Anti-Mullerian Hormone-to-Testosterone Ratio is Predictive of Positive Sperm Retrieval in Men with Idiopathic Non-Obstructive Azoospermia.
Anti-Mullerian Hormone-to-Testosterone Ratio is Predictive of Positive Sperm Retrieval in Men with Idiopathic Non-Obstructive Azoospermia.
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DOI：
10.1038/s41598-017-17420-z
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发表时间：
2017-12-15
影响因子：
4.6
通讯作者：
Salonia A
中科院分区：
文献类型：
--
作者：
Alfano M;Ventimiglia E;Locatelli I;Capogrosso P;Cazzaniga W;Pederzoli F;Frego N;Matloob R;Saccà A;Pagliardini L;Viganò P;Zerbi P;Nebuloni M;Pontillo M;Montorsi F;Salonia A
由于缺乏临床可靠的生物标志物，无法预测非梗阻性无精子症（NOA）男性睾丸精子提取（TESE）的精子回收结果，导致高达50%的不必要的手术干预。分析了47例接受显微解剖TESE（microTESE）的白人-高加索特发性NOA（iNOA）男性的临床数据、激素谱和睾丸实质组织学分类。Logistic回归分析测试了精子回收阳性的潜在临床预测因素。所有变量的预测准确性进行了评估，使用受试者工作特征衍生的曲线下面积，并通过决策曲线分析（DCA）估计的临床净效益。总体而言，23例（49%）和24例（51%）患者在microTESE中被分类为精子回收阳性和阴性。虽然与原发性性腺功能减退症相关的循环激素不能预测精子回收，但抗苗勒管激素（AMH）水平和AMH与总睾酮的比值（AMH/tT）在microTESE中获得了精子回收的独立预测地位，预测准确性为93%和95%。使用AMH <4.62 ng/ml和AMH/tT <1.02的临界值，预测所有个体的精子回收率均为阳性，47名男性中有19名可能免于手术。DCA结果证明了在microTESE中使用AMH和AMH/tT进行患者选择的临床净获益。
The lack of clinically-reliable biomarkers makes impossible to predict sperm retrieval outcomes at testicular sperm extraction (TESE) in men with non-obstructive azoospermia (NOA), resulting in up to 50% of unnecessary surgical interventions. Clinical data, hormonal profile and histological classification of testis parenchyma from 47 white-Caucasian idiopathic NOA (iNOA) men submitted to microdissection TESE (microTESE) were analyzed. Logistic regression analyses tested potential clinical predictors of positive sperm retrieval. The predictive accuracy of all variables was evaluated using the receiver operating characteristic-derived area under the curve, and the clinical net benefit estimated by a decision-curve analysis (DCA). Overall, 23 (49%) and 24 (51%) patients were classified as positive and negative sperm retrievals at microTESE. While circulating hormones associated to a condition of primary hypogonadism did not predict sperm retrieval, levels of anti-Mullerian hormone (AMH) and the ratio AMH-to-total Testosterone (AMH/tT) achieved independent predictor status for sperm retrieval at microTESE, with a predictive accuracy of 93% and 95%. Using cutoff values of <4.62 ng/ml for AMH and <1.02 for AMH/tT, positive sperm retrieval was predicted in all individuals, with 19 men out of 47 potentially spared from surgery. DCA findings demonstrated clinical net benefit using AMH and AMH/tT for patient selection at microTESE.
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DOI：
10.1093/humrep/dew284
发表时间：
2017-01
期刊：
Human reproduction (Oxford, England)
影响因子：
--
作者：
Punab M;Poolamets O;Paju P;Vihljajev V;Pomm K;Ladva R;Korrovits P;Laan M
通讯作者：
Laan M
影响因子：
5.8
作者：
La Marca, Antonio;Marzotti, Stefania;Falorni, Alberto
通讯作者：
Falorni, Alberto
影响因子：
6.1
作者：
McLachlan, R. I.;Rajpert-De Meyts, E.;Skakkebaek, N. E.
通讯作者：
Skakkebaek, N. E.
影响因子：
5.8
作者：
Aksglaede, L.;Sorensen, K.;Juul, A.
通讯作者：
Juul, A.
影响因子：
6.7
作者：
Olesen, Inge Ahlmann;Andersson, Anna-Maria;Juul, Anders
通讯作者：
Juul, Anders