精索静脉曲张患者精索内静脉血管平滑肌细胞雄激素受体表达和血清睾酮水平的研究

doi:10.3877/cma.j.issn.1674-3253.2026.01.009

目的

研究精索静脉曲张（VC）患者精索内静脉血管平滑肌细胞和无VC男性对照组正常精索内静脉血管平滑肌细胞雄激素受体（AR）阳性表达水平，以及VC组和对照组血清睾酮（ST）水平是否存在差异，为进一步探讨VC发病机制和治疗提供理论依据。

方法

回顾性收集中山市人民医院泌尿外科2009年12月至2025年1月的58例VC患者左侧精索内静脉标本（Ⅱ级组28例、Ⅲ级组30例）和26例对照组正常左侧精索内静脉标本，以及各研究对象ST水平。采用免疫组织化学方法检测精索内静脉血管平滑肌细胞AR阳性的比率（APR）。应用化学发光免疫分析法检测ST水平。对各组研究对象APR和ST进行对比分析。

结果

VC组（Ⅱ级组、Ⅲ级组）精索内静脉血管平滑肌细胞APR显著低于对照组（P<0.05），VCⅢ级组精索内静脉血管平滑肌细胞APR显著低于VCⅡ级组血管平滑肌细胞APR（P<0.05）。Ⅱ级组、Ⅲ级组和对照组间ST水平差异无统计学意义（P>0.05）。

结论

VC不影响患者ST水平；VC患者精索内静脉血管平滑肌细胞APR显著低于正常精索内静脉血管平滑肌细胞APR，并与VC严重程度有显著负相关。

关键词: 精索静脉曲张, 睾酮, 雄激素受体

Objective

To investigate whether the positive expression levels of androgen receptor (AR) were different between the internal spermatic veins vascular smooth muscle cells in patients with varicocele (VC) and that of normal internal spermatic veins vascular smooth muscle cells in the control group without VC, and whether there were differences of the serum testosterone (ST) level between VC groups and control group. To provide a theoretical basis for further exploring the pathogenesis and treatment of VC.

Methods

From December 2009 to January 2025, 58 left internal spermatic veins of patients with VC (grade Ⅱ group 28, grade Ⅲ group 30) and 26 normal left internal spermatic veins of males without VC, as well as the ST level of each study subject were collected. The AR positive ratio (APR) of the internal spermatic veins vascular smooth muscle cells was detected by immunohistochemistry.The level of ST was detected by chemiluminescent immunoassay. The APR and ST were compared and analyzed in three groups.

Results

The APR of the internal spermatic veins vascular smooth muscle cells in VC groups (grade Ⅱ group, grade Ⅲ group) were significantly lower than that of the control group (P<0.05), the APR of the internal spermatic veins vascular smooth muscle cells in VC III group was significantly lower than that of VC II group (P<0.05). There was no significant difference of ST levels between three groups (P>0.05).

Conclusion

VC did not affect the ST level of the patients. The APR in internal spermatic veins vascular smooth muscle cells of patients with VC was significantly lower than that of controls without VC, and there was a significant negative correlation with the severity of VC.

Key words: Varicocele, Testosterone, Androgen receptor

图1 精索静脉曲张（VC）患者和正常精索静脉男性精索内静脉血管平滑肌细胞雄激素受体（AR）表达情况注：图a、b、c分别为对照组、VCⅡ级组、VCⅢ级组精索内静脉血管平滑肌细胞AR表达情况，图d为参照的前列腺增生患者前列腺组织AR表达情况（×50）

表1 VC组和对照组年龄、ST和APR参数比较

组别	例数	年龄（岁）	ST（ng/dL）	APR（%）
VCⅡ级组	28	22.89±4.46^*	441.50±34.99	33.86±2.25^*
VCⅢ级组	30	21.47±3.86^*	432.74±32.06	21.37±1.80^*#
对照组	26	33.69±5.44	434.58±31.94	60.70±4.11
F值		57.370	0.557	1376.513
P值		<0.001	0.575	<0.001

表1 VC组和对照组年龄、ST和APR参数比较

组别	例数	年龄（岁）	ST（ng/dL）	APR（%）
VCⅡ级组	28	22.89±4.46^*	441.50±34.99	33.86±2.25^*
VCⅢ级组	30	21.47±3.86^*	432.74±32.06	21.37±1.80^*#
对照组	26	33.69±5.44	434.58±31.94	60.70±4.11
F值		57.370	0.557	1376.513
P值		<0.001	0.575	<0.001

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Study on the expression of androgen receptor in vascular smooth muscle cells of the internal spermatic veins and serum testosterone levels in patients with varicocele

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Study on the expression of androgen receptor in vascular smooth muscle cells of the internal spermatic veins and serum testosterone levels in patients with varicocele