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目的:探讨血清抑制素B(INHB)检测在无精子症患者经睾丸抽吸术(TESE)结局预评估中的意义。方法:根据研究需要将受试者分为3组:梗阻性无精子症(OA)组(n=191),非梗阻性无精子症(NOA)组(n=360),精液参数正常对照组(n=100)。NOA组根据TESE结局分为TESE无精子组(TESE-,n=127)和TESE有精子组(TESE+,n=233)。血液标本均于上午8:00~10:00收集,测定其INHB值。采用受试者工作特征曲线(ROC)分析评价血清INHB预测TESE结局的敏感性和特异性。结果:TESE-组的血清INHB水平[(19.7±34.8)pg/ml]显著低于OA组[(106.8±66.2)pg/ml]、TESE+组[(98.2±62.4)pg/ml]及精液参数正常对照组[(108.3±65.0)pg/ml](P<0.01),TESE+组的血清INHB水平与OA组、精液参数正常对照组无显著性差异(P>0.05)。ROC曲线分析显示,血清INHB最佳分割点为19.1 pg/ml,此时ROC曲线下面积(AUCROC)为0.88,敏感性为90.1%,特异性为84.2%,诊断准确性达88.1%。结论:血清INHB是一种良好的非侵入性的精子生成预测指标,无精子症患者TESE前应该常规行血清INHB检测以评估其TESE结局。
Objective: To investigate the significance of serum inhibin B (INHB) test in the pre-assessment of outcome of testis aspiration (TESE) in patients with azoospermia. Methods: Subjects were divided into three groups: obstructive azoospermia (n = 191), non-obstructive azoospermia (n = 360), sperm parameters control group (n = 100). The NOA group was divided into TESE azoospermia group (TESE-, n = 127) and TESE sperm group (TESE +, n = 233) according to TESE outcome. Blood samples were collected at 8:00 am to 10:00 am and their INHB values were measured. The receiver operating characteristic curve (ROC) analysis was used to assess the sensitivity and specificity of serum INHB in predicting TESE outcome. Results: The level of serum INHB in TESE-group [(19.7 ± 34.8) pg / ml] was significantly lower than that in OA group (106.8 ± 66.2 pg / ml) and TESE + group (98.2 ± 62.4 pg / ml) The level of serum INHB in TESE + group was not significantly different from those in normal control group and normal control group (P> 0.05) [(108.3 ± 65.0) pg / ml] (P <0.01). ROC curve analysis showed that the best cut point of serum INHB was 19.1 pg / ml. The area under ROC curve (AUCROC) was 0.88, the sensitivity was 90.1%, the specificity was 84.2% and the diagnostic accuracy was 88.1%. CONCLUSIONS: Serum INHB is a good predictor of noninvasive spermatogenesis, and sera should be routinely tested by a serum-free INHB test in patients with azoospermia to assess their TESE outcome.