Lee Richard, Goldstein Marc, Ullery Brant W, Ehrlich Joshua, Soares Marc, Razzano Renee A, Herman Michael P, Callahan Mark A, Li Philip S, Schlegel Peter N, Witkin Steven S
The Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Cornell Institute for Reproductive Medicine, New York, New York, USA.
J Urol. 2009 Jan;181(1):264-9. doi: 10.1016/j.juro.2008.09.004. Epub 2008 Nov 14.
The requisite presence of active spermatogenesis for antisperm antibody production may be useful in identifying obstructive azoospermia. The diagnostic performance of serum antisperm antibody was evaluated as a test for obstructive azoospermia.
A total of 484 men with male infertility who had undergone antisperm antibody testing were evaluated. Demographic data, patient history, and followup were recorded. Obstruction was confirmed by surgical exploration. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated to quantify diagnostic performance. ROC curves were calculated and compared.
Of 484 men 272 possessed documented obstruction of the vas or epididymis and 212 had documented infertility without azoospermia. The obstructed group had significantly increased antisperm antibody levels compared to the nonobstructed group. IgG, IgA, and IgM were analyzed as diagnostic tests for obstruction. The AUC for IgG, IgA and IgM ROC curves was 0.92, 0.85 and 0.67, respectively. The AUC for serum IgG against sperm tails was 0.92, 0.87 against sperm heads and 0.79 against sperm midpieces. IgG demonstrated the highest sensitivity (85%) with a specificity of 97% (chi-square test p <0.01). IgA possessed the highest specificity (99%), positive predictive value (99%) and positive likelihood ratio (70.0).
The presence of serum antisperm antibody was highly accurate in predicting obstructive azoospermia, particularly after vasectomy. It can obviate the need for testis biopsy, the current but more invasive and costly gold standard of detection. This allows the surgeon to proceed directly to surgical reconstruction or sperm retrieval after a simple blood test.
抗精子抗体产生所需的活跃精子发生的存在可能有助于识别梗阻性无精子症。评估血清抗精子抗体作为梗阻性无精子症检测方法的诊断性能。
对总共484名接受抗精子抗体检测的男性不育患者进行评估。记录人口统计学数据、患者病史和随访情况。通过手术探查确认梗阻情况。计算敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比以量化诊断性能。计算并比较ROC曲线。
在484名男性中，272名有输精管或附睾梗阻的记录，212名有非无精子症的不育记录。与非梗阻组相比，梗阻组的抗精子抗体水平显著升高。对IgG、IgA和IgM作为梗阻诊断测试进行分析。IgG、IgA和IgM的ROC曲线的AUC分别为0.92、0.85和0.67。血清IgG针对精子尾部的AUC为0.92，针对精子头部的为0.87，针对精子中段的为0.79。IgG表现出最高的敏感性（85%），特异性为97%（卡方检验p<0.01）。IgA具有最高的特异性（99%）、阳性预测值（99%）和阳性似然比（70.0）。
血清抗精子抗体的存在在预测梗阻性无精子症方面具有高度准确性，尤其是在输精管切除术后。它可以避免进行睾丸活检，而睾丸活检是目前检测梗阻性无精子症的金标准，但具有更高的侵入性且成本更高。这使得外科医生在进行简单的血液检测后可以直接进行手术重建或取精。
