Gao Long, Chen Bin, Lu Yong-Ning, Hu Kai, Wang Hong-Xiang, Han Yin-Fa, Wang Yi-Xin, Huang Yi-Ran
Shanghai Institute of Andrology, Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China.
Zhonghua Nan Ke Xue. 2011 Jun;17(6):492-7.
To detect the levels of seminal plasma leptin (SPL) and serum leptin (SL) in patients with azoospermia, and to explore the methods of using SPL and SL alone or the combination of SPL, SL and follicle stimulating hormone (FSH) for the differential diagnosis of obstructive azoospermia (OA) and non-obstructive azoospermia (NOA).
We enrolled in this study 45 patients with diagnosed OA, 41 with unexplained NOA and 30 men with normal semen parameters as controls. The azoospermia patients underwent percutaneous aspiration from the epididymis (PESA) or aspiration/extraction from the testis (TESA/TESE), and all the subjects were detected for the levels of serum FSH, SPL and SL. Individual and multiple indexes were evaluated by Fisher's discriminant analysis combined with ROC curve analysis.
There were no significant differences in the body mass index (BMI) among the three groups. Compared with the normal control, the OA patients showed an obviously elevated level of SPL (P = 0.048), and the NOA patients remarkably increased levels of FSH (P = 0.000), SL (P = 0.000) and SPL (P = 0.000). In comparison with the OA group, the levels of FSH (P = 0.000), SL (P = 0.006) and SPL (P = 0.033) were significantly increased in the NOA group. For the differential diagnosis of OA and NOA, the areas under the ROC curve of SPL and SL were 0.658 (P = 0.014) and 0.702 (P = 0.002) , respectively, both significantly greater than 0.5, while that of the combination of SPL, SL and FSH was the greatest (0.953). In addition, with 0.026 x SPL +0.05 x SL +0.106 x FSH -2.197 as the combined indicator value and -0.289 as the cut-off value (> or = cut-off value for NOA), the sensitivity and specificity of the combination were 0.878 and 0.902, respectively, both reached the maximum.
Both the levels of SPL and SL are valuable for the differential diagnosis of OA and NOA, but the joint consideration of SPL, SL and FSH may provide better indicators.
检测无精子症患者精浆瘦素（SPL）和血清瘦素（SL）水平，探讨单独使用SPL、SL或联合SPL、SL及卵泡刺激素（FSH）对梗阻性无精子症（OA）和非梗阻性无精子症（NOA）进行鉴别诊断的方法。
本研究纳入45例确诊为OA的患者、41例不明原因的NOA患者以及30例精液参数正常的男性作为对照。无精子症患者接受经皮附睾穿刺抽吸术（PESA）或睾丸抽吸/活检术（TESA/TESE），检测所有受试者血清FSH、SPL和SL水平。采用Fisher判别分析结合ROC曲线分析对单个及多个指标进行评估。
三组患者的体重指数（BMI）无显著差异。与正常对照组相比，OA患者的SPL水平明显升高（P = 0.048），NOA患者的FSH（P = 0.000）、SL（P = 0.000）和SPL（P = 0.000）水平显著升高。与OA组相比，NOA组的FSH（P = 0.000）、SL（P = 0.006）和SPL（P = 0.033）水平显著升高。对于OA和NOA的鉴别诊断，SPL和SL的ROC曲线下面积分别为0.658（P = 0.014）和0.702（P = 0.002），均显著大于0.5，而SPL、SL和FSH联合检测的ROC曲线下面积最大（0.953）。此外，以0.026×SPL + 0.05×SL + 0.106×FSH - 2.197作为联合指标值，以- 0.289作为截断值（≥截断值为NOA），联合检测的灵敏度和特异度分别为0.878和0.902，均达到最大值。
SPL和SL水平对OA和NOA的鉴别诊断均有价值，但联合考虑SPL、SL和FSH可能提供更好的指标。
