关键词: 无精子症, 非梗阻性, 睾丸, 睾丸体积, 生殖激素, 泌乳素, 卵泡刺激素, 黄体生成素, 雌二醇, 睾酮, 睾丸穿刺取精术, 精子, 灵敏度, 特异度, 预测价值

Abstract: Background　Testicular sperm aspiration（TESA）is the most commonly used technique for assessing infertility patients at present.However，it is a traumatic procedure that affects patient's bodily functions.Therefore，how to determine the presence of sperm in the testis according to the actual condition of the patient by measuring patient's testicular volume and reproductive hormone levels is very important to determine whether a patient receives TESA and in vitro fertilization（IVF）technology for fertility.Objective　To explore the predictive value of testicular volume and reproductive hormone levels on the presence and absence of spermatozoa in testis of patients with non-obstructive azoospermia（NOA），in order to provide a theoretical basis for clinical non-invasive diagnosis and treatment of NOA.Methods　Seventy-eight patients with NOA admitted to Maternity and Child Health Hospital of Guiyang from February 2014 to March 2018 were retrospectively selected.According to TESA results，patients were divided into spermatozoa group（32 cases）and azoospermia group（46 cases）.The patient's age，testicular volume，reproductive hormone〔prolactin（PRL），follicle stimulating hormone（FSH），luteinizing hormone（LH），estradiol（E2），total testosterone（TT）〕levels were collected.Results　The left testicular volume and right testicular volume were smaller，and LH level and E2 level were lower in the azoospermia group than those in the spermatozoa group，while the PRL level and FSH level were higher（P<0.05）.The left testicular volume（rs=0.837，P<0.001），right testicular volume（rs=0.862，P<0.001），FSH level（rs=-0.218，P=0.026）and E2 level（rs=0.218，P=0.021）were correlated with TESA results in patients with NOA.Multivariate Logistic regression analysis showed that left testicular volume〔OR=0.741，95% CI（0.542，0.860）〕，right testicular volume〔OR=1.047，95% CI（1.008，1.113）〕，and FSH level〔OR=3.168，95% CI（1.216，8.872）〕were influencing factors of azoospermia in NOA patients（P<0.05）.The AUC of the left and right testicular volume to predict the azoospermia of NOA patients were 0.983 and 0.957，and the critical values were 6.3 ml and 6.5 ml with the sensitivity of 65.5% and 92.4% and the specificity of 99.4% and 99.8%.The AUC of the PRL，FSH，LH，E2 and TT levels to predict the azoospermia of NOA patients were 0.537，0.742，0.607，0.628，and 0.568，and the critical values were 9.3 μg/L，12.2 U/L，4.9 U/L，48.5 pmol/L，and 9.9 nmol/L with the sensitivity of 56.7%，69.4%，77.5%，88.4%，and 79.2% and specificity of 89.4%，90.5%，91.3%，91.6%，and 90.4%.Conclusion　The testicular volume and FSH level have a certain predictive effect on the presence or absence of sperm in the testis of patients with NOA，and the accuracy of testicular volume prediction is higher than that of FSH level，which is of certain guiding significance in clinical practice.

Key words: Azoospermia, Non-obstructive, Testis, Testicular volume, Reproductive hormone, Prolactin, Follicle stimulating hormone, Luteinizing hormone, Estradiol, Testosterone, Testicular sperm aspiration, Serisitivity, Spermatozoa, Specificity, Predictive value