来曲唑治疗睾丸生精功能障碍疗效及对性激素水平的影响

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摘要目的探讨来曲唑对睾丸生精功能障碍疗效及对雌二醇(Estradiol, E₂)、睾酮(testosterone ,T)、卵泡刺激素(follicle stimulating hormone , FSH)、黄体生成素(luteinizing hormone, LH)、泌乳素(prolactin , PRL)、T/E₂、抑制素B(inhibin B , INH-B)的影响。方法选取2014年6月—2017年8月期间在我科经来曲唑治疗的203例睾丸生精功能障碍患者为研究对象,包括中重度少精子症组(n=165)和无精症组(n=38),均给予来曲唑治疗至少6个月(2.5 mg/d),观察给药前后的性激素水平、精液分析与睾丸活检结果,以及不良反应情况。结果 (1)给药后患者的血T、FSH、LH、INH-B水平、T/ E₂的比值显著升高,血E₂水平显著降低,差异有统计学意义(P＜0.05),而血PRL水平给药前后无明显变化,差异无统计学意义(P＞0.05)。(2)中重度少精子症组患者给药6个月后的精子总数、形态正常率、存活率、a+b级的精子比例、有效精子总数比给药前均显著升高,差异有统计学意义(P＜0.05),仅有11例(6.7%)患者的精液分析结果无改善。(3)无精症组38例患者中仅有2.6%患者给药6个月后的精液中出现精子,其有效精子总数的平均值为0.43×10⁶/ml,在睾丸活检方面,给药前JOHNSEN评分为(6.8±2.4)分,治疗6个月后JOHNSEN评分为(8.5±0.9)分,组间比较具有统计学意义。(4)全部患者在治疗期间均未出现严重并发症,耐受性良好,所有不良事件在停药后均消失。结论来曲唑能显著降低睾丸生精功能障碍患者的血E₂水平,提高血T、FSH、LH、INH-B的水平,明显改善生精功能可为无精症治疗提供一个新的选择,具备进一步研究价值。

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	王澍弘
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	李美材
	李晓霞
	龙腾博
	王顺德

关键词 ：来曲唑, 生精功能, 性激素, 睾丸

Abstract：Objective To investigate the effect of letrozole on Estradiol (E₂), testosterone (T), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), T/E₂ and inhibin B in patients with testicular spermatogenesis dysfunction . Methods 203patients with testicular spermatogenesis dysfunction who received letrozole treatment from June 2014 to August 2017 were enrolled for the study, and divided into moderate-severe oligospermatism group (n=165) and azoospermia group (n=38). All cases were treated with letrozole for at least 6 months (2.5mg/d), and then observed their hormone level, semen analysis, testicular biopsy results and adverse reaction conditions. Results (1)The blood levels of T, FSH, LH, INH-B, T/E₂ increased significantly after administration, and the blood level of E₂ was significantly decreased (P<0.05). There was no statistically significant difference in the blood PRL level before and after administration of letrozole (P>0.05). (2)The total sperm count, percentages of normal morphology, survival, grade a+b sperm and effective sperm number in moderate-severe oligospermatism group at 6 months after treatment were significantly better than that before administration (P<0.05), and only 11 cases (6.7%) patients′ semen analysis results showed no improvement. (3)In the azoospermia group, only 2.6% patients were emerge semen in sperm at 6 months after treatment, and the value of total number of effective sperm was 0.43×10⁶/ml. In terms of testicular biopsy, JOHNSEN before administration was scored (6.8±2.4), and JOHNSEN was scored (8.5±0.9) six months after treatment, with statistically significant intergroup comparisons (t=4.1, P=0.0).(4)None of the patients had serious complications during the treatment, and all the adverse events disappeared after discontinuation. Conclusion Letrozole could significantly reduce the blood E₂ level and increase the levels of T, FSH, LH and INH-B in patients with testicular spermatogenesis dysfunction, and significantly improve the spermatogenic function.And provide a new choice for treatment of azoospermia, so it had further research value.

Key words： Letrozole Spermatogenesis function Hormone Testicles

收稿日期: 2018-09-06

基金资助:重庆市卫生计生委面上项目(项目编号:2016MSXM114)

通讯作者: 李晓霞(635784196@qq.com)

引用本文:

王澍弘, 李晶, 李行, 李美材, 李晓霞, 龙腾博, 王顺德. 来曲唑治疗睾丸生精功能障碍疗效及对性激素水平的影响[J]. 中国生育健康杂志, 2020, 31(3): 223-226.
WANG Shuhong, LI Jing, LI Hang, LI Meicai, LI Xiaoxia, LONG Tengbo, WANG Shunde.. Effect ofletrozole on the patients with testicular spermatogenesis dysfunction. Chinese Journal of Reproductive Health, 2020, 31(3): 223-226.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2020/V31/I3/223

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