非梗阻性无精子症患者睾丸穿刺获精子结局的预测因素研究

目的探讨非梗阻性无精子症(NOA)患者睾丸体积、血清抑制素B(INHB)及性激素水平对预测睾丸穿刺(TESA)获精子结局的意义。方法实验组为162例NOA患者,按TESA获精子结局分为有精子组(TESA^+,n=74)和无精子组(TESA^-,n=88);正常组为60例同期精液常规参数正常者。比较各组的睾丸体积、血清INHB及性激素水平,筛选有显著性差异的指标,应用ROC曲线评价其对预测TESA获精子结局的意义。结果睾丸体积、血清INHB及FSH三项指标在TESA^+组和TESA^-组间存在显著性差异(P<0.05),因此为优选的预测指标。三者的ROC曲线下面积(AUC)分别为0.816、0.861、0.777,且后两者间有显著性差异(P<0.05),最佳切点值分别为8.15 ml、70.15 pg/ml、5.52 U/L,对应的诊断灵敏度分别为93.2%、87.8%、74.3%,特异度分别为65.9%、81.8%、77.3%。结论睾丸体积、血清INHB及FSH对预测NOA患者TESA获精子结局有重要意义,且INHB的预测意义优于FSH。各指标的预测意义与其对应的诊断灵敏度和特异度不成正相关,表明联合诊断的重要性。

Predictive indicators for the outcome of testicular sperm aspiration in patients with non-obstructive azoospermia

Objective:To explore the significance of testicular volume,serum inhibin B(INHB)and sex hormones levels in predicting the outcome of testicular sperm aspiration(TESA)in patients with non-obstructive azoospermia(NOA).Methods:A total of 162 NOA patients in the experimental group were divided into sperm existence group(TESA+,n=74)and non-sperm group(TESA-,n=88)according to the results of TESA,while the normal group consisted of 60 patients with normal semen parameters.The testicular volume,serum INHB and sex hormone levels were compared among the three groups and the ROC curves were established to identify the indicators with significant differences.Results:There were significant differences in testicular volume,serum INHB and FSH between TESA+group and TESA-group(P<0.05),so they were the three preferred indicators for predicting the outcome of TESA.The ROC-AUCs of them were 0.816,0.861 and 0.777 respectively,and there was significant difference in that of serum INHB and FSH between the two groups(P<0.05).The optimal cut-off value of them was 8.15 ml,70.15 pg/ml and 5.52 U/L,respectively.The corresponding diagnostic sensitivity of them was 93.2%,87.8%,74.3%,while the specificity was 65.9%,81.8%and 77.3%,respectively.Conclusions:The testicular volume,serum INHB and FSH levels have significant value for predicting sperm existence of TESA in NOA patients,and serum INHB level has the higher predictive value than FSH level.The predictive value of each indicator is not positively correlated with its corresponding diagnostic sensitivity and specificity,indicating the importance of combined diagnosis.