AMH在NOA患者显微取精术前评估中的应用  

Application of AMH in preoperative evaluation of micro-TESE in NOA patients

作　　者：张靖[1] 陈剑辉 陈红 孙桂花 王一达 刘贵华[1] 赵鲁刚[1] 方丛[1] 梁晓燕[1] Jing Zhang;Jianhui Chen;Hong Chen;Guihua Sun;Yida Wang;Guihua Liu;Lugang Zhao;Cong Fang;Xiaoyan Liang(Reproductive Medicine Research Centre,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院生殖医学中心,广州510655

出　　处：《中华生殖与避孕杂志》2022年第10期1008-1013,共6页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨血清抗苗勒管激素(anti-Müllerian hormone,AMH)测定在评估非梗阻性无精子症(non-obstructive azoospermia,NOA)患者显微取精成功率中的价值。方法采用回顾性病例对照研究分析2014年9月至2022年5月期间于中山大学附属第六医院生殖医学中心接受显微取精手术的502例NOA患者的临床资料,根据手术结果分为获精组和未获精组,根据取精术中生精小管是否出现可辨别的差异分为差异可辨组和差异不可辨组,比较各组年龄、睾丸体积、血清AMH以及卵泡刺激素(follicle-stimulating hormone,FSH)、睾酮水平的差异,根据NOA病因分为睾丸炎组(特发性或腮腺炎继发)、AZFc区基因缺失组、隐睾下降固定术后组、克氏综合征(Klinefelter’s syndrome,KS)组、特发性NOA组,比较不同病因NOA患者获精率(sperm retrieval rate,SRR)与AMH水平的差异。结果270例患者成功获取到精子,SRR为53.8%;获精组AMH水平显著低于未获精组[0.81(0.16,3.26)μg/L比1.37(0.21,4.84)μg/L,P<0.001],两组间年龄、睾丸体积、FSH、睾酮水平差异均无统计学意义(均P>0.05)。不同病因NOA的血清AMH水平差异有统计学意义(P<0.001),睾丸炎、AZFc缺失、隐睾下降、KS和特发性NOA的AMH水平分别为0.15(0.01,0.41)μg/L、5.71(3.57,8.26)μg/L、2.29(1.36,3.81)μg/L、0.15(0.05,0.39)μg/L、2.46(0.75,5.49)μg/L。在特发性NOA患者中,显微取精获精组的年龄高于未获精组[(35.2±8.9)岁比(32.5±5.5)岁,P=0.010],睾酮、AMH水平显著低于未获精组[(3.1±1.4)μg/L比(3.7±2.1)μg/L,P=0.029;1.63(0.35,3.84)μg/L比3.00(1.20,6.68)μg/L,P=0.001],两组睾丸体积与FSH水平差异均无统计学意义(均P>0.05);AMH水平对显微取精SRR的受试者工作特征(receiver operating characteristic,ROC)曲线分析,AMH切点值为2.96μg/L、敏感度为0.710、特异度为0.523、曲线下面积(area under the curve,AUC)为0.649。生精小管差异可辨组的AMH水平显著低于差异不可辨组[0.55(0.12,2.05)μg/L�Objective To investigate the value of anti-Müllerian hormone(AMH)determination for estimating the sperm retrieval rate(SRR)of microdissection testicular sperm extraction(micro-TESE)in non-obstructive azoospermia(NOA)patients.Methods This was a retrospective case-control study.Totally 502 NOA patients treated with micro-TESE in Reproductive Medicine Research Centre,the Sixth Affiliated Hospital,Sun Yat-sen University from September 2014 to May 2022 were involved in the investigation.Patients were divided into different groups according to their surgery outcome and seminiferous tubules appearance.Age,testis volume,serum AMH,follicle-stimulating hormone(FSH),testosterone level were compared between the different groups.According to the cause of NOA,they were divided into orchitis group(idiopathic or parotid),AZFc gene deletion group,cryptorchidism descending fixation group,Klinefelter's syndrome(KS)group and idiopathic NOA group.The differences of SRR and AMH level in NOA patients with different etiologies were compared.Results Testicular sperms were successfully retrieved in 270 cases(SRR=53.8%).There were no statistical differences in age,testicular volume,FSH and testosterone levels between the patients who succeeded or failed to obtain sperm(all P>0.05).The patients who obtained sperms had lower serum AMH level than those without sperm[0.81(0.16,3.26)μg/L vs.1.37(0.21,4.84)μg/L,P<0.001].Patients with orchitis or AZFc deletion,cryptorchidism,KS,idiopathic azoospermia have different AMH levels[0.15(0.01,0.41)μg/L,5.71(3.57,8.26)μg/L,2.29(1.36,3.81)μg/L,0.15(0.05,0.39)μg/L,2.46(0.75,5.49)μg/L,P<0.001].Idiopathic azoospermia patients who obtained sperms also had lower testosterone and AMH levels but higher age than those without sperm[(35.2±8.9)years vs.(32.5±5.5)years,P=0.010;(3.1±1.4)μg/L vs.(3.7±2.1)μg/L,P=0.029;1.63(0.35,3.84)μg/L vs.3.00(1.20,6.68)μg/L,P=0.001].There were no statistical differences in testicular volume and FSH level between the two groups(all P>0.05).Receiver operating character

关 键 词：抗苗勒管激素 无精子症 显微取精 

分 类 号：R698.2[医药卫生—泌尿科学]