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目的:对Y染色体AZF区域微缺失不育患者进行精液细胞学检查,从而评估其生精功能。方法:收集35例AZF缺失不育患者,年龄23~44岁,经3次以上精液常规分析证实,26例为非梗阻性无精子症,9例为严重少精子症。按照AZF缺失部位分为以下4组进行观察:AZFa+b+c区域缺失组5例,AZFb+c缺失(4例)及单独AZFb缺失(3例)组7例,AZFc缺失组23例。采集患者精液,待自然液化后离心,生理盐水洗涤2次,离心沉淀物经生理盐水稀释后涂于干净玻片上,瑞吉染色,光学显微镜下观察。对其中6例患者进行了睾丸组织病理学检查。结果:AZFa+b+c缺失组,精液细胞学检查均未见各级生精细胞,可见少量上皮细胞。其中1例经睾丸活组织病理学检查,生精小管中未见各级生精细胞,为唯支持细胞综合征,与精液细胞学检查结果一致。AZFb+c缺失及单独AZFb缺失组,精液细胞学检查其中6例细胞停滞在精母细胞阶段,2例睾丸活检见生精阻滞在初级精母细胞阶段。1例AZFb缺失的患者精液细胞学检查见初级精母细胞、次级精母细胞和精子细胞,但睾丸活检显示阻滞在精母细胞阶段。AZFc缺失组中,少精子症组(8例)患者生精细胞检查5例停滞在精母细胞阶段,见少量精子细胞,另3例未见各级生精细胞;无精子症组(15例)患者未见各级生精细胞,其中2例经睾丸活检,证实为唯支持细胞综合征。结论:精液细胞学检查对AZF缺失患者能有效评估生精功能,作为一项无创检查技术,容易被患者接受,推荐作为临床评估生精功能的一项方法。
OBJECTIVE: To assess the function of spermatogenesis by semen cytology in patients with Y chromosome AZF microdeletions in infertility. Methods: Totally 35 infertile patients with AZF were enrolled in this study. The age ranged from 23 to 44 years old. According to routine analysis of more than 3 semen samples, 26 cases were non-obstructive azoospermia and 9 cases were severe oligospermia. According to the deletion of AZF, we divided into 4 groups: AZFa + b + c region deletion group 5 cases, AZFb + c deletion group 4 cases and AZFb deletion group 3 cases 7 cases and AZFc deletion group 23 cases. Patients were collected semen, to be naturally liquefied and centrifuged, washed twice with saline, the pellet was diluted with saline and applied to a clean slide, Stichting, observed under light microscope. Six of the patients underwent testicular histopathology. Results: In the group of AZFa + b + c deletion, no spermatogenic cells at all levels were seen in the seminal cytology examination. A small amount of epithelial cells were observed. One case of testicular biopsy, no spermatogenic cells in the seminiferous tubules, support for cell syndrome, consistent with the results of semen cytology. AZFb + c deletion and AZFb deletion alone group, semen cytology in which 6 cases of cells arrested in the spermatocyte stage, 2 cases of testicular biopsy see spermatogenic arrest in primary spermatocyte stage. One case of AZFb-null patients underwent seminal cytology for primary spermatocytes, secondary spermatocytes, and spermatids, but testicular biopsy showed arrest in the spermatocyte stage. In AZFc deletion group, there were 5 cases of spermatogenic cells in oligozoospermia group (8 cases) stopped in spermatocyte stage, a small amount of spermatids cells were observed, and 3 cases showed no spermatogenic cells in all cases. Azoospermia group (15 cases ) Patients showed no spermatogenic cells at all levels, of which 2 cases by testicular biopsy confirmed the only support cell syndrome. Conclusion: Sperm cytology can effectively assess the function of spermatogenesis in patients with AZF deficiency. As a noninvasive technique, it is easily accepted by patients and recommended as a method for clinical evaluation of spermatogenesis.