非梗阻性无精子症患者血清抗缪勒氏管激素水平与睾丸显微取精结果的关系
|
摘要
目的探讨非梗阻性无精子症患者血清抗缪勒氏管激素(anti-Müllerian hormone, AMH)、抑制素B(inhibin B, InhB)、卵泡刺激素(follicle-stimulating hormone, FSH)、黄体生成素(luteinizing hormone, LH)、雌二醇(estradiol, E_2)、总睾酮(total testosterone, TT)水平与睾丸显微取精术(microdissection testicular sperm extraction, M-TESE)结果的相关性。方法非梗阻性无精子症患者58例,均行M-TESE,并依据检查结果分为获精组32例和无精组26例。采用ELISA法检测2组血清AMH、InhB水平,采用电化学发光法检测2组血清FSH、LH、E_2、TT水平;绘制ROC曲线,分析血清AMH水平预测M-TESE获精的效能。结果获精组血清AMH[(1.75±1.64)μg/L]水平低于无精组[(5.40±4.80)μg/L](P<0.05),血清InhB[(19.18±16.92)ng/L]、FSH[(24.73±14.00)u/L]、LH[(16.83±9.26)u/L]、E_2[(72.56±35.67)pmol/L]、TT[(9.82±7.39)nmol/L]水平与无精组[(13.63±7.28)ng/L、(26.10±9.78)u/L、(14.47±6.55)u/L、(95.86±57.51)pmol/L、(12.73±7.39)nmol/L]比较差异无统计学意义(P>0.05);AMH以2.425μg/L为最佳截断值,预测M-TESE获精的AUC为0.737(95%CI:0.602～0.873,P=0.002),灵敏度为65.4%、特异度为78.1%。结论对非梗阻性无精子症患者,检测血清AMH有助于预测M-TESE能否获得精子。
Objective To investigate the correlations of serum anti-Müllerian hormone(AMH), inhibin B(InhB), follicle-stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E_2) and total testosterone(TT) with the results of microdissection testicular sperm extraction(M-TESE) in patients with non-obstructive azoospermia(NOA). Methods Fifty-eight patients with NOA were divided into M-TESE-positive group(n=32) and M-TESE-negative group(n=26) accoding to M-TESE result. The levels of AMH and Inh-B were detected by ELISA technique, and the levels of FSH, LH, E_2 and TT were detected by ECLA. The efficiency of AMH on predicting M-TESE was analyzed by ROC. Results The serum AMH level was significantly lower in M-TESE-positive group((1.75±1.64) μg/L) than that in M-TESE-negative group((5.40±4.80) μg/L)(P<0.05). There were no significant differences in the levels of InhB((19.18±16.92) ng/L vs.(13.63±7.28) ng/L), FSH((24.73±14.00) u/L vs.(26.10±9.78) u/L), LH((16.83±9.26) u/L vs.(14.47±6.55) u/L), E_2((72.56±35.67) pmol/L vs.(95.86±57.51) pmol/L) and TT((9.82±7.39) nmol/L vs.(12.73±7.39) nmol/L) between M-TESE-positive group and M-TESE-negative group(P>0.05). When the optimal cut-off value of AMH was 2.425 μg/L, the AUC for predicting M-TESE-positive was 0.737(95%CI: 0.602-0.873, P=0.002), the sensitivity was 65.4% and specificity was 78.1%. Conclusion The detection of serum AMH contributes to the prediction of M-TESE results in NOA patients.
Objective To investigate the correlations of serum anti-Müllerian hormone(AMH), inhibin B(InhB), follicle-stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E_2) and total testosterone(TT) with the results of microdissection testicular sperm extraction(M-TESE) in patients with non-obstructive azoospermia(NOA). Methods Fifty-eight patients with NOA were divided into M-TESE-positive group(n=32) and M-TESE-negative group(n=26) accoding to M-TESE result. The levels of AMH and Inh-B were detected by ELISA technique, and the levels of FSH, LH, E_2 and TT were detected by ECLA. The efficiency of AMH on predicting M-TESE was analyzed by ROC. Results The serum AMH level was significantly lower in M-TESE-positive group((1.75±1.64) μg/L) than that in M-TESE-negative group((5.40±4.80) μg/L)(P<0.05). There were no significant differences in the levels of InhB((19.18±16.92) ng/L vs.(13.63±7.28) ng/L), FSH((24.73±14.00) u/L vs.(26.10±9.78) u/L), LH((16.83±9.26) u/L vs.(14.47±6.55) u/L), E_2((72.56±35.67) pmol/L vs.(95.86±57.51) pmol/L) and TT((9.82±7.39) nmol/L vs.(12.73±7.39) nmol/L) between M-TESE-positive group and M-TESE-negative group(P>0.05). When the optimal cut-off value of AMH was 2.425 μg/L, the AUC for predicting M-TESE-positive was 0.737(95%CI: 0.602-0.873, P=0.002), the sensitivity was 65.4% and specificity was 78.1%. Conclusion The detection of serum AMH contributes to the prediction of M-TESE results in NOA patients.
引文
[1] WOSNITZER M,GOLDSTEIN M,HARDY M P.Review of azoospermia[J].Spermatogenesis,2014,4(3):e282181-e282187.
[2] 崔险峰,丁攀,张云山.非梗阻性无精子症患者的外科取精方法应用进展[J].山东医药,2015,55(43):98-100.
[3] SHAH R,GUPTA C.Advances in sperm retrieval techniques in azoospermic men:a systematic review[J].Arab J Urol,2017,16(1):125-131.
[4] 赵连明,姜辉,洪锴,等.显微取精失败患者特点分析[J].中国男科学杂志,2016,30(10):34-37.
[5] 王彦飞,胡蓉.抗苗勒管激素与男性生殖相关疾病的研究进展[J].国际生殖健康/计划生育杂志,2017,36(1):49-52.
[6] 巨清华,姜卫,李森,等.血清抑制素B联合性激素检测在显微取精术术前评估中的临床意义[J].西北国防医学杂志,2018,39(4):221-223.
[7] ALRABEEAH K,WACHTER A,PHILLIPS S,et al.Sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE) in men with cryptozoospermia[J].Andrology,2015;3(3):462-466.
[8] CETINKAYA M,ONEM K,ZORBA OU,et al.Evaluation of microdissection testicular sperm extraction results in patients with non-obstructive azoospermia:independent predictive factors and best cut-off values for sperm retrieval[J].Urol J,2015,12(6):2436-2443.
[9] 路锦,李杭生,韦多,等.抗苗勒管激素及体质量指数与多囊卵巢综合征患者控制性促排卵结局的相关性分析[J].中华实用诊断与治疗杂志,2018,32(6):529-532.
[10] 吴寒,刘德风,赵连明,等.抗缪勒氏管激素在男科及辅助生殖领域的应用[J].中国性科学,2017,26(8):114-118.
[11] ALFANO M,VENTIMIGLIA E,LOCATELLI I,et al.Anti-Müllerian hormone-to-testosterone ratio is predictive of positive sperm retrieval in men with idiopathic non-obstructive azoospermia[J].Sci Rep,2017,7(1):17638-17647.
[12] 梁琳琳,李杭生,张翠莲.卵巢功能评估研究现状[J].中华实用诊断与治疗杂志,2012,26(3):213-215.
[13] XU T,PENG L,LIN X,et al.Predictors for successful sperm retrieval of salvage microdissection testicular sperm extraction (TESE) following failed TESE in non-obstructive azoospermia patients[J].Andrologia,2017,49(4):12642-12651.
[14] LEI B,LV D,ZHOU X,et al.Biochemical hormone parameters in seminal and blood plasma samples correlate with histopathologic properties of testicular biopsy in azoospermic patients[J].Urology,2015,85(5):1074-1078.
[15] 刘永杰,王莹,刘芳,等.无精子症患者雌二醇与雌激素受体α、β间的相关性及其对精子的影响[J].上海医学,2016,39(1):35-38.
[2] 崔险峰,丁攀,张云山.非梗阻性无精子症患者的外科取精方法应用进展[J].山东医药,2015,55(43):98-100.
[3] SHAH R,GUPTA C.Advances in sperm retrieval techniques in azoospermic men:a systematic review[J].Arab J Urol,2017,16(1):125-131.
[4] 赵连明,姜辉,洪锴,等.显微取精失败患者特点分析[J].中国男科学杂志,2016,30(10):34-37.
[5] 王彦飞,胡蓉.抗苗勒管激素与男性生殖相关疾病的研究进展[J].国际生殖健康/计划生育杂志,2017,36(1):49-52.
[6] 巨清华,姜卫,李森,等.血清抑制素B联合性激素检测在显微取精术术前评估中的临床意义[J].西北国防医学杂志,2018,39(4):221-223.
[7] ALRABEEAH K,WACHTER A,PHILLIPS S,et al.Sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE) in men with cryptozoospermia[J].Andrology,2015;3(3):462-466.
[8] CETINKAYA M,ONEM K,ZORBA OU,et al.Evaluation of microdissection testicular sperm extraction results in patients with non-obstructive azoospermia:independent predictive factors and best cut-off values for sperm retrieval[J].Urol J,2015,12(6):2436-2443.
[9] 路锦,李杭生,韦多,等.抗苗勒管激素及体质量指数与多囊卵巢综合征患者控制性促排卵结局的相关性分析[J].中华实用诊断与治疗杂志,2018,32(6):529-532.
[10] 吴寒,刘德风,赵连明,等.抗缪勒氏管激素在男科及辅助生殖领域的应用[J].中国性科学,2017,26(8):114-118.
[11] ALFANO M,VENTIMIGLIA E,LOCATELLI I,et al.Anti-Müllerian hormone-to-testosterone ratio is predictive of positive sperm retrieval in men with idiopathic non-obstructive azoospermia[J].Sci Rep,2017,7(1):17638-17647.
[12] 梁琳琳,李杭生,张翠莲.卵巢功能评估研究现状[J].中华实用诊断与治疗杂志,2012,26(3):213-215.
[13] XU T,PENG L,LIN X,et al.Predictors for successful sperm retrieval of salvage microdissection testicular sperm extraction (TESE) following failed TESE in non-obstructive azoospermia patients[J].Andrologia,2017,49(4):12642-12651.
[14] LEI B,LV D,ZHOU X,et al.Biochemical hormone parameters in seminal and blood plasma samples correlate with histopathologic properties of testicular biopsy in azoospermic patients[J].Urology,2015,85(5):1074-1078.
[15] 刘永杰,王莹,刘芳,等.无精子症患者雌二醇与雌激素受体α、β间的相关性及其对精子的影响[J].上海医学,2016,39(1):35-38.