| Background:In today's society,more and more infertility patients are present.Males often present with azoospermia,especially non-obstructive azoospermia?NOA?patients,some of which are currently able to obtain sperm from testicular biopsy for In-Vitro Fertilization.However,blind biopsy is deeply traumatic,so it is not the first choice,it is greatly necessary to explore minimally invasive or non-invasive methods to replace biopsy.In recent years,real-time sonoelastography?RTE?has been explored in evaluating spermatogenesis in patients with azoospermia,and has shown gerat prospects for clinical application.At the same time,many studies have shown that serum inhibin-B?INHB?has excellent application value in assessing testicular spermatogenesis.Objective:1.To investigate the RTE for testes and serum INHB in patients with azoospermia,and look forward to finding a noninvasive,painless,easy-to-operate technique to evaluate testicular spermatogenesis in these patients;2.To explore the sperm retrieval rate of fine needle aspiration biopsy in patients with NOA guided by RTE combined with serum INHB.Methods:Patients with azoospermia who were treated in our department of Andrology from July 2018 to November 2019 were strictly selected according to the inclusion criteria.163 participants were included for 40 in the obstructive azoospermia?OA?group,69 in the NOA group and 54 in the normal control group.All these participants were analyzed for general data,ultrasound elastography scoring of Testicles,and serum INHB concentration measurements.At the same time,NOA patients were tested to analyse for elastography strain ratio and fine needle puncture testicular sperm aspiration?TESA?.Results:1.In the general data statistics,the smoking rate?68.8%?in the azoospermia group was higher than that?46.3%?in the normal control group,and the difference was statistically significant?P<0.05?.While there were no significant differences in alcohol consumption,age,and body mass index?BMI?between the groups?P?0.05?.2.The elasticity score of 3 and 4 in the NOA group accounted for a total of 73.8%,and the score of 2 and 3 in the OA group and the normal group accounted for 77.50%and 75.93%,respectively.And the score of 2 account for the most among them.The M?P25,P75?of INHB concentration in NOA,OA and normal group were 28.40?14.20,44.70?,154.10?99.83,234.00?,158.55?110.88,247.00?pg/ml,respectively.In the NOA group,both the elasticity score and the serum INHB were statistically significant compared with the OA group and the normal group?P<0.05?,while the OA group and the normal group were not significantly different?P>0.05?.The RTE score of overall participants was negatively linearly correlated with serum INHB?r=-0.634,P<0.001?.3.From the biopsy results of NOA patients,the sperm retrieval rate?SRR?of TESA was 39.1%;the testicular elastic strain rate?SR?and serum INHB were statistically different between the TESA?-?and?+?groups?P<0.001?.There was a negative linear correlation between SR and INHB concentration?r=-0.626,P<0.001?.Using TESA as the gold standard,the ROC curve was used to evaluate SR,INHB,and SR combined with INHB to predict the value of the SRR of testicular biopsy.The area under the ROC curve?AUC?of SR,INHB,and SR+INHB was obtained and is 0.89,0.90,0.93,respectively.The best cutoff values for SR and INHB were 0.46 and 33.9 pg/ml,respectively.The x±s of SR from Sertoli cell only syndrome?SCOS?,hypospermatogenesis?H S?,a n d m a t u r a t i o n a r r e s t?M A?w e r e 0.6 6±0.2 1,0.4 5±0.1 2,0.44±0.14,respectively.while the M(P25,P75)of INHB are 14.10?8.25,24.45?,37.50?27.83,47.75?,32.60?20.48,47.75?,respectively.Regardless of SR or INHB,there are statistical differences among the former and the latter two,however the differences between the latter two are not significant.Conclusion:Both ultrasound strain elasticity RTE and serum INHB can be used as indicators to evaluate testicular spermatogenesis in patients with azoospermia,and have certain clinical value for differentiating OA and NOA.The combination of two indicators can better predict SRR.Although SR and serum INHB cannot accurately predict the pathological types,a better distinction can be made for patients with SCOS from other types to avoid blind puncture and guide clinical diagnosis and treatment of male infertility. |
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