结合血清卵泡刺激素、抑制素B、染色体核型和Y染色体AZF基因微缺失与睾丸穿刺取精术成功率的相关性

Combined evaluation of serum follicle-stimulating hormone, inhibin B, chromosome karyotyping and AZF microdeletion of Y-chromosome for predicting outcomes of testicular sperm aspiration in azoospermic patients

目的探讨无精子症患者血清卵泡刺激素(FSH)、抑制素B(INHB)、染色体核型、Y染色体AZF基因微缺失(AZF-MD-Ych)与睾丸穿刺精子抽吸(TESA)成功率的相关性。方法在162例血清FSH正常组和100例血清FSH异常组的育龄期无精子症患者中进行对比分析,分析两组患者INHB水平、INHB/FSH的比值、外周血染色体核型和AZF-MD-Ych的差异性。排除INHB异常、染色体异常和AZF-MD-Ych阳性后,再比较两组患者TESA的成功率。结果两组患者中,血清INHB水平、INHB/FSH比值和外周血染色体核型均具有显著性差异(P<0.05),而AZF-MD-Ych这两组中没有统计学上的差异(P>0.05);在未检测到染色体异常、AZF-MD-Ych阳性及INHB异常的患者中,TESA显示精子获取率在FSH正常组为61.82%(34/55),FSH异常组均未成功(0/16),二者存在统计学差异(P<0.01)。结论现有的血清FSH正常值结合INHB、染色体核型分析和AZF-MD-Ych检查,能够综合判断TESA的成功率,四项指标均出现异常者,TESA的成功率极低。

Objective To assess the value of combined evaluation of serum follicle- stimulating hormone（FSH）, inhibin B（INHB）, chromosome karyotyping and AZF microdeletion of Y- chromosome（AZF- MD- Ych） in predicting the success of testicular sperm aspiration（TESA） in azoospermic patients. Methods A total of 262 azoospermic patients were divided into two groups with normal（n=162） and abnormal（n=100） serum FSH levels. INHB levels, INHB/FSH ratio, chromosome karyotype patterns of the peripheral lymphocytes, and AZF- MD- Ych were compared between the two groups. Among the patients receiving TESA, the success rate of the procedure was compared between the two groups after excluding abnormalities in INHB, chromosome karyotype and AZF- MD- Ych. Results Significant differences were found between the two groups in serum INHB level, INHB/FSH and chromosome karyotypes（P0.05）, but not in AZF-MD-Ych（P0.05）. After excluding the abnormalities in chromosome karyotypes, AZF-MD-Ych and INHB, sperms were obtained successfully by TESA from 61.82%（34/55） of patients with normal FSH but from none of those with abnormal FSH（P0.01）. Conclusion A combined evaluation of serum FSH, INHB, chromosome karyotypes and AZF- MD- Ych can effectively predict the success of TESA in azoospermic patients, and abnormalities in all the 4 indices suggest a very low success rate of sperm retrieval by TESA.