Эпидемиология и причины аутоиммунного мужского бесплодия
- Авторы: Божедомов ВА1, Теодорович ОВ2
-
Учреждения:
- РМАПО
- Научный центр акушерства, гинекологии и перинатологии РАМН
- Выпуск: № 1 (2005)
- Страницы: 35-44
- Раздел: Статьи
- URL: https://journals.eco-vector.com/1728-2985/article/view/276386
- ID: 276386
Цитировать
Полный текст
Аннотация
To study epidemiology and etiopathogenesis of male autoimmune infertility, we examined ejaculate samples from 3660 males of reproductive age, clinico-laboratory data on 560 males from infertile couples with antispermal antibodies (ASAB), 647 males without ASAB and 40 fertile males. Ejaculate was tested according to WHO recommendations, ASAB were identified by mixed agglutination reaction (MAR) and flow cytofluorometry (FCFM), infections of the reproductive tract (IRT) - by polymerase chain reaction (PCR). Experiments were made on 136 white non-inbred mature male rats and 40
mature female rats: 1/3 of the only testis was removed in male rats, then morphology of the operated on testis was studied as well as real fertility. ASAB were detected in 18% males of reproductive age. Factors of risk of antispermal immunity are the following: IRT (52%), varicocele (35%), blunt scrotal injuries without orchitis (21%) and previous epididymoorchitis (6%), obstruction (3%), cryptorchism and anejaculation (1 %). Absolute risk of immune infertility makes up 67% after orchitis and epididymoorchitis, 66% after blunt scrotal injuries without clinical orchitis, 39-43% in clinical and previously operated varicocele, 32% after IRT. Combination of the risk factors raises immune infertility probability 1.2-4.1 fold. The efficacy of antibiotic therapy for bacterial IRT in ASAB is described. It is shown than it is possible to preserve spermatogenesis after testicular trauma by stimulation of its regeneration. Immunological mechanisms of male autoimmune infertility are analysed. Thus, main causes of male autoimmune infertility are mechanical, infectious or other affection of the testis leading to impairment of hematotesticular barrier, varicocele increases the risk of autoimmune reactions and orchitis after traumas; cross-over interaction between antigenic determinants of sperm and IRT; obstruction of the ejaculatory tract; specific features of antiinfectious immunity.
mature female rats: 1/3 of the only testis was removed in male rats, then morphology of the operated on testis was studied as well as real fertility. ASAB were detected in 18% males of reproductive age. Factors of risk of antispermal immunity are the following: IRT (52%), varicocele (35%), blunt scrotal injuries without orchitis (21%) and previous epididymoorchitis (6%), obstruction (3%), cryptorchism and anejaculation (1 %). Absolute risk of immune infertility makes up 67% after orchitis and epididymoorchitis, 66% after blunt scrotal injuries without clinical orchitis, 39-43% in clinical and previously operated varicocele, 32% after IRT. Combination of the risk factors raises immune infertility probability 1.2-4.1 fold. The efficacy of antibiotic therapy for bacterial IRT in ASAB is described. It is shown than it is possible to preserve spermatogenesis after testicular trauma by stimulation of its regeneration. Immunological mechanisms of male autoimmune infertility are analysed. Thus, main causes of male autoimmune infertility are mechanical, infectious or other affection of the testis leading to impairment of hematotesticular barrier, varicocele increases the risk of autoimmune reactions and orchitis after traumas; cross-over interaction between antigenic determinants of sperm and IRT; obstruction of the ejaculatory tract; specific features of antiinfectious immunity.
Об авторах
В А Божедомов
РМАПОКафедра эндоскопической урологии; РМАПО
О В Теодорович
Научный центр акушерства, гинекологии и перинатологии РАМНМосква; Научный центр акушерства, гинекологии и перинатологии РАМН
Список литературы
- WHO laboratory manual for the examination of human sperm and semem-cervical mucus interaction. - 4-th ed., Cambridge: Cambridge universiti press., 1999.
- WHO manual for the standardized investigation and diagnosis of the infertile couple. - 3-th ed. Cambridge: Cambridge universiti press, 2000.
- Божедомов В. А., Лоран О. Б., Николаева М. А., Сухих Г. Т. Влияние антиспермальных антител на мужскую репродуктивную функцию. Андрол. и генитальная хир. 2000; 2: 25- 33.
- Mazumdar M. D., Levine A. S. Antisperm antibodies: etiology, pathogenesis, diagnosis and treatment. Fertil. and Steril. 1998; 70: 799-810.
- Heidenreich A., Bonfig R., Wilbert D. M. et al. Risk factors for antisperm antibodies in infertile men. Am. J. Reprod. Immunol. - 1994; 31: 69-76.
- Лопаткин H. А. (ред.). Руководство по урологии. М.: Медицина; 1998. 89-98; 600-601.
- Божедомов В. А., Лоран О. Б., Сухих Г. Т. Этиология и патогенез мужского аутоиммунного бесплодия. Часть 1 и 2. Андрол. и генитальная хир. 2001; 1: 72-77; 78-87.
- Nikolaeva M. A., Kulakov V. I., Terekhina L. M. et al. Detection of antisperm antibodies on the surface of living spermatozoa using flow cytometry: preliminary studv. Fertil. and Steril. 1993; 59: 639-644.
- Райцина С. С. Сперматогенез и структурные основы его регуляции. - М.: Наука; 1985.
- Чичинадзе Н. К. Стимуляция восстановительных процессов в травмированном семеннике. - Тбилиси: Мецниереба: 1981.
- Srinivas M., Hashim S., Mitra D. К. Unilateral blunt testicular trauma in prepubertal rats. Pediatr. Surg. Int. 1999: 15 (7): 457-460.
- Курносова Т. P., Вербицкий М. Ш., Сухих Г. Т.. Молнар Е. М. Современные представления о структурных основах репаративной регенерации семенника млекопитающих животных и человека. Бюл. экспер. биол. 1994; 4: 396-399.
- Hayashi H., Cernach M. С., Cedenho A. P. Fertility of the monorchid rat after partial resection of testes. Arch. Androl. 1985; 14: 267-269.
- Cosentino M. J., Sheifeld I., Erturk E. et al. The effect of graded unilateral testicular biopsi on the reproductive capacity of male rats. J. Urol. (Baltimore). 1986; 135: 155-158.
- Божедомов В. А., Билич Г. Л., Чичинадзе Н. К. Возможности фармакологической регуляции мужской гипофизарно-гонадной системы и профилактики атрофии единственного яичка после его резекции. В кн.: Билич Г. П., Лепеха П. Н. (ред.) Современные проблемы регенерации. Грозный; 1993. 58-73.
- Чичинадзе Н. К., Божедомов В. А., Билич Г. Л. Способ предотвращения атрофии яичка. Пат. № 2019177 от 15.09.1994.
- Божедомов В. А., Билич Г. Л. Способ сохранения сперматогенеза после оперативных вмешательств на яичках. Пат. №2099053 от 20.12.1997.
- Vicari E., Mongioi A. Effectiveness of long-acting gonadotrophin-releasing hormone agonist treatment in combination with conventional therapy on testicular outcome in human orchitis/epididymo-orchitis. Hum. Reprod. 1995; 10(8): 2072- 2078.
- Ендолов В. В. Патогенез и иммунотерапия посттравматического орхита (экспериментальное исследование): Дис. ... д-ра мед. наук. - М.; 1985.
- Tung К. S., Teuscher С. Mechanisms of autoimmune disease in the testis and ovary. Hum. Reprod. Update. 1995; 1: 30-50.
- Коган М. И., Сизякин Д. В., Дерижанова И. С. Морфологические эквиваленты иммунного бесплодия при варикоцеле. Андрол. и генитальная хир. 2000; 1: 41.
- Knudson G., Ross L., Stuhldrener D. et al. Prevalence of sperm bound antibodies in infertile men with varicocele: the effect of varicocele ligation on antibody levels and semen response. J. Urol. (Baltimore). 1994; 151 (5): 1260-1262.
- Сизякин Д. В. Некоторые механизмы формирования бесплодия при варикоцеле: Дис. ... канд. мед. наук. М.; 1996.
- Comhaire F. Н, Mahmoud A. M., Depuydt С. Е. et al. Mechanisms and effects of male genital tract infection on sperm quality and fertilizing potential: the andrologist's viewpoint. Hum. Reprod. Update. 1999; 5 (5): 393-398.
- Gubin D. A., Dmochowski R., Kutteh W. H. Multivariant analysis of men from infertile couples with and without antisperm antibodies. Am. J. Reprod. Immunol. 1998; 39 (2): 157-160.
- Евдокимов В. В., Синюхин В. Н., Смирнова Е. Н., Буров В. Н. Клинико-иммунологические параллели мужского бесплодия. Андрол. и генитальная хир. 2000; 1: 34-35.
- Kurpisz M., Alexander N. J. Carbohydrate moieties on sperm surface: physiological relevance. Fertil. and Steril. 1995; 63 (1): 158-165.
- Witkin S. S. Circulating antibodies to Chlamydia trachomatis in women: relationship to antisperm and antichlamydial antibodies in semen of male partners. Hum. Reprod. 1996; 11 (8): 1635- 1637.
- Hargreave Т. В., Harvey J., Elton R. A. et al. Serum agglutinating and immobilising sperm antibodies in men attending a sexually transmitted diseases clinic. Andrologia. 1984; 16(2): 111- 115.
- Eggert-Kruse W., Rohr G., Probst S. et al. Antisperm antibodies and microorganisms in genital secretions - a clinically significant relationship? Andrologia. 1998; 30 (1): 61-71.
- Флетчер Р., Флетчер С., Вагнер Э. Клиническая эпидемиология. Основы доказательной медицины: Пер. с англ. М.: Медиа Сфера; 1998.
- Роит А., Бростофф Дж., Мейл Д. Иммунология: Пер. с англ. М.: Мир; 2000.
- Fiszer D., Kurpisz M. Major histocompatibility complex expression on human, male germ cells: a review. Am. J. Reprod. Immunol. 1998; 40 (3): 172-176.
- Лолор-младший Г. и др. (ред.) Клиническая иммунология и аллергология. М.: Практика; 2000.
- Vazquez-Levin M. H., Kupchik G. S., Torres Y. et al. Cystic fibrosis and congenital agenesis of the vas deferens, antisperm antibodies and CF-genotype. J. Reprod. Immunol. 1994; 27 (3): 199-212.
- Omu A. E., al-Qattan F., Ismail A. A. et al. Relationship between unexplained infertility and human leukocyte antigens and expression of circulating autogeneic and allogeneic antisperm antibodies. Clin. Exp. Obstet. Gynecol. 1999; 26 (3-4): P. 199- 202.
- Coulam С. В., Stern J. J. Evaluation of immunological infertility. Am. J. Reprod. Immunol. 1992; 27 (3-4): 130-135.
Дополнительные файлы
