T in serum and INH-B in seminal plasma(all P＜0.05).INH-B in seminal plasma was negatively correlated with FSH and LH in serum(P＜0.05).There was a significantly positive correlation between INH-B levels in serum or seminal plasma and total sperm counts in Group A,B and C(P＜0.01).INH-B levels in serum was highly positively correlated with total testicular volume,and negatively correlated with FSH and LH levels in serum(P＜0.01).INH-B levels in seminal plasma was negatively correlated with FSH in serum(P＜0.05).Total testicular volume and INH-B levels in serum in men with successful sperm retrieval from testis was significantly higher than those with failure group(P＜0.01),while FSH and LH levels in serum was significantly lower than those with failure outcomes(P＜0.01).Conclusions:INH-B in serum and seminal plasma were correlated with sex hormones in serum and total sperm counts.These results could provide references for evaluation of male spermatogenic function.INH-B in serum can be used to estimate spermatogenic status,differential diagnose of azoospermia and predict surgical outcomes of sperm retrieval for men with azoospermia,especially with NOA patients.%目的 探讨血清和精浆抑制素B(INH-B)与睾丸生精功能的关系. 方法 回顾性分析2015年1～6月来深圳中山泌尿外科医院生殖医学中心就诊的141例男性不育症患者资料.根据精液参数分为5组:精子浓度正常组(A组,43例)、轻中度少精子症组(B组,40例)、重度少精子症组(C组,27例)、梗阻性无精子症组(OA组,9例)和非梗阻性无精子症组(NOA组,22例);NOA组中有1 7例患者接受睾丸细针精子抽吸术(TESA)取精,根据TESA结果分为成功组(13例)和失败组(4例).比较各组的精液参数(精子总数、浓度及活动力),测定其血清和精浆INH-B水平及血清FSH、LH、T、E2、泌乳素(PRL)、孕酮(P)的水平,分析血清性激素、INH-B与精液质量之间的关系. 结果 A、B组的睾丸总体积显著高于OA和NOA组(P＜0.05).C组和NOA组的血清INH-B显著低于A组和OA组,A组的精浆INH-B浓度显著高于C组、OA组和NOA组(P均＜0.05).不同生精功能男性的血清INH-B与血清FSH、LH及PRL呈负相关,与血清T和精浆INH-B呈正相关(P均＜0.05);精浆INH-B与血清FSH和LH呈负相关(P＜0.05).A、B、C组中血清和精浆INH-B与总精子数呈低度正相关(P＜0.01).NOA组中血清INH B与睾丸总体积呈高度正相关,与血清FSH和LH呈负相关(P均＜0.01);精浆INH-B与血清FSH呈极弱负相关(P＜0.05).TESA取精成功组的睾丸总体积和血清INH-B显著高于TESA失败组,血清FSH和LH则显著低于TESA失败组(P均＜0.01). 结论 血清和精浆INH-B与血清性激素、总精子数具有一定相关性,可作为评估男性生精功能的参考.无精子症中尤其是NOA患者,血清INH-B可以评估睾丸生精状态、鉴别诊断无精子症、预测取精结局.