血清卵泡刺激素与抑制素B联合检测评估无精子症睾丸生精功能

Serum follicle-stimulating hormone in combination with serum inhibin B evaluates spermatogenesis of azoospermic men

目的联合检测育龄男性无精子患者血清卵泡刺激素(FSH)和抑制素B(INHB)水平评估睾丸生精功能的临床诊断价值。方法 95例无精子症患者均行血清FSH、INHB检测,根据睾丸活检病理组织学分类,唯支持细胞综合征20例、生精低下25例、成熟阻滞18例和生精功能正常32例。统计分析FSH和INHB的血清水平与病理分类的相关性。结果血清FSH、INHB和INHB/FSH在唯支持细胞综合征组与其他组比较具有显著性差异(P<0.05),生精功能低下组、成熟阻滞组和生精功能正常组比较没有显著性差异(P>0.05);FSH、INHB和INHB/FSH与精细胞成熟阻滞无显著相关性(P>0.05),而在其他组别中均具有显著负相关性(P>0.05);INHB和INHB/FSH在所有研究组别中均具有显著性正相关(P<0.05);血清INHB小于28.55 pg/ml诊断唯支持细胞综合征的敏感度为97%,特异性为85%。结论血清FSH和INHB水平不能有效区分睾丸生精功能状态,但能有效确定唯支持细胞综合征,其他类型的生精功能异常仍需依赖活检病理组织学检查。

Objective This study is in an attempt to evaluate the diagnostic significance to predict the spermatogenesis of azoospermic men in examination of serum follicle-stimulating hormone （FSH） combinatiing with serum inhibin B （INHB）. Methods Quantitative examination of serum FSH and INHB was performed in 95 case of azoospermic men. According to their classifications of testicular biopsy with histopathological examination, there were 20 patients of Sertoli cell only, 25 of hypospermatogenesis, 18 of spermatogenic maturation arrest （complete or incomplete）, and 32 of normal spermatogenesis. The association of serum FSH and INHB levels with histopathological classifications were analyzed by using statistical software. Results Serum FSH, INHB and INHB/FSH levels of Sertoli cell only differed with statistical significance from hypospermatogenesis, spermatogenic maturation arrest and normal spermatogenesis （P〈0.05）. FSH, in which there were no statistical significance among the latter three classifications （P〉0.05）. Serum FSH, INHB and INHB/FSH levels were no relationship with maturation arrest （P〉0.05）, but were negatively related to the other classifications （P〈0.05）. INHB level less than 28.55 pg/ml predicted Sertoli cell only in a sensitivity of 97% and a specificity of 85%. Conclusion Serum FSH and INHB levels is ineffective to distinguish the spermatogenic classifications from azoospermic men, but they are available to confirm the disease of Sertoli cell only. The other abnormalities of azoospermic men is also dependent on bioptic histopathology to confirm the subtypes.