超声联合血清性激素预测NOA患者睾丸显微取精的Logistic回归分析

Logistic regression analysis of ultrasound combined with serum sex hormones for predicting micro-TESE in NOA patients

摘要:

目的应用Logistic回归分析超声联合血清性激素与非梗阻性无精子症睾丸显微取精的相关性，构建回归模型预测显微取精结果。 方法选取经显微取精的102例非梗阻性无精子症患者(共204个睾丸)，术前超声测量睾丸体积，睾丸网厚度，附睾各部位厚度以及检验血清性激素，根据显微取精是否获取精子分为两组，采用方差分析比较两组各指标差异性，将具有显著差异的指标引入Logistic回归模型，并绘制ROC曲线，评价超声联合血清性激素对显微取精结果的预测价值。 结果二分类Logistic回归模型筛选出睾丸体积(X1)、睾丸网厚度(X2)、黄体生成素(X3)及睾酮(X4)这4个对取精结果预测有统计学意义的变量，Logistic回归方程为: Logit(P)=-0.100-0.170X1+0.950X2-0.066X3-0.279X4，该模型预测取精结果的灵敏度为81.6%，特异度为60.8%，ROC曲线下面积为0.764。 结论超声测量睾丸网厚度、睾丸体积结合黄体生成素及睾酮建立起的Logistic回归模型对于术前无创预测NOA患者显微取精结果具有良好的预测价值。

Abstract:

ObjectiveTo investigate the correlation between ultrasound combined with serum sex hormones and microdissection testicular sperm extraction in patients with non-obstructive azoospermia with Logistic regression analysis, and construct a regression model to predict the results of microdissection testicular sperm extraction. MethodsA total of 102 patients with non-obstructive azoospermia(204 testes) who underwent microdissection testicular sperm extraction were selected. Preoperative ultrasound was used to measure testicular volume, rete testis thickness, thickness of various parts of the epididymis, and serum sex hormones were tested. According to whether sperm was obtained by microdissection testicular sperm extraction, the patients were divided into two groups. Analysis of variance was used to compare the differences in various indicators between the two groups. The indicators with significant differences were introduced into the Logistic regression model, and receiver operating characteristic(ROC) curves were drawn to evaluate the predictive value of ultrasound combined with serum sex hormones for microdissection testicular sperm extraction results. ResultsThe binary Logistic regression model selected four variables with statistical significance for predicting sperm retrieval results: testicular volume(X1), rete testis thickness(X2), luteinizing hormone(X3), and testosterone(X4). The Logistic regression equation was: Logit(P)=-0.100-0.170X1+0.950X2-0.066X3-0.279X4, the sensitivity and specificity of this model for predicting microdissection testicular sperm extraction results was 81.6%, 60.8%, respectively; and the area under the ROC curve was 0.764. ConclusionThe Logistic regression model established by ultrasound measurement of rete testis thickness, testicular volume combined with luteinizing hormone and testosterone has good predictive value for preoperative non-invasive prediction of microdissection testicular sperm extraction in NOA patients.