目的:本研究旨在确定FSH水平的诊断准确性,睾丸体积,和睾丸组织学在预测接受常规睾丸精子提取(TESE)的非梗阻性无精子症患者的成功精子回收(SSR)中的作用。
方法:我们回顾性评估了2004年6月至2009年7月间356例非梗阻性无精子症患者。二元逻辑回归用于评估我们的预测模型的诊断准确性,将精子提取率确定为二元因变量。用源自受试者工作特征(ROC)曲线的曲线下面积(AUC)估计值对单独评价的所有变量的预测准确性进行定量。
结果:患者平均年龄为36.8岁。356例患者中有158例(44.3%)获得了睾丸精子。216例患者(60.6%)获得仅支持细胞综合征(SCO)的组织学诊断,55例患者(15.4%)患有成熟停滞(MA),85例(23.8%)患有精子生成减少(HYPO)。二元logistic回归模型具有统计学意义(χ2=96.792,p<0.0001),正确分类了72.8%的病例,敏感性为46.8%,特异性为93.4%,阳性预测值(PPV)85.06%,阴性预测值(NPV)68.7%,+似然比(LR)7.13和-LR0.57。只有睾丸组织学对模型有重要意义,而FSH和睾丸体积没有。HYPO患者的精子恢复率(SRR)明显高于SCO或MA患者(88.2vs30.5和30.9%,分别,p<0.0001)结论:这项研究表明,在预测精子回收的模型中包括睾丸组织学可以提高其诊断准确性。由于在TESE之前没有组织学,该模型仅适用于以前进行过睾丸手术的患者。
OBJECTIVE: The present
study sought to determine the diagnostic accuracy of FSH level, testicular volume, and testicular histology in predicting the successful sperm retrieval (SSR) in a large cohort of patients with non-obstructive azoospermia undergoing conventional testicular sperm extraction (TESE).
METHODS: We retrospectively evaluated 356 patients with non-obstructive azoospermia between June 2004 and July 2009. Binary logistic regression was used to evaluate the diagnostic accuracy of our predicting model, identifying sperm retrieval rate as binary dependent variable. The predictive accuracy of all variables individually evaluated was quantified with area under curve (AUC) estimates derived from receiver operating characteristic (ROC) curve.
RESULTS: The mean patients\' age was 36.8 years. Testicular sperm were retrieved in 158 out of 356 patients (44.3 %). Histological diagnosis of Sertoli cell only syndrome (SCO) was obtained in 216 patients (60.6 %), while 55 patients (15.4 %) had maturation arrest (MA) and 85 (23.8 %) had hypospermatogenesis (HYPO). The binary logistic regression model was statistically significant (χ 2 = 96.792, p < 0.0001) and correctly classified 72.8 % of cases with 46.8 % sensitivity and 93.4 % specificity, positive predictive value (PPV) 85.06 %, negative predictive value (NPV) 68.7 %, +likelihood ratio (LR) 7.13, and -LR 0.57. Only testicular histology was significant to the model, while FSH and testicular volume were not. Sperm retrieval rate (SRR) was significantly higher in patients with HYPO compared to patients with SCO or MA (88.2 vs 30.5 and 30.9 %, respectively, p < 0.0001) CONCLUSIONS: This
study demonstrates that including testicular histology in a model for predicting sperm retrieval increases its diagnostic accuracy. As histology is not available prior to TESE, this model applies only to patients with previous testicular surgery.