血清抑制素B和FSH检测预测非梗阻性无精子症患者睾丸精子获取并卵胞浆内单精子注射术成功的价值

Serum Inhibin B and FSH Determination Predicts A Successful Sperm Recovery of Testicular Sperm Extraction in Men with Non-obstructive Azoospermia to be Treated by Intracytoplasmic Sperm Injection

目的 探讨血清抑制素B和FSH测定用于预测同时进行卵胞浆内单精子注射术（ICSI）治疗的男性非梗阻性无精子症患者睾丸精子获取术（TESE）成功与否的价值.方法 根据研究需要将所有受试者分成3组.第1组包括24例需要进行TESE术同时进行ICSI术治疗的男性非梗阻性无精子症患者;额外2组作为阳性的对照组,第2组包括22例梗阻性无精子症的不育男性,第3组包括26例精液参数正常的精液捐献者.使用市售试剂盒对受试者的血清促卵泡激素（FSH）和二聚体抑制素B（INHB）浓度进行测定,均采用酶联免疫吸附法（ELISA）.结果 第1组与第2组、第3组相比,FSH浓度显著增高（P＜0.01）,而INHB水平显著降低（P＜0.001）.TESE成功男性与TESE失败男性相比,血清INHB的浓度显著升高（P＜0.001）.相比之下,这两个组的血清FSH或睾丸大小之间没有可检测到的区别.此外,与对照组相比,血清INHB而不是FSH可区分第1组受试者的TESE术的成功与失败.根据受试者工作特性曲线分析,INHB区分TESE成功与失败的最佳值是＞42 pg/ml（敏感度为92.0％,特异度为90.0％）.结论 血清INHB的测定是一个有用的非侵入性的精子生成的预测指标.因此,在进行TESE术之前,除了测定FSH和分析核型外,所有无精子症的男性都应该测定血清INHB的浓度.

Objective To investigate the usefulness of serum inhibin B （INHB） and FSH measurement to predict the success of testicular sperm extraction （TESE） in men with nonobstructive azoospermia to be treated by intracytoplasmic sperm injection （ICSI）.Methods According to the requirement of the study,all subjects were divided into three groups.Group 1 consisted of 24 men with nonobstructive azoospermia underwent TESE to be treated by intracytoplasmic sperm injection （ICSI） synchronized （or study group）.Two additional groups were used as positive controls,group 2 comprised 22 infertile men having obstructive azoospermia,and group 3,which included 26 semen donors having normal seminal parameters.Serum FSH concentrations and dimeric INHB concentrations of all the subjects were measured in enzyme-linked immunosorbent assay methods （ELISA） both with two monoclonal antibodies by commercially available kits.Results Follicle stimulating hormone （FSH） was significantly higher （P＜0.01） and INHB significantly lower （P＜0.001）,in group 1 as compared with groups 2 and 3.Serum INHB concentrations were significantly higher （P＜0.001） among successful TESE men as compared with those having failed TESE.In contrast,no differences were detected between these two groups with respect to serum FSH or testicular size.In addition,serum INHB but not FSH discriminated between successful and failed TESE in group 1 subjects as compared with control groups.According to the receiver operating characteristics curve analysis,the best INHB value for discriminating between successful and failed TESE was ＞42 pg/ml （sensitivity 92.0 ％,specificity 90.0 ％）.Conclusion Serum INHB measurement is a useful non-invasive predictor of spermatogenesis and thus,all azoospermic males should have serum INHB concentrations determined in addition to FSH measurement and karyotyping prior to undergoing TESE.