血清抗缪勒管激素检测在无精子症临床诊治中的意义-东南大学学报医学版

血清抗缪勒管激素检测在无精子症临床诊治中的意义

单位：上海交通大学附属第一人民医院泌尿外科医学中心男科男性健康评估中心, 上海 200080

分类号：R698.2

出版年·卷·期（页码）：2020·39·第一期（53-57）

摘要：

目的：探讨血清抗缪勒管激素（AMH）测定在无精子症患者睾丸功能评估中的应用价值。方法：2016年5月至2018年5月间上海交通大学附属第一人民医院泌尿中心男科收治310例接受睾丸切开取精手术的无精子症患者，其中梗阻性无精子症（OA）80例为OA组，非梗阻性无精子症（NOA）230例为NOA组。NOA组中38例经显微手术成功取得精子者为NOA-RS组，192例未取得精子者为NOA-RF组。NOA组根据睾丸体积分为NOA-Ⅰ组（≥10 ml，155例）和NOA-Ⅱ组（<10 ml，75例）。对这些病例的临床资料进行回顾分析，应用酶联免疫的方法检测各组血清AMH水平。结果：OA组睾丸体积显著大于NOA两组（P<0.01），其血清AMH水平与睾丸体积大小不相关。OA组的AMH水平高于NOA两组，而NOA-Ⅰ及NOA-Ⅱ组的血清AMH水平均随睾丸体积缩小而降低。OA组中AMH水平与INHB水平呈显著正相关（P<0.01），与FSH、LH、T水平无相关性。NOA-Ⅰ组AMH水平与INHB水平有相关性（P<0.05），与FSH、T水平呈显著相关性（P<0.01），与LH水平无相关性。伴随AMH水平下降，INHB、T水平下降，FSH水平升高。NOA-Ⅱ组AMH水平与FSH、LH水平呈显著相关性（P<0.01），伴随AMH水平下降，与INHB、T水平无关，FSH、LH水平明显升高。NOA-RS组的AMH水平显著低于NOA-RF组（P<0.05），两组年龄差异无统计学意义。结论：血清AMH、INHB联合检测有助鉴别OA与NOA，并对于NOA患者睾丸生精功能评估具有一定意义。血清AMH不能单独用于预测NOA睾丸取精率。

Objective: To explore the clinical significance of serum anti-Müllerian hormone (AMH) detection in assessment of testis spermatogenic function in patients with azoospermia. Methods: 310 azoospermic patients received microscope assisted testicular sperm extraction in the Urology Center of Shanghai General Hospital Affiliated to Shanghai Jiaotong University from May 2016 to May 2018, including 80 cases with obstructive azoospermia (OA) and 230 cases with non-obstructive azoospermia (NOA). 38 NOA cases succeeded in microsurgical sperm retrieval (NOA-RS group), while the rest 192 cases failed (NOA-RF group). The NOA cases were also subdivided according their testis volume, NOA-Ⅰ group (≥10 ml, 155 cases), NOA-Ⅱ group (<10 ml, 75 cases). The clinical data were retrospectively analyzed. Results: The testis volumes of OA group were significantly larger than those in NOA-Ⅰ and Ⅱ groups (P<0.01), and the AMH level was not related to testis volume. The AMH levels in OA group were higher than those in NOA-Ⅰ and Ⅱ groups, while the AMH levels decreased together with the testis volumes in NOA groups. The AMH level was positively related with INHB level(P<0.01), but not associated with FSH, LH and T levels in OA group. The AMH level correlated with INHB level in NOA-Ⅰ group(P<0.05), while significantly correlated with FSH and T levels(P<0.01), but not correlated with the LH level. The INHB and T levels dropped alongside with the AMH lelvel decrease, while FSH level increased instead. In NOA-Ⅱ group, AMH level significantly correlated with FSH and LH levels (P<0.01).The FSH and LH levels increased significantly in contrast to AMH level decrease, but not correlated with the INHB and T levels. The AMH level in NOA-RS group was significantly lower then that in the NOA-RF group(P<0.05).The age distribution was similar between NOA-RS group and NOA-RF group. Conclusion: Concurrent analysis of serum AMH and INHB levels may not only be useful in differentiation of OA and NOA patients, but also can help in assessment of testis spermatogenic function. However, the serum AMH level alone is not related to the sperm retrieval results in NOA patients.

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