非梗阻性无精子症患者睾丸体积、生殖激素水平与睾丸穿刺取精结果的相关性研究

Correlation of testicular volume and reproductive hormone level with the results of testicular sperm aspiration in non-obstructive azoospermia patients

目的:探讨非梗阻性无精子症患者睾丸体积、生殖激素水平与睾丸穿刺取精术(TESA)结果的相关性,以及可用于预测TESA结果的睾丸体积、生殖激素水平的切点值,从而为非梗阻性无精子症患者进一步诊疗提供重要资料。方法:121例研究对象均为非梗阻性无精子症患者(NOA),测定其睾丸体积和生殖激素水平,并根据TESA结果分为无精子组和有精子组。结果:无精子组和有精子组的左侧睾丸体积(ml)、右侧睾丸体积(ml)、泌乳素(PRL,ng/ml)、卵泡刺激素(FSH,mIU/ml)、黄体生成素(LH,mIU/ml)、雌二醇(E2,pmol/L)、血清总睾酮(TT,nmol/L)水平分别为7.07±1.06和11.75±1.38、7.37±1.37和11.70±1.98、12.43±11.69和9.60±4.55、15.77±10.84和8.01±7.43、6.12±2.92和8.11±20.11、119.36±43.52和141.12±48.33、11.43±4.05和12.46±4.60。无精子组血清FSH和PRL水平平均值高于有精子组,并且有显著的统计学差异。虽然无精子组的睾丸体积平均数小于有精子组,但两组之间没有统计学差异。对于年龄、血清E2和TT水平,两组之间也没有统计学差异。利用ROC曲线优选的睾丸体积切点值为9 ml,此点其敏感性为93.8%/89.6%(左/右),特异性为100%/94.3%(左/右),睾丸体积ROC曲线的AUC为0.984/0.961(左/右),表明其诊断准确性较高;优选的血清FSH水平切点值为8.18 mIU/ml,此点其敏感性为71.2%,特异性为75.0%,FSH水平ROC曲线的AUC为0.743,表明其诊断准确性中等。结论:睾丸体积和FSH水平对于预测NOA患者TESA结果具有重要意义,并且睾丸体积诊断准确性明显优于FSH。

Objective： To investigate the correlation of the testis volume and reproductive hormone level with the results of testicular sperm aspiration（TESA） in non-obstructive azoospermia（NOA） patients,and to explore the cut-off value of the testis volume and reproductive hormone level in predicting the results of TESA so as to provide reliable information for the diagnosis and treatment of NOA.Methods： We enlisted 121 NOA patients in this study,divided them into a sperm group and a non-sperm group based on the results of TESA,and measured their testis volumes and reproductive hormone levels.Results： The left testis volume,the right testis volume,and the levels of prolactin（PRL）,follicle-stimulating hormone（FSH）,luteinising hormone（LH）,estradiol（E2） and total testosterone（T） in the non-sperm and sperm groups were（7.07±1.06） ml vs（11.75±1.38） ml,（7.37±1.37） ml vs（11.70±1.98） ml,（12.43±11.69） ng/ml vs（9.60±4.55） ng/ml,（15.77±10.84） mIU/ml vs（8.01±7.43） mIU/ml,（6.12±2.92） mIU/ml vs（8.11±20.11） mIU/ml,（119.36±43.52） pmol/L vs（141.12±48.33） pmol/L,and（11.43±4.05） nmol/L vs（12.46±4.60） nmol/L,respectively.The mean levels of serum FSH and PRL were significantly higher in the non-sperm than in the sperm group.Although the mean testis volume of the former was less than that of the latter,there were no significant differences between the two groups,and nor were any significant differences in age and the levels of E2 and T.The cut-off value of the testis volume was 9 ml,with sensitivity of 93.8%/89.6%（left/right） and specificity of 100%/94.3%（left/right）.The area under curve（AUC） of the left testis volume was 0.984 and that of the right was 0.961,indicating a high diagnostic accuracy.The cut-off value of the serum FSH level was 8.18 mIU/ml,with a sensitivity of 71.2% and a specificity of 75.0%.The AUC of the FSH level was 0.743,suggestive of a moderate diagnostic accuracy.Conclusion： The testis volume and FSH level are important for predicting the TESA results of NOA patients,and the former has even a higher diagnostic accuracy than the latter.