血清抑制素B在鉴别梗阻性与非梗阻性无精子症中的意义  

The significance of serum inhibin B in distinguishing obstructive and non-obstructive azoospermia

作　　者：蔡文娟[1,2] 许剑锋[2] 周善杰[2] 卢文红[2] 李鸿[2] 袁冬[2] 谷翊群[2] 

机构地区：[1]北京协和医学院研究生院.北京,100730 [2]国家人口计生委科学技术研究所男性临床研究室,北京100081

出　　处：《生殖医学杂志》2009年第5期442-446,共5页Journal of Reproductive Medicine

基　　金：中央级公益性科研院所基本科研业务费专项(2007计生所JZ01)

摘　　要：目的通过测定血清抑制素B(INHB)并与卵泡刺激素(FSH)和精浆中性α-葡糖苷酶(α-Glu)等经典指标比较,评价INHB在鉴别诊断梗阻性(OA)和非梗阻性无精子症(NOA)中的应用价值,并对睾丸精子发生障碍作出预判。方法实验采集健康生育男性组(n=60),以睾丸活检为金标准确定OA组(n=39)和NOA组(n=77),留取血液和精液标本,进行精液常规分析,检测血清INHB、FSH和精浆中性α-Glu的水平;采用受试者工作特征(ROC)曲线法,通过计算ROC曲线下面积,确定切点值并分析评价检测指标的敏感性和特异性。结果本实验室健康育龄男性血清INHB的95%参考值范围为:20.37～206.21 pg/ml。血清INHB、FSH、精浆中性α-Glu、血清INHB/FSH比值以及INHB+FSH联合在OA组与NOA组之间均差别显著,具有统计学意义(P<0.01)。其中血清INHB的曲线下面积最大,为0.985,诊断价值最高,敏感性为97.4%,特异性为92.2%,切点值为49.89 pg/ml。结论血清INHB比血清FSH、精浆中性α-Glu、血清INHB/FSH比值或INHB+FSH联合指标在鉴别OA与NOA方面具有更好的敏感性与特异性。Objective： To evaluate the applicable value of serum inhibin B（INHB）in distinguishing obstructive and non-obstructive azoospermia and compare it with classical parameters including follicle-stimulating hormone（FSH）and seminal plasma neutral α-glucosidase. Meanwhile,to predict the spermatogenetic malfunc- tion in testes. Methods： Semen and blood samples were collected from healthy tertlie males（n=60）,non-obstructivc azoospermia（NOA, n=77）and obstructive azoospermia（OA, n= 39）that was defined by testicular biopsy as golden standard for diagnosis. Semen parameters were analyzed. Levels of the serum INHB,FSH and seminal plasma neutral α-glucosidase were determined and their area under curve（AUC）, cut-off points, sensitivities and specificities were calculated through receiver operating characteristics（ROC）curve. Results： The 95% confidence interval of serum inhibin B in healthy fertile males was between 20.37 and 206.21 pg/ml in our laboratory. There were significant differences in levels of serum inhibin B, FSH, seminal plasma neutral α-glucosidase, INHB/FSH ratio and combination of INHB plus FSH between the OA and NOA（P〈0.01）,among which,serum INHB alone had the largest AUC of ROC with diagnostic value of 0. 985, while the sensitivity and specificity were 97.4% and 92.2% respectively. Conclusion： Serum inhibin B has better sensitivity and specificity in distinguishing OA and NOA than FSH, seminal plasma neutral α-glucosidase, INHB/FSH ratio and combination of INHB plus FSH.

关 键 词：血清抑制素B 卵泡刺激素 精浆中性α-葡糖苷酶 梗阻性无精子症 非梗阻性无精子症 

分 类 号：R698.2[医药卫生—泌尿科学] R339.21[医药卫生—外科学]