三维超声监测特发性低促性腺激素性性腺功能减退症无精子患者睾丸体积对患者生精功能的预测价值

Value of three-dimensional ultrasonic monitoring testicular volume for predicting spermatogenic function in patients with idiopathic hypogonadotropic hypogonadism

目的:采用三维超声监测特发性低促性腺激素性性腺功能减退症(idiopathic hypogonadotropic hypogonadism,IHH)无精子男性患者治疗前、后的睾丸体积,并检测其性激素水平变化,探讨两者预测患者治疗后生精的价值。方法:选取2019年1月至8月期间在本院接受微量泵脉冲输注戈那瑞林治疗12周的IHH男性无精子患者52例,按照治疗后有无精子生成分为生精组(15例)和未生精组(37例,包含1例左侧隐睾患者)。比较2组患者治疗前、后的睾丸体积及性激素[促卵泡素(follicle-stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、睾酮]水平的变化及精液常规。结果:治疗12周后生精组与未生精组的睾丸体积整体均较治疗前增大(P<0.05),生精组治疗前睾丸体积及治疗前后血清睾酮水平增量均大于未生精组,差异有统计学意义(P<0.05);在生精组和未生精组中,患者治疗前后的睾丸体积增量[左侧(0.40±0.72)mL、右侧(0.54±0.77)mL]与其睾酮水平增量呈正相关(P<0.05),与FSH、LH水平增量无关(P>0.05)。右侧及左侧睾丸治疗前体积(临界值分别为3.75 mL、3.50 mL)预测治疗后睾丸生精的灵敏度为93.33%、99.8%,特异度为75.68%、81.08%;在生精组,治疗后睾酮水平增量[(1.76±2.62)ng/mL]预测治疗后睾丸生精的灵敏度为80%,特异度为97.3%,灵敏度差异有统计学意义。结论:三维超声检测IHH无精子男性患者治疗前的睾丸体积,对预测患者治疗后睾丸生精有一定的价值,且睾丸治疗前体积预测治疗后生精的灵敏度高于治疗后血清睾酮水平增量。

Objective:To explore use of three-dimensional ultrasound for predicting spermatogenic function by monitoring testicular volume before and after treatment in patients with idiopathic hypogonadotropic hypogonadism(IHH),and to compare application value with those of changes in sex hormone levels.Methods:A total of 52 male patients with azoospermia due to IHH received micro-pump pulse infusion of gonarelin for 12 weeks in our hospital from January to August 2019 were selected.Patients were divided into 2 groups:spermatogenic groups(15 cases)and non-spermatogenic group(37 cases,including one case of left cryptorchidism).The testicular volume and sex hormones[follicle-stimulating hormone(FSH),luteinizing hormone(LH),testosterone(T)]levels before and after treatment in the two groups were compared,as well as the semen routine.Results:After 12 weeks of treatment,the overall testicular volume of patients in the spermatogenic group and the non-spermatogenic group increased(P<0.05).The testicular volume before treatment and the increase of serum T level after treatment in the spermatogenic group were higher than those in the non-spermatogenic group(P<0.05).In both spermatogenic group and the non-spermatogenic group,the increase in testicular volume after treatment was positively correlated with the increase in T level(P<0.05),and was not related to FSH,LH level increase(P>0.05).The sensitivity of the right and left testicular volume before treatment to predict spermatogenesis after treatment was 93.33%and 99.8%,and the specificity was 75.68%and 81.08%respectively.The increase in T level before and after treatment for predicting spermatogenesis had a sensitivity of 80%and a specificity of 97.3%after treatment.Conclusions:Testicular volume monitoring with three-dimensional ultrasound before treatment is helpful to predict spermatogenesis in male patients with azoospermia,and sensitivity of which is higher than that of increase in T after treament.