PDF(Pubmed)
Abstract：
Azoospermia is a serious leading male-factor cause of infertility in couples of childbearing age. The two main azoospermia types, obstructive (OA) and non-obstructive (NOA) azoospermia, differ in their treatment approaches. Therefore, their clinical diagnosis is extremely important, requiring an accurate, efficient, and easy-to-use diagnostic model. This retrospective observational study included 707 patients with azoospermia treated between 2017 and 2021, 498 with OA, and 209 with NOA. Hematological and seminal plasma parameters, hormone levels, and testicular volume were used in logistic regression analysis to evaluate and compare their diagnostic performance, results showed that the optimal diagnostic model is constructed by five variables including semen volume, semen pH, seminal plasma neutral α-glucosidase activity, follicle-stimulating hormone in the serum, and testicular volume, compared with follicle-stimulating hormone-based and testicular volume-based models. The 5-factor diagnostic model had an accuracy of 90.4%, sensitivity of 96.4%, positive predictive value of 90.6%, negative predictive value of 89.8%, and area under the curve of 0.931, all higher than in the other two models. However, its specificity (76.1%) was slightly lower than in the other models. Meantime, the internal 5-fold cross-validation results indicated that the 5-factor diagnostic model had a good clinical application value. This study established an accurate, efficient, and relatively accessible 5-factor diagnostic model for OA and NOA, providing a reference for clinical decision-making when selecting an appropriate treatment.
摘要：
无精子症是育龄夫妇不育的一个严重的男性因素。两种主要的无精子症类型，阻塞性（OA）和非阻塞性（NOA）无精子症，不同的治疗方法。因此,他们的临床诊断非常重要，需要一个准确的，高效,和易于使用的诊断模型。这项回顾性观察性研究包括2017年至2021年接受治疗的707例无精子症患者，其中498例患有OA，209和NOA。血液学和精浆参数，激素水平,和睾丸体积用于逻辑回归分析，以评估和比较它们的诊断性能，结果表明,最优诊断模型由精液体积,精液pH值,精浆中性α-葡萄糖苷酶活性，血清中的促卵泡激素,和睾丸体积,与基于卵泡刺激素和基于睾丸体积的模型相比。5因素诊断模型的准确率为90.4%，灵敏度为96.4%，阳性预测值为90.6%，阴性预测值为89.8%，曲线下面积为0.931，均高于其他两个模型。然而,其特异性(76.1%)略低于其他模型.同时,内部5倍交叉验证结果表明,5因素诊断模型具有良好的临床应用价值.这项研究建立了一个准确的，高效,OA和NOA的5因素诊断模型，为临床选择合适的治疗方案提供参考。
