摘要
目的探讨非梗阻性无精症(non-obstructive azoospermia,NOA)患者生殖激素水平、睾丸体积等参数对睾丸内是否存在精子的预测价值,以及可用于预测经皮睾丸精子抽吸术(testicular sperm aspiration,TESA)结果的切点值。方法将我中心男科门诊就诊的133例NOA患者按TESA的结果分为有精子组(n=33)和无精子组(n=100),测定生殖激素水平、睾丸体积、精浆果糖、中性-ɑ糖苷酶、染色体、AZF等。结果有精子组和无精子组左侧睾丸体积分别为(9.12±2.25)、(6.25±2.63)m L,右侧睾丸体积分别为(9.23±2.02)、(6.47±2.48)m L,促卵泡生成素(follicle-stimulating hormone,FSH)分别为(9.82±2.09)、(22.62±15.00)m IU/m L,总睾酮(total testosterone,TT)分别为(5.19±0.68)、(4.15±1.82)ng/m L,总睾酮/黄体生成素(T/LH)分别为:0.61±0.19、0.57±0.35,总睾酮/雌激素(T/E2)分别为:162.40±16.66和141.40±93.40。无精子组血清FSH显著高于有精子组,优选的FSH水平切点值为13.31 m IU/m L时,其敏感度为74.1%,特异性为96.2%。FSH水平ROC曲线的AUC为0.850,表明其诊断准确性中等。结论就单一因素而言,FSH水平对于NOA患者预测睾丸内是否有精子发生具有相当重要的价值,并且明显优于睾丸体积;两者的联合应用对非梗阻性无精子症患者预测其睾丸内精子存在更有意义。
Objective To investigate whether reproductive hormone levels, testicular volume and other parameters can predict the existence of sperm in the patients with non-obstructive azoospermia （NOA）, and then be used as cutoff-point for the outcome of testicular sperm aspiration （TESA） so as to provide important clinical information of unnecessary surgical trauma. Methods A total of 133 NOA patients admitted in our outpatient center from January 2013 to January 2014 were enrolled in this study. They were divided into 2 group according to the results of TESA, that is, sperm group and non-sperm group. Reproductive hormone levels, testicular volume, seminal fructose, neutral-α glucosidase, chromosome, azoospermia factor （AZF） were detected, and the results were compared between the 2 groups. Results There were significant differences in testis volume （left： 9.12 ±2.25 vs 6.25 ：t：2.63 mL, right： 9.23 ±2. 02 vs 6.47 ±2.48 mL）, follicle-stimulating hormone （FSH, 9.82 ±2.09 vs 22.62 ± 15.00 mIU/mL）, total testosterone （TT, 5.19 ±0.68 vs 4.15 ± 1.82 ng/mL）, ratio of T/luteotropic hormone （T/LH, 0. 61 ±0.19 vs 0.57 ±0.35 ） , and ratio of T/estrogen （T/E2, 162.40 ± 16.66 vs 141.40 ±93.40） between the sperm group and non-sperm group （all P 〈0.01 ）. The FSH level was significantly higher in the non-sperm group than the sperm group. When the cutoff-point of preferred FSH level was 13.31 mlU/mL, the sensitivity was 74.1% and specificity of 96.2% when compared with the results by TESA, and the area under curve （AUC） of FSH receiver operating characteristic （ROC） curve was 0. 850, indicating that the diagnostic accuracy was moderate. Conclusion When a single factor is concerned, FSH level is essential to predict whether there is spermatogenesis in the testis of NOA patients, and its value is superior to testicular volume. However, combination of the 2 factors is more significant in the prediction.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2015年第1期69-73,共5页
Journal of Third Military Medical University
基金
河南省卫生厅科技攻关项目(2011020127)~~
关键词
非梗阻性无精子症
促卵泡生成素
睾丸体积
预测价值
non-obstructive azoospermia
follicle stimulating hormone
testicular volume
predictivevalue
