抗缪勒管激素检测在非梗阻性无精子症诊断中的临床应用  

Clinical Application of Detection of Anti- Mü llerian Hormone in Diagnosis of Non-obstructive Azoospermia

作　　者：黄永富[1,2] 张峰 

机构地区：[1]扬州大学第四临床医学院 [2]南通瑞慈医院检验医学中心,江苏南通226010 [3]南通市通州区人民医院检验科,江苏南通226300

出　　处：《黑龙江医学》2014年第10期1196-1200,共5页Heilongjiang Medical Journal

摘　　要：目的通过测定非梗阻性无精子症患者精浆抗缪勒管激素（AMH）,了解其对非梗阻性无精子症患者睾丸精子生成状况的预测作用,探讨其是否可以作为睾丸精子生成的精浆标志物。方法使用酶联免疫法、固相化学发光免疫法测定正常生育组（n=20）、梗阻性无精子症组（OA组,n=12）、非梗阻性无精子症组（NOA组,n=24）3组年轻男性精浆中的AMH浓度和血清促卵泡激素（FSH）和睾酮（T）浓度,经阴囊B超测量睾丸体积（TV）,并用睾丸组织病理活检或睾丸精子获取术（TESE）寻找此3组男性的精子生成证据。运用ROC曲线来确定各实验诊断指标对NOA患者TESE术成功与否的预测诊断价值,并运用ROC曲线决定图来确定各指标的最佳诊断阈值。结果 AMH在正常生育组人员精浆中的浓度范围为未检出（〈3.20 pmol/L）至556.00 pmol/L（几何平均值为118.73 pmol/L）,高于血清水平（范围从〈3.20-84.82 pmol/L,几何平均值为28.72 pmol/L）。OA组患者精浆AMH浓度均未检出,这就确认了其睾丸来源。NOA组患者精液AMH浓度比正常生育组显著降低（范围：〈3.20-68.60 pmol/L,几何平均值为17.70 pmol/L）（P〈0.01）,但与血清FSH水平无关。NOA组患者精浆AMH浓度和睾丸活检的结果比较显示,13例检测不出精浆AMH的患者有11例与精子缺乏有关;而检出精浆AMH（浓度为7.60-68.60 pmol/L）的11例患者中有8例与存在持续性睾丸生精功能有关。精浆AMH、血清FSH、睾丸体积和联合参数用于区分NOA患者TESE术成功与否的最佳诊断阈值分别为≥8.60 pmol/L、≤11.3 IU/L、≥12.5 mL和≥18.6。结论精液AMH在非梗阻性无精子症患者中可作为一种非侵入性持久性精子发生过少的标志物,这可在卵胞浆内单精子显微注射术（ICSI）前预示睾丸精子恢复成功与否的可能性。Objective By determining the seminal plasma anti -mullerian hormone in non -obstructive azoospermia, to study its role in predicting a situation of testicular spermatogenesis in patients with non - obstructive azoospermia , and to investigate whether it can be used as a seminal plasma marker of spermatogenesis in men＇s testes. Methods AMH seminal concentrations, FSH and Testosterone serum concentrations have been detected by an enzyme - linked immunoassay and solid - phase chemiluminescent immunoassay respectively and testicular volume have been measured by transscrotal B ultrasonography in three groups of young men ： fertile donors, obstructive azoospermia and non - obstructive azoospermia. Evidence of spermatogenesis in three male groups has been sought for by testicular tissue biopsy or TESE. ROC curve was applied to confirm the predictive diagnostic value of various experimental diagnostic indicators in distinguishing successful results from failed ones in TESE for NOA patients, and ROC decision curves was also used to determine the best diagnostic cutoff value for each indicator. Results Seminal plasma AMH concentration （from 〈3.20 pmol/L to 556.00 pmol/L, 118.73 pmol/L as the geometric mean） was higher than serum level （ from 〈 3.20 pmol/L to 84.82 pmol/L, 28.42 pmol/L as the geometric mean） in most fertile donors. Seminal AMH concentrations were undetectable in all obstructive azoospermic patients, confirming its testicular origin. In non - obstructive azoospermia, seminal AMH concentration was lower than that in fertile donors without correlation with serum FSH values （from 3.20 pmol/L to 68.60 pmol/L, 17.70 pmol/L as the geometric mean）. Comparison of seminal AMH concentration and the results of histological analysis of testicular biopsies in NOA patients revealed that undetectable AMH found in 13 cases was associated in 11 of them with lack of spermatozoa, while detectable concentrations of AMH（ concentration rate was 7.60 - 68.60 pmol/L） found in eleven cases were associated in

关 键 词：抗缪勒管激素 非梗阻性无精子症 梗阻性无精子症 精浆标志物 

分 类 号：R446[医药卫生—诊断学]