폐쇄성 무정자증 환자에서 부고환내 정자상의 예측지표에 관한 연구

Abstract

[한글]

실험실적 부고환정자 채취술로 부차적으로 알게된 부고환내 정자상과 대상 환자의 연령, 병력, 고환조직검사 및 고환조직의 apoptosis정도, 내분비검사, 음낭초음파검사 등에 어떤 관련성이 있을 것이라고 가정하여 이에 대한 분석을 통해 이들의 예측 지표로서의 유용성을 규명하고자 하였다.

연구자는 1992년부터 1997년까지 국내 한 의과대학 부속병원에서 폐쇄성 무정자증으로 실험실적 부고환 정자 채취술을 시행받은 환자중 고환조직검사표본의 재검토가 가능한 41례를 대상으로 고환조직검사와 함께 정세관내 정자세포의 apoptosis 여부를 알기위한 TUNEL assay로 apoptosis index를 정하여 판독하였고, 임상적으로 대상환자의 연령, 병력, 내분비검사, 그리고 고환과 부고환에 대한 초음파 소견 등을 관찰하여 이들의 결과들과 실험실적 부고환 정자 채취법에서 얻은 부고환 정자상과 비교 분석하였다.

이상의 분석결과를 종합해 보았으나 폐쇄성 무정자증 환자에서 고환조직소견이나 임상소견으로 부고환내 정자상을 예측할 수 있는 지표는 찾을 수 없었다. 그러나 apoptosis와 정자의 운동성간에 역비례 관계의 경향성을 보인 점은 주목할 만한 사실로 생각된다.

[영문]

A variety of methods have been introduced so far the treatment of the male infertility due to obstructive azoospermia, and recently an epochal turning point was made by in vitro fertilization(IVF) using epididymal sperm extracted through

the microsurgical epididymal sperm aspiration(MESA). However, it had a limit in increasing the pregnancy success rate on account of the deficiency in quality and in quantity of the sperm extracted in this procedure. In the meanwhile, Kim & Han devised in vitro retrieval of epididymal sperm in 1992 and made it possible to get more good quality sperms. But the method was controversial in that the chances of extracting epididymal sperm are limited to just twice of them and that it is too invasive method.

On the other hand, in spite of this controversy, excision of the epididymal inevitably on the process of in vitro retrieval of epididymal sperm makes the comprehensive and exact understanding. Before the introduction of this method the only way to know the condition of epididymal sperm was anologizing in the condition

of sperm extracted through the microsurgical epididymal sperm aspiration but MESA cannot reveal the condition of epididymal sperm in the whole epididymis. The study on the predictable guiding indices for the status of the epididymal sperm is clinically important because it is possible to know in advance which method is better to choose among the various methods for retrieval of sperm for the patient of the obstructive azoospermia in case of the condition of epididymal sperm is predictable.

If the result of the existing testis biopsy, endrocrinologic test, scrotal ultrasonogram study are related to the condition of the epididymal sperm, the clinical significance of these tests comes to gain the new value. Even though it isn't related, it is significant because there has been no research on this relationship. On the assumption that there will be a certain relationship between epididymal sperm conditions and various study parameters, the researcher intends to examine the usefulness of these tests closely as a predictable guiding indices through the statistical analysis.

Putting the above results of analysis together, it was impossible to find a guiding indices to predict epididymal sperm condition through testis biopsy finding or clinical finding in case of the obstructive azoospermia patient. But one noteworthy fact is that there was a tendency of a reverse proportion relationship between apoptosis and the motility of sperm.