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

摘要： 背景　目前，评估不育症患者睾丸内有无精子最常用的技术为睾丸穿刺取精术（TESA），但其为有创性操作，对患者的身体机能造成影响。所以实际工作中怎样根据患者实际状况，如睾丸体积及生殖激素水平等，评估其睾丸中是否存在精子，对后续患者是否接受TESA及试管婴儿技术达到生育目的相当重要。目的　探讨睾丸体积和生殖激素水平对非梗阻性无精子症患者睾丸中有无精子的预测价值，以期为NOA的临床无创诊疗提供理论依据。方法　回顾性选择2014年2月—2018年3月贵阳市妇幼保健院收治的NOA患者78例。按照TESA结果分为有精组（32例）和无精组（46例）。收集患者年龄、睾丸体积、生殖激素〔泌乳素（PRL）、卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）、总睾酮（TT）〕水平。结果　无精组左侧睾丸体积、右侧睾丸体积、LH水平、E2水平小于有精组，PRL、FSH水平大于有精组（P<0.05）。NOA患者左侧睾丸体积（rs=0.837，P<0.001）、右侧睾丸体积（rs=0.862，P<0.001）、FSH水平（rs=-0.218，P=0.026）、E2水平（rs=0.218，P=0.021）与TESA结果有关。多因素Logistic回归分析结果显示，左侧睾丸体积〔OR=0.741，95%CI（0.542，0.860）〕、右侧睾丸体积〔OR=1.047，95%CI（1.008，1.113）〕、FSH水平〔OR=3.168，95%CI（1.216，8.872）〕是NOA患者无精子的影响因素（P<0.05）。左侧睾丸体积、右侧睾丸体积预测NOA患者无精子的AUC为0.983、0.957，临界值为6.3、6.5 ml，灵敏度为65.5%、92.4%，特异度为99.4%、99.8%；PRL、FSH、LH、E2、TT预测NOA患者无精子的AUC为0.537、0.742、0.607、0.628、0.568，临界值为9.3 μg/L、12.2 U/L、4.9 U/L、48.5 pmol/L、9.9 nmol/L，灵敏度为56.7%、69.4%、77.5%、88.4%、79.2%，特异度为89.4%、90.5%、91.3%、91.6%、90.4%。结论　NOA患者的睾丸体积、FSH水平均对其睾丸中有无精子有一定预测作用，且睾丸体积的预测准确性高于FSH水平，这对临床操作有一定指导意义。

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