Department of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
Department of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2018 Jun;81(6):531-535. doi: 10.1016/j.jcma.2017.09.009. Epub 2017 Oct 25.
An accurate diagnosis of the etiology of azoospermia is crucial, as sperm retrieval methods differ between patients with non-obstructive azoospermia (NOA) and obstructive azoospermia (OA). The aim of this study was to determine hormone and testes size cutoff values to identify the cause of azoospermia in Taiwanese patients.
The medical records of azoospermic patients were retrospectively collected from April 2008 to July 2016, including hormone profile, physical examination findings, and testes size. Bilateral testes biopsies or microdissection testicular sperm extraction were performed in all patients for a definite diagnosis. The diagnostic parameters used to distinguish NOA from OA were analyzed using the t-test and receiver operating characteristic curves.
A total of 51 patients with OA and 156 with NOA were included. The mean levels of testosterone (4.5 vs. 3.4 ng/ml) and E2 (26.3 vs. 19.2 pg/ml) were significantly higher in the OA group, whereas the levels of follicular stimulating hormone (FSH) (5.6 vs. 25.4 mIU/ml) and Leutinizing hormone (LH) (3.7 vs. 11.6 mIU/ml) were lower. Receiver operating characteristic curve analysis revealed that FSH and right testis size were the best individual diagnostic predictors. Using a combination of FSH >9.2 mIU/ml and right testis size <15 ml, the positive predictive value for NOA was 99.2% and 81.8% for OA.
A combination of FSH >9.2 mIU/ml and right testis size <15 ml was a strong predictor of NOA in our Taiwanese patients.
准确诊断无精子症的病因至关重要，因为非梗阻性无精子症（NOA）和梗阻性无精子症（OA）患者的精子获取方法不同。本研究旨在确定激素和睾丸大小的临界值，以确定台湾患者无精子症的病因。
回顾性收集了 2008 年 4 月至 2016 年 7 月无精子症患者的病历，包括激素谱、体格检查结果和睾丸大小。所有患者均行双侧睾丸活检或微创睾丸精子提取术以明确诊断。使用 t 检验和受试者工作特征曲线分析用于区分 NOA 和 OA 的诊断参数。
共纳入 51 例 OA 患者和 156 例 NOA 患者。OA 组的睾酮（4.5 对 3.4ng/ml）和雌二醇（26.3 对 19.2pg/ml）水平明显较高，而卵泡刺激素（FSH）（5.6 对 25.4mIU/ml）和黄体生成素（LH）（3.7 对 11.6mIU/ml）水平较低。受试者工作特征曲线分析显示，FSH 和右侧睾丸大小是最佳的个体诊断预测指标。使用 FSH >9.2mIU/ml 和右侧睾丸大小<15ml 的组合，对 NOA 的阳性预测值为 99.2%，对 OA 的阳性预测值为 81.8%。
在我们的台湾患者中，FSH >9.2mIU/ml 和右侧睾丸大小<15ml 的组合是 NOA 的有力预测指标。
