Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India.
Andrologia. 2022 Oct;54(9):e14364. doi: 10.1111/and.14364. Epub 2022 Aug 9.
Differentiating obstructive (OA) from non-obstructive (NOA) azoospermia is clinically important in managing infertile men. Classically, the differentiation has been based on clinical, hormonal and histological analysis. Histological tests are invasive and may miss spermatogenic areas. Seminal fluid can serve as a medium to assess the status of spermatogenesis and presence or absence of certain markers can help diagnosing and differentiating azoospermia. We evaluated the role of cell-free seminal markers: DDX4, PRM1 and PRM2 in diagnosing and differentiating between OA and NOA and classifying their subtypes. We observed DDX4 was more sensitive for NOA compared with OA. Among various subtypes of NOA, DDX4 positivity was higher in patients with maturation arrest and hypospermatogenesis compared with Sertoli cell only syndrome. PRM1 and PRM2 had very low positivity rate for any meaningful comparison. Seminal cell-free markers can serve as non-invasive tests in diagnosing and differentiating etiologies of azoospermia but their validity needs to be proved in long-term trials with more refined molecular techniques.
区分梗阻性（OA）和非梗阻性（NOA）无精子症对于男性不育的治疗具有重要的临床意义。传统上，这种区分是基于临床、激素和组织学分析的。组织学检查具有侵袭性，可能会错过生精区。精液可以作为评估生精状态的媒介，某些标志物的存在或缺失有助于诊断和区分无精子症。我们评估了无细胞精液标志物：DDX4、PRM1 和 PRM2 在诊断和区分 OA 和 NOA 以及对其亚型进行分类中的作用。我们观察到 DDX4 对 NOA 的敏感性高于 OA。在各种类型的 NOA 中，与唯支持细胞综合征相比，在成熟阻滞和少精子症患者中 DDX4 阳性率更高。PRM1 和 PRM2 的阳性率非常低，没有任何有意义的比较。精液无细胞标志物可作为诊断和区分无精子症病因的非侵入性检查，但它们的有效性需要在具有更精细分子技术的长期试验中得到证实。
