您的位置:山东大学 -> 科技期刊社 -> 《山东大学学报(医学版)》

山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (10): 67-73.doi: 10.6040/j.issn.1671-7554.0.2019.765

• • 上一篇    

克氏综合征的生育相关研究进展

马刚,许超   

  1. 山东大学附属生殖医院 国家辅助生殖与优生工程技术研究中心 生殖内分泌教育部重点实验室(山东大学)山东省生殖医学重点实验室, 山东 济南 250001
  • 发布日期:2022-09-27
  • 通讯作者: 许超. E-mail:xuchao@sduivf.com
  • 基金资助:
    山东省医药卫生科技发展计划(2016WS0370)

Research progress on fertility of the Klinefelter syndrome

MA Gang, XU Chao   

  1. Center for Reproductive Medicine, Shandong University;
    National Research Center for Assisted Reproductive Technology and Reproductive Genetics;
    Key Laboratory of Reproductive Endocrinology(Shandong University), Ministry of Education;
    Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan 250001, Shandong, China
  • Published:2022-09-27

摘要: 克氏综合征是男性不育中最常见的遗传性疾病。由于睾丸发育不良,无法正常生产精子常导致无精子症,无法生育后代。许多夫妇选择收养或使用捐精者的精子生育。近些年来,随着辅助生殖技术的发展,对克氏综合征患者的治疗有了更多的策略,可采用内分泌治疗以及通过获取睾丸精子进行卵母细胞内单精子注射治疗。对克氏综合征生育相关研究进行综述,探讨克氏综合征患者取精年龄、手术方式、内分泌治疗以及遗传风险相关问题。

关键词: 克氏综合征, 男性不育, 临床表现, 睾丸取精, 内分泌治疗

Abstract: The Klinefelter syndrome is the most frequent chromosomal aberration in infertile males. Due to testicular 山 东 大 学 学 报 (医 学 版)57卷10期 -马刚,等.克氏综合征的生育相关研究进展 \=-dysplasia, patients are often diagnosed with azoospermatism and cannot have offspring. Many couples choose to adopt or use donor sperms to have babies. In recent years, with the development of assisted reproductive technology, there have been more strategies for the treatment of patients with Klinefelter syndrome. Endocrine therapy and intracytoplasmic sperm injection with sperm acquired from the testicle make it possible for patients to have offspring. In this paper, we will review the research on fertility related to Klinefelter syndrome, and discuss the age of sperm extraction, surgical methods, endocrine therapy and genetic risks in patients with Klinefelter syndrome.

Key words: Klinefelter syndrome, Male infertility, Clinical manifestation, Testicular sperm extraction, Endocrine therapy

中图分类号: 

  • R574
[1] Klinefelter HF, Reifenstein EC, Albright F. Syndrome characterized by gynecomastia, aspermatogenesis without a-leydigism, and increased excretion of follicle-stimulating hormone[J]. J Clin Endocrinol, 1942, 2(11): 615-627.
[2] Shiraishi K, Matsuyama H. Klinefelter syndrome: from pediatrics to geriatrics [J]. Reprod Med Biol, 2019, 18(2): 140-150.
[3] Chang S, Skakkebæk A, Gravholt CH. Klinefelter syndrome and medical treatment: hypogonadism and beyond [J]. Hormones(Athens), 2015, 14(4): 531-548.
[4] Groth KA, Skakkebæk A, Host C, et al. Clinical review: Klinefelter syndrome—a clinical update [J]. J Clin Endocrinol Metab, 2013, 98(1): 20-30.
[5] Morris JK, Alberman E, Scott C, et al. Is the prevalence of Klinefelter syndrome increasing? [J]. Eur J Hum Genet, 2008, 16(2): 163-170.
[6] Garcia-Quevedo L, Blanco J, Sarrate Z, et al. Hidden mosaicism in patients with Klinefelters syndrome: implications for genetic reproductive counselling [J]. Hum Reprod, 2011, 26(12): 3486-3493.
[7] Van Assche E, Bonduelle M, Tournaye H, et al. Cytogenetics of infertile men [J]. Hum Reprod, 1996, 11(Suppl 4):1-24.
[8] Vincent MC, Daudin M, De MP, et al. Cytogenetic investigations of infertile men with low sperm counts: a 25-year experience [J]. J Androl, 2002, 23(1): 18-22.
[9] Tüttelmann F, Gromoll J. Novel genetic aspects of Klinefelters syndrome [J]. Mol Hum Reprod, 2010, 16(6): 386-395.
[10] Lanfranco F, Kamischke A, Zitzmann M, et al. Klinefelters syndrome [J]. Lancet, 2004, 364(9430): 273-283.
[11] Bojesen A, Juul S, Gravholt CH. Prenatal and postnatal prevalence of Klinefelter syndrome: a national registry study [J]. J Clin Endocrinol Metab, 2003, 88(2): 622-626.
[12] Wikström AM, Raivio T, Hadziselimovic F, et al. Klinefelter syndrome in adolescence: onset of puberty is associated with accelerated germ cell depletion [J]. J Clin Endocrinol Metab, 2004, 89(5): 2263-2270.
[13] Brilli S, Forti G. Managing infertility in patients with Klinefelter syndrome [J]. Expert Rev Endocrinol Metab, 2014, 9(3): 239-250.
[14] Bojesen A, Stochholm K, Juul S, et al. Socioeconomic trajectories affect mortality in Klinefelter syndrome [J]. J Clin Endocrinol Metab, 2011, 96(7): 2098-2104.
[15] Schiff JD, Palermo GD, Veeck LL, et al. Success of testicular sperm extraction [corrected] and intracytoplasmic sperm injection in men with Klinefelter syndrome [J]. J Clin Endocrinol Metab, 2005, 90(11): 6263-6267.
[16] Gottlieb S, Rey RA, Malozowski. Klinefelter syndrome and cryptorchidism[J]. JAMA, 2009, 301(14): 1436-1437.
[17] Chang S, Skakkebæk A, Trolle C, et al. Anthropometry in Klinefelter syndrome—multifactorial influences due to CAG length, testosterone treatment and possibly intrauterine hypogonadism [J]. J Clin Endocrinol Metab, 2015, 100(3): E508-517. doi: 10.1210/jc.2014-2834.
[18] Lahlou N, Fennoy I, Carel JC, et al. Inhibin B and anti-Mullerian hormone, but not testosterone levels, are normal in infants with nonmosaic Klinefelter syndrome [J]. J Clin Endocrinol Metab, 2004, 89(4): 1864-1868.
[19] Ross JL, Samango-Sprouse C, Lahlou N, et al. Early androgen deficiency in infants and young boys with 47,XXY Klinefelter syndrome [J]. Horm Res, 2005, 64(1): 39-45.
[20] Aksglaede L, Petersen JH, Main KM, et al. High normal testosterone levels in infants with non-mosaic Klinefelters syndrome[J]. Eur J Endocrinol, 2007, 157(3): 345-350.
[21] Cabrol S, Ross JL, Fennoy I, et al. Assessment of Leydig and Sertoli cell functions in infants with nonmosaic Klinefelter syndrome: insulin-like peptide 3 levels are normal and positively correlated with LH levels [J]. J Clin Endocrinol Metab, 2011, 96(4): E746-753. doi: 10.1210/jc.2010-2103.
[22] Hawksworth DJ, Szafran AA, Jordan PW, et al. Infertility in patients with Klinefelter syndrome: optimal timing for sperm and testicular tissue cryopreservation [J]. Rev Urol, 2018, 20(2): 56-62.
[23] Salbenblatt JA, Bender BG, Puck MH, et al. Pituitary-gonadal function in Klinefelter syndrome before and during puberty [J]. Pediatr Res, 1985, 19(1): 82-86.
[24] Smyth CM, Bremner WJ. Klinefelter syndrome [J]. Arch Intern Med, 1998, 158(12): 1309-1314.
[25] Bay K, Hartung S, Ivell R, et al. Insulin-like factor 3 serum levels in 135 normal men and 85 men with testicular disorders: relationship to the luteinizing hormone-testosterone axis [J]. J Clin Endocrinol Metab, 2005, 90(6): 3410-3418.
[26] Christiansen P, Andersson AM, Skakkebaek NE. Longitudinal studies of inhibin B levels in boys and young adults with Klinefelter syndrome [J]. J Clin Endocrinol Metab, 2003, 88(2): 888-891.
[27] Aksglaede L, Christiansen P, Sorensen K, et al. Serum concentrations of Anti-Mullerian Hormone(AMH)in 95 patients with Klinefelter syndrome with or without cryptorchidism [J]. Acta Paediatr, 2011, 100(6): 839-845.
[28] Bojesen A, Kristensen K, Birkebaek NH, et al. The metabolic syndrome is frequent in Klinefelters syndrome and is associated with abdominal obesity and hypogonadism [J]. Diabetes Care, 2006, 29(7): 1591-1598.
[29] Corona G, Petrone L, Paggi F, et al. Sexual dysfunction in subjects with Klinefelters syndrome[J]. Int J Androl, 2010, 33(4): 574-580.
[30] Aksglaede L, Wikström AM, Rajpert-De Meyts E, et al. Natural history of seminiferous tubule degeneration in Klinefelter syndrome [J]. Hum Reprod Update, 2006, 12(1): 39-48.
[31] Van Saen D, Vloeberghs V, Gies I, et al. When does germ cell loss and fibrosis occur in patients with Klinefelter syndrome? [J]. Hum Reprod, 2018, 33(6): 1009-1022.
[32] Aksglaede L, Juul A. Testicular function and fertility in men with Klinefelter syndrome: a review [J]. Eur J Endocrinol, 2013, 168(4): R67-76.
[33] Gies I, De Schepper J, Goossens E, et al. Spermatogonial stem cell preservation in boys with Klinefelter syndrome: to bank or not to bank, thats the question [J]. Fertil Steril, 2012, 98(2): 284-289.
[34] Gies I, De Schepper J, Van Saen D, et al. Failure of a combined clinical- and hormonal-based strategy to detect early spermatogenesis and retrieve spermatogonial stem cells in 47,XXY boys by single testicular biopsy [J]. Hum Reprod, 2012, 27(4): 998-1004.
[35] Bearelly P, Oates R. Recent advances in managing and understanding Klinefelter syndrome [J]. F1000Res, 2019, 8. doi: 10.12688/f1000research.16747.1.
[36] Van Saen D, Tournaye H, Goossens E. Presence of spermatogonia in 47,XXY men with no spermatozoa recovered after testicular sperm extraction [J]. Fertil Steril, 2012, 97(2): 319-323.
[37] Van Saen D, Gies I, De Schepper J, et al. Can pubertal boys with Klinefelter syndrome benefit from spermatogonial stem cell banking? [J]. Hum Reprod, 2012, 27(2): 323-330.
[38] Rives N, Milazzo JP, Perdrix A, et al. The feasibility of fertility preservation in adolescents with Klinefelter syndrome [J]. Hum Reprod, 2013, 28(6): 1468-1479.
[39] Franik S, Hoeijmakers Y, DHauwers K, et al. Klinefelter syndrome and fertility: sperm preservation should not be offered to children with Klinefelter syndrome [J]. Hum Reprod, 2016, 31(9): 1952-1959.
[40] Oates R. Adolescent Klinefelter syndrome: is there an advantage to testis tissue harvesting or not? [J]. F1000Res, 2016, 5. doi: 10.12688/f1000research.8395.1.
[41] Plotton I, Giscard dEstaing S, Cuzin B, et al. Preliminary results of a prospective study of testicular sperm extraction in young versus adult patients with nonmosaic 47,XXY Klinefelter syndrome [J]. J Clin Endocrinol Metab, 2015, 100(3): 961-967.
[42] Wikström AM, Hoei-Hansen CE, Dunkel L, et al. Immunoexpression of androgen receptor and nine markers of maturation in the testes of adolescent boys with Klinefelter syndrome: evidence for degeneration of germ cells at the onset of meiosis [J]. J Clin Endocrinol Metab, 2007, 92(2): 714-719.
[43] Okada H, Goda K, Yamamoto Y, et al. Age as a limiting factor for successful sperm retrieval in patients with nonmosaic Klinefelters syndrome [J]. Fertil Steril, 2005, 84(6): 1662-1664.
[44] 陈胤伟, 牛永华, 汪道琦, 等. 克氏综合征生育相关问题的研究进展 [J]. 中国男科学杂志, 2017, 31(3): 60-63.
[45] Mehta A, Bolyakov A, Roosma J, et al. Successful testicular sperm retrieval in adolescents with Klinefelter syndrome treated with at least 1 year of topical testosterone and aromatase inhibitor [J]. Fertil Steril, 2013, 100(4): 970-974.
[46] Dabaja AA, Schlegel PN. Microdissection testicular sperm extraction: an update [J]. Asian J Androl, 2013, 15(1): 35-39.
[47] 洪锴,毛加明. 显微镜下睾丸切开取精术在非梗阻性无精子症治疗中的临床应用新进展 [J]. 北京大学学报(医学版), 2018, 50(4): 585-589.
[48] Rohayem J, Fricke R, Czeloth K, et al. Age and markers of Leydig cell function, but not of Sertoli cell function predict the success of sperm retrieval in adolescents and adults with Klinefelters syndrome [J]. Andrology, 2015, 3(5): 868-875.
[49] Nahata L, Yu RN, Paltiel HJ, et al. Sperm retrieval in adolescents and young adults with klinefelter syndrome: a prospective, pilot study [J]. J Pediatr, 2016, 170: 260-265. doi: 10.1016/j.jpeds.2015.12.028.
[50] Majzoub A, Arafa M, Al Said S, et al. Outcome of testicular sperm extraction in nonmosaic Klinefelter syndrome patients: what is the best approach? [J]. Andrologia, 2016, 48(2): 171-176.
[51] Corona G, Pizzocaro A, Lanfranco F, et al. Sperm recovery and ICSI outcomes in Klinefelter syndrome: a systematic review and meta-analysis [J]. Hum Reprod Update, 2017, 23(3): 265-275.
[52] Haliloglu AH, Tangal S, Gulpinar O, et al. Should repeated TESE be performed following a failed TESE in men with Klinefelter Syndrome? [J]. Andrology, 2014, 2(1): 42-44.
[53] Okada H, Dobashi M, Yamazaki T, et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia [J]. J Urol, 2002, 168(3): 1063-1067.
[54] Ramasamy R, Yagan N, Schlegel PN. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction [J]. Urology, 2005, 65(6): 1190-1194.
[55] Amer M, Ateyah A, Hany R, et al. Prospective comparative study between microsurgical and conventional testicular sperm extraction in non-obstructive azoospermia: follow-up by serial ultrasound examinations [J]. Hum Reprod, 2000, 15(3): 653-656.
[56] Okada H, Shirakawa T, Ishikawa T, et al. Serum testosterone levels in patients with nonmosaic Klinefelter syndrome after testicular sperm extraction for intracytoplasmic sperm injection [J]. Fertil Steril, 2004, 82(1): 237-238.
[57] Takada S, Tsujimura A, Ueda T, et al. Androgen decline in patients with nonobstructive azoospemia after microdissection testicular sperm extraction [J]. Urology, 2008, 72(1): 114-118.
[58] Bojesen A, Gravholt CH. Klinefelter syndrome in clinical practice [J]. Nat Clin Pract Urol, 2007, 4(4): 192-204.
[59] Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an endocrine sciety clinical practice guideline [J]. J Clin Endocrinol Metab, 2018, 103(5): 1715-1744.
[60] Høst C, Skakkebæk A, Groth KA, et al. The role of hypogonadism in Klinefelter syndrome [J]. Asian J Androl, 2014, 16(2): 185-191.
[61] Flannigan R, Patel P, Paduch DA. Klinefelter syndrome. The effects of early androgen therapy on competence and behavioral phenotype [J]. Sex Med Rev, 2018, 6(4): 595-606.
[62] Ramasamy R, Ricci JA, Palermo GD, et al. Successful fertility treatment for Klinefelters syndrome [J]. J Urol, 2009, 182(3): 1108-1113.
[63] Sangster P, Johnson M, Raheem A, et al. A UK multicentre study analysing the surgical sperm retrieval rates in men with non-mosaic Klinefelters syndrome undergoing mTESE [J]. European Urology Supplements, 2018, 17(2): e214. doi: 10.1016/S1569-9056(18)30992-8.
[64] Staessen C, Tournaye H, Van Assche E, et al. PGD in 47,XXY Klinefelters syndrome patients [J]. Hum Reprod Update, 2003, 9(4): 319-330.
[65] Kahraman S, Findikli N, Berkil H, et al. Results of preimplantation genetic diagnosis in patients with Klinefelters syndrome [J]. Reprod Biomed Online, 2003, 7(3): 346-352.
[66] Ni TX, Yan JH, Wang B, et al. Outcomes of 13 ICSI-PGD cycles with ejaculated spermatozoa in patients with Klinefelter syndrome [J]. Asian J Androl, 2016, 18(3): 498-499.
[67] Yu Y, Xi Q, Jing J, et al. Intracytoplasmic sperm injection outcome of ejaculated spermatozoa from a man with mosaic Klinefelters Syndrome: case report and literature review [J]. J Int Med Res, 2018, 46(10): 4323-4331.
[68] Zhang B, Lu BY, Yu B, et al. Noninvasive prenatal screening for fetal common sex chromosome aneuploidies from maternal blood [J]. J Int Med Res, 2017, 45(2): 621-630.
[1] 赵海青,李保敏,杨小凡,张童,李军,赵永恒,高靓. 急性间歇性卟啉病伴婴儿痉挛1例及文献复习[J]. 山东大学学报 (医学版), 2022, 60(6): 82-89.
[2] 许长娟,梁子婷,曾荣,黄思源,王静,董亮. 结节性硬化症合并肺淋巴管肌瘤病1例[J]. 山东大学学报 (医学版), 2021, 59(8): 119-121.
[3] 张信美,钱洪浪. 子宫内膜异位症的临床表现[J]. 山东大学学报 (医学版), 2019, 57(6): 16-22.
[4] 杨慎敏,张锋,李铮. 精子鞭毛多发形态异常的临床诊断[J]. 山东大学学报 (医学版), 2018, 56(4): 38-42.
[5] 凌瑞,张聚良. 乳腺癌内分泌治疗的相关进展[J]. 山东大学学报 (医学版), 2018, 56(1): 27-31.
[6] 王殊,彭媛. 从2017年美国临床肿瘤学会大会报告看早期乳腺癌治疗加减法[J]. 山东大学学报 (医学版), 2018, 56(1): 17-21.
[7] 陈波,张磊. 2017年乳腺癌新辅助治疗进展[J]. 山东大学学报 (医学版), 2018, 56(1): 12-16.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!