非梗阻性无精子症患者TESA手术结局的预测模型研究

Predictive modeling of testicular sperm aspiration surgical outcomes in patients with non⁃obstructive azoospermia

目的探究非梗阻性无精子症(NOA)患者行TESA手术结局的预测模型。方法我们对2021年1月到12月在北京大学第三医院男科门诊就诊的患者进行了回顾性调查。一共有166例患者的临床资料纳入研究。他们都接受TESA手术治疗,其中取精阳性组(38例),阴性组(128例)。比较各组之间的精液参数以及生殖激素水平的差异,采用二元逻辑回归分析探究NOA患者行TESA手术结局的预测模型,并且采用ROC曲线评估TESA预测模型的准确性。结果在TESA结局分组中,阳性组的血清FSH、LH和INHB水平要高于阴性组(P<0.05),血清T和AMH水平要低于阴性组(P<0.05)。通过对年龄,睾丸体积,以及生殖激素进行二元逻辑回归分析,发现只有AMH和T与TESA的阳性结果相关,AMH具有正相关性(OR=1.143,95%CI:1.027~1.271,P=0.014),T具有负相关性(OR=0.009,95%CI:0.990~1.192,P=0.011)。其余参数无显著相关性。ROC曲线验证模型的准确度,曲线下面积0.868,约登指数0.655,敏感度84.2%,特异度81.25%,cutoff值0.27。结论NOA患者中,血清AMH和T对TSEA阳性结局具有一定预测作用。

Objective To explore the prediction model of the outcome of TESA in patients with non⁃obstructive azoospermia.Methods A retrospective survey was conducted on patients who visited the andrology clinic of Peking University Third Hospital from January to December 2021.A total of 166 patients were included in the study.All of them underwent TESA surgery,including 38 cases in positive group and 128 cases in negative group.The differences of semen parameters and reproductive hormone levels among the groups were compared.Binary logistic regression analysis was used to explore the prediction model of TESA outcome in NOA patients,and ROC curve was used to evaluate the accuracy of TESA prediction model.Results In TESA outcome group,the serum levels of FSH,LH and INHB in the positive group were higher than those in the negative group(P<0.05),and the serum levels of T and AMH were lower than those in the negative group(P<0.05).Binary logistic regression analysis on age,testicular volume,and reproductive hormones showed that only AMH and T were associated with positive TESA results,and AMH had a positive correlation(OR=1.143,95%CI:1.027⁃1.271,P=0.014),and T had a negative correlation(OR=0.009,95%CI:0.990⁃1.192,P=0.011).The other parameters had no significant correlation.ROC curve verified the accuracy of the model.The area under the curve was 0.868,Youden index was 0.655,sensitivity was 84.2%,specificity was 81.25%,and cutoff value was 0.27.Conclusion Serum AMH and T have a certain predictive value for TSEA positive outcome in patients with non⁃obstructive azoospermia.