经阴囊及直肠超声联合血清AMH检测对梗阻性与非梗阻性无精子症的鉴别诊断价值

Differential Diagnostic Value of Trans-scrotal and Rectal Ultrasonography Combined with Serum AMH Detection in Obstructive and Nonobstructive Azoospermia

目的:探讨经阴囊及直肠超声联合血清抗米勒管激素(AMH)检测对无精子症的鉴别诊断价值。方法:选取2017年3月—2021年3月咸宁市第一人民医院收治的无精子症患者90例,均行阴囊及直肠超声检查、血清AMH检测,并根据睾丸活检结果将患者分为梗阻性无精子症(OA)组(n=38)和非梗阻性无精子症(NOA)组(n=52)。比较两组睾丸体积及超声征象、血清AMH水平,通过绘制受试者操作特征(ROC)曲线,分析经阴囊及直肠超声、血清AMH及联合诊断OA的效能。结果:超声结果显示,OA组睾丸体积≥12 mL、附睾及远端精道异常超声征象比例均显著高于NOA组,差异均有统计学意义(P<0.05)。OA组血清AMH水平为(8.43±2.57)ng/mL,明显高于NOA组的(5.58±1.72)ng/mL,差异有统计学意义(P<0.05)。ROC曲线显示,睾丸体积≥12 mL、附睾及远端精道异常超声征象(梗阻征象)、血清AMH、超声联合血清AMH诊断OA的曲线下面积(AUC)分别为0.788、0.793、0.881、0.964。结论:经阴囊及直肠超声联合血清AMH检测鉴别OA与NOA有较高的价值。

Objective:To investigate the differential diagnostic value of trans-scrotal and rectal ultrasonography combined with serum anti-Müllerian hormone(AMH)detection in azoospermia.Method:A total of 90 patients with azoospermia admitted to Xianning First People's Hospital from March 2017 to March 2021 were selected,all of whom underwent trans-scrotal and rectal ultrasonography and serum AMH detection,and the patients were divided into obstructive azoospermia(OA)group(n=38)and nonobstructive azoospermia(NOA)group(n=52)according to the results of testicular biopsy.Testicular volume,ultrasonic signs and serum AMH levels were compared between the two groups.The efficacy of trans-scrotal and rectal ultrasonography,serum AMH and combined diagnosis of OA were analyzed by drawing receiver operator characteristic(ROC)curve.Result:The ultrasonographic results showed that the proportion of testicular volume≥12 mL,abnormal ultrasonic signs of epididymis and distal vas deferens in OA group were significantly higher than those in NOA group,the differences were statistically significant(P<0.05).Serum AMH level in OA group was(8.43±2.57)ng/mL,which was significantly higher than(5.58±1.72)ng/mL in NOA group,the difference was statistically significant(P<0.05).ROC curve showed that the area under the curve(AUC)of testicular volume≥12 mL,abnormal ultrasonic signs of epididymis and distal vas deferens(obstruction signs),serum AMH,and ultrasound combined with serum AMH in diagnosing OA were 0.788,0.793,0.881 and 0.964,respectively.Conclusion:Trans-scrotal and rectal ultrasonography combined with serum AMH detection has a high value in identifying OA and NOA.