Application of nomograms in predicting sperm retrieval possibility with PESA/TESA procedures in men with azoospermia
Application of nomograms in predicting sperm retrieval possibility with PESA/TESA procedures in men with azoospermia
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列线图在预测无精子症男性 PESA/TESA 手术取精可能性中的应用
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影响因子：
0.1
通讯作者：
Chen Bin
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作者：
Song Xin;Lin Nanhe;Wang Youlin;Chen Bin
目的：建立无精子症患者经皮附睾精子抽吸术(PESA)和睾丸精子抽吸术(TESA)取精的预测模型。方法：对139例接受PESA/TESA治疗的无精子症患者的临床资料进行回顾性分析。Logistic回归分析年龄、不育期、体重指数、睾丸体积、卵泡刺激素、黄体生成素、催乳素、T、E_2、抑制素B、精浆中性α-葡萄糖苷酶、果糖对取精液的预测价值。根据多元Logistic回归分析结果建立正常图，并用受试者操作特征曲线(AUC)下面积、校正曲线和协调性指数进行测量。结果：67例患者均成功获取睾丸精子。总的平均取精率为48.2%。单因素Logistic回归分析显示，睾丸体积、血清卵泡刺激素、胰岛素B和精浆中性α-葡萄糖苷酶与精子获取率相关(P<0.0 5)。多因素Logistic回归分析显示，卵泡刺激素、胰岛素样生长因子B和精浆中性α-葡萄糖苷酶是影响精子取出率的独立预测因素(P<0.05)。AUC值为0.857(95%CI：0.794~0.921，P<0.05)。经内部验证的诺模图的C指数为0.862。校正曲线接近最佳曲线，重合度的平均绝对差值为0.022。结论：FSH、InHB和精浆中性α-葡萄糖苷酶是预测无精子症患者PESA/TESA取精可能性的可靠指标。诺模图简明易懂，在临床决策中具有重要价值。
Objective: The goal of this study was to build a nomogram predicting sperm retrieval possibility with percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) in men with azoospermia. Methods: This study retrospectively evaluated clinical parameters of 139 azoospermia patients that underwent PESA/TESA. Predictive values of age, duration of infertility, BMI, testicular volume, FSH, LH, PRL, T, E2, Inhibin B, seminal plasma neutral α-glucosidase, and fructose for retrieving testicular sperm were analyzed by logistic regression analysis. The nomogram was built according to results of multiple logistic regression analysis and measured by area under the receiver-operating characteristic curve (AUC), calibration curve, and concordance index. Results: Testicular sperm was successfully retrieved in 67 patients. The overall mean sperm retrieval rate was 48.2%. According to univariable logistic regression analysis, testicular volume, serum FSH, Inh B, and seminal plasma neutral α-glucosidase were associated with sperm retrieval rates (p＜0.05). The nomogram, built after multivariable logistic regression analysis, demonstrated that FSH, Inh B, and seminal plasma neutral α-glucosidase were independent predictors of sperm retrieval rates (p＜0.05). The AUC was 0.857 (95% CI: 0.794–0.921, p＜0.05). The C-index of the nomogram through internal validation was 0.862. The calibration curve was close to the optimum curve, with an average absolute difference of coincidence degree of 0.022. Conclusion: The nomogram, including FSH, Inh B, and seminal plasma neutral α-glucosidase, was proven to be accurate in predicting sperm retrieval possibility with PESA/TESA procedures in men with azoospermia. The nomogram is easy to understand and has an important value in clinical decision-making.