精浆AMH水平对非梗阻性无精症的临床预测价值  

Clinical predictive value of seminal plasma AMH level for non-obstructive azoospermia

作　　者：段丽 陈艺[2] 杨帆[2] 杜丹[2] 王可耕[1] 卢思宇 沈文涛 刘彦 DUAN Li;CHEN Yi;YANG Fan;DU Dan;WANG Kegeng;LU Siyu;SHEN Wentao;LIU Yan(Institute of Pathogenic Biology,Hengyang Medical College,Nanhua University,Hengyang 421001,China;Chenzhou First People's Hospital,Chenzhou 423000,China;School of Nursing,Nanhua University,Hengyang 421001,China;Huilongshan Town Health Center of Tuanfeng County in Huibei Province,Tuanfeng 438800,China)

机构地区：[1]南华大学衡阳医学院病原生物学研究所,湖南衡阳421001 [2]湖南省郴州市第一人民医院,湖南郴州423000 [3]南华大学护理学院,湖南衡阳421001 [4]湖北省团风县回龙山镇卫生院,湖北团风438800

出　　处：《中国现代医生》2019年第31期1-4,9,共5页China Modern Doctor

基　　金：湖南省卫生计生委基金项目（B2015-52）

摘　　要：目的探讨抗缪勒管激素(AMH)水平对非梗阻性无精子症(NOA)的临床预测价值。方法采用酶联免疫法和电化学发光免疫分析法检测NOA患者精浆AMH、血清促卵泡激素(FSH)以及睾酮(T)的浓度;B超检测其睾丸体积;通过睾丸显微取精术(M-TESE)检获精子;同时设置对照组,并进行统计学分析。结果 NOA组的AMH浓度分别低于OA组[(19.53±9.13)pmol/L,(52.34±15.13)pmol/L,P<0.05]及NF组[(158.53±37.45)pmol/L,P<0.05];NOA组的FSH浓度分别高于OA组[(18.36±8.95)U/L,(5.51±3.32)U/L,P<0.05]及NF组[(6.12±3.02)U/L,P<0.05];NOA患者的睾酮浓度[(15.32±5.43)nmol/L]分别与OA组[(15.63±6.23)nmol/L]、NF组[(15.81±5.73)nmol/L]比较无显著性差异(P>0.05,P>0.05);NOA组左右睾丸体积TV[(9.58±3.83)mL,(7.46±3.57)mL]分别与OA组[(16.97±2.56)mL,(15.32±3.63)mL]、NF组[(16.23±3.53)mL,(16.84±2.83)mL]存在显著性差异(P<0.05,P<0.05)。NOA组有10人检获精子,OA组19人检获精子(P<0.05)。Logistic回归分析检验发现AMH预测NOA患者睾丸内是否存在精子的拟合优度最佳(Wald χ2=26.198,P<0.01);ROC曲线图显示精浆AMH的AUC值最大;精浆AMH的阳性似然比为7.36[81.82%/(1-88.89%)],阴性似然比为0.20[(1-81.82%)/88.89%]。结论精浆AMH浓度对于预测NOA患者M-TESE成功与否具有重要的意义。Objective To evaluate the clinical predictive value of anti-Mullerian hormone(AMH) level for non-obstructive azoospermia(NOA). Methods Enzyme-linked immunosorbent assay and electrochemiluminescence immunoassay were used to detect the concentration of seminal plasma AMH, serum follicle stimulating hormone(FSH) and testosterone(T) in NOA patients. B-ultrasound was used to test testicular volume. And Sperm was acquired by M-TESE. The control group was set up at the same time and statistical analysis was performed. Results The AMH concentration(19.53±9.13) pmol/L in the NOA group was lower than that in the OA group(52.34±15.13) pmol/L and that in the NF group(158.53±37.45) pmol/L, P<0.05. The FSH concentration(18.36±8.95) U/L in the NOA group was higher than that in the OA group(5.51±3.32) U/L and that in the NF group(6.12±3.02) U/L, P<0.05. The testosterone concentration in NOA patients(15.32±5.43) nmol/L was not significantly different from that of OA group(15.63±6.23)nmol/L and NF group(15.81±5.73)nmol/L, P>0.05. The left and right testicular volume TV in the NOA group was(9.58±3.83)mL and(7.46±3.57)mL, which was significantly different from that in the OA group(16.97±2.56)mL and(15.32±3.63) mL, and that in the NF group(16.23±3.53)mL and(16.84±2.83)mL, P<0.05. Sperm was detected in 10 patients in the NOA group and19 in the OA group(P<0.05). Logistic regression analysis showed that AMH predicted the best fit of sperm in the testis of NOA patients(Wald χ2=26.198, P<0.01).ROC curve showed the AUC value of seminal plasma AMH was the highest.The positive likelihood ratio of the seminal plasma AMH was 7.36(81.82%/(1-88.89%)),and the negative likelihood ratio was 0.20(1-81.82%)/88.89%). Conclusion The concentration of seminal plasma AMH is important for predicting whether the success of M-TESE in patients with NOA or not.

关 键 词：非梗阻性无精症 抗缪勒管激素 睾丸显微取精术 精子检获 

分 类 号：R446.6[医药卫生—诊断学]