精索静脉曲张所致不育的免疫组化

    变化和临床研究(附编者按)

    郑骏年 谢叔良 连保罗 陈家存 顾 骧 温儒民 陈仁富 王军启

    摘要 为了进一步探讨精索静脉曲张(VC)与不育症的关系 ,对 22 例正常人 ,35 例左侧 VC患者行

    远红外阴囊测温及血清抗精子抗体(AsAb)测定 ,及睾丸组织免疫组化染色检测三种 AsAb ( IgM、 IgG、IgA)含量。结果发现:精液异常 VC患者睾丸温度显著升高( P < 01001) ,睾丸温度与静脉曲张程度无

    关 ,而与精子总数、活动率呈显著负相关( P < 0101) ;VC患者血清 AsAb阳性率 57 % ,显著高于正常人

    ( P < 01025) ;睾丸 IgM阳性率 53 % , IgG 73 % ,均显著高于正常人。IgM、 IgG含量与睾丸温度呈显著正

    相关( ( P < 0101 , P < 0104) 。其中 IgM含量与睾丸生精功能呈显著负相关( P < 0101) 。病理检查发现

    Sertoli细胞变性。认为 VC患者同时存在睾丸温度升高及抗精子免疫反应 ,共同损害生精功能 ,睾丸温

    度升高使 Sertoli细胞变性 ,破坏血睾屏障导致自身免疫反应发生。

    关键词 精索静脉曲张 不育症 ,男性

    The mechanism of varicocele 2induced infertil ity Zheng J unnian , Xie S hul iang , L ian Baoluo , et al . Depart2

    ment of Urology , The A f f il iated Hospt ial of Xuz hou Medical Col lege , Xuz hou 221002

    Abstract Scrotal temperature and antis permatozoal antibody (AsAb) were measured in 22 normal men

    and 35 left varicocele patients. The immunolocalization of AsAb( IgM , IgG, IgA) was studied in the testicular

    tissue of 15 normal men and 15 varicocele patients with immunohistochemist ry. The testicular temperature of

    varicocele patients with poor semen was significantly higher than those of normal men ( P < 01001) . There was

    no correlation between the testicular temperature and the degree of varicocele. There was negative correlation

    between testicular temperature and sperm count or sperm motility ( P < 0101) . The positive rate of serum

    AsAb in varicocele patients was 57 % ,significantly higher than that in normal men ( P < 01025) . The positive

    rates of IgM and IgG in testicular tissue of varicocele patients were 53 % and 73 % res pectively ,being signifi2

    cantly higher than those of normal men ( P < 0105 , P < 0101) . There was positive correlation between testicu2

    lar temperature and the content of IgM or IgG ( P < 0101 , P < 0104) ,and the content of IgM was related to

    impaired spermatogenesis. Degeneration of sertoli cells was observed on testicular bio psy. The result suggests

    that testicular hyperthermia leads to the disru ption of the blood testis barrier which is a prerequisite for AsAb

    formation. The testicular hyperthermia and the antis perm immunologic response are related to infertility.

    Key words Varicocele Infertility ,male

    作者单位:221002 徐州医学院附属医院泌尿外科

    我们对 35 例精索静脉曲张(VC)患者 ,22

    例正常人行远红外阴囊测温及血清抗精子抗体

    (AsAb)测定 ,并行睾丸活检免疫组化染色检测

    IgG、 IgM 及 IgA三种AsAb。报告如下。

    资料与方法

    一、临床资料

    左侧 VC 患者 35 例 ,平均年龄 2513 岁。

    曲张程度 Ⅰ级 7 例 , Ⅱ级 21 例 , Ⅲ级 7 例。其

    中精液正常者 14 例(精子总数 ≥20 ×108

    / L ,1

    小时活动率 ≥016) ;精液异常者 18 例 ,包括无

    精症 7 例 ,少精症 11 例 ......