血清生物标记物在非梗阻性和梗阻性无精子症鉴别诊断中的应用

Clinical Application of Serum T/LH Ratio and FSH to Distinguish between Non-Obstructive and Obstructive Azoospermia

摘要: 目的：阐释血清生物标记物在非梗阻性(NOA)和梗阻性无精子症(OA)鉴别诊断中的临床应用价值。方法：本研究回顾性分析2020年7月至2022年7月在云南省第一人民医院辅助生殖中心309例无精子症患者的临床资料，其中梗阻性无精子症(OA)患者118例，非梗阻性无精子症(NOA)患者191例。对血清AMH、FSH、LH、E2、Te、PRL、T与LH比以及睾丸平均体积采用二元Logistic回归分析联合ROC评价。结果：有临床诊断价值的指标为血清T/LH、FSH、Te。血清T/LH比值区分梗阻性和非梗阻性无精子症患者的ROC AUC为0.869 (临界值2.033，敏感性为96.6%，特异性为65.4%)，血清FSH水平ROC AUC为0.938 (临界值10.035 mIU/mL，敏感性为84.8%，特异性为99.2%)，血清Te水平ROC AUC为0.649，曲线下面积小于0.7。结论：临床区分男性梗阻性和非梗阻性无精子症可将血清T/LH比值 < 2.033作为初筛指标，敏感度为96.6%；FSH > 10.035 mIU/mL作为非梗阻性无精子症的诊断指标，特异性为99.2%。

Abstract: Objective: To explain the clinical application value of serum biomarkers in the differential diagnosis of non-obstructive azoospermia (NOA) and obstructive azoospermia (OA). Methods: This study ret-rospectively analyzed the clinical data of 309 azoospermia patients in the Assisted Reproduction Center of the First People’s Hospital of Yunnan Province from July 2020 to July 2022, including 118 patients with obstructive azoospermia (OA) and 191 patients with non-obstructive azoospermia. The serum AMH, FSH, LH, E2, Te, PRL, T to LH ratio and average testicular volume were evaluated by binary Logistic regression analysis combined with ROC. Results: The indexes of clinical diagnostic value were serum T/LH, FSH, and Te. The ROC AUC of serum T/LH ratio for distinguishing obstruc-tive and non-obstructive azoospermia patients was 0.869 (critical value 2.033, sensitivity 96.6%, specificity 65.4%), the serum FSH ROC AUC was 0.938 (critical value 10.035 mIU/mL, the sensitivity was 84.8%, the specificity was 99.2%), the serum Te ROC AUC was 0.649, and the area under the curve was less than 0.7. Conclusion: To clinically distinguish male obstructive and non-obstructive azoospermia, the serum T/LH ratio < 2.033 can be used as a primary screening index, with a sensi-tivity of 96.6%; FSH > 10.035 mIU/mL can be used as a diagnostic index for non-obstructive azoo-spermia. The specificity was 99.2%.