睾酮与促卵泡激素比值可预测特发性非梗阻性无精子症患者的取精成功
这项多机构回顾性队列研究纳入60例严格定义的特发性非梗阻性无精子症男性，评估术前激素指标对显微取精成功率的预测价值。结果显示睾酮/促卵泡激素比值区分能力最强（AUC=0.81），外部验证中唯一保持显著（AUC=0.74），两步模型（T/FSH>20且LH<10）预测敏感度93%、特异度81%。
要点
- 术前睾酮/促卵泡激素比值是特发性非梗阻性无精子症患者显微取精成功的可重复预测指标。
- T/FSH比值预测能力优于单一激素指标，外部验证AUC为0.74。
- T/FSH>20且LH<10的两步模型预测敏感度93%、特异度81%。
核心结论
- 睾酮/促卵泡激素比值是特发性非梗阻性无精子症患者显微取精成功的可重复且具临床意义的预测指标。
- 该比值在两个独立队列中均优于单一激素预测指标，且是唯一经外部验证的术前预测指标。
研究设计与样本
- 多机构回顾性队列研究，2014至2024年开展。
- 纳入60例严格定义的特发性非梗阻性无精子症男性，包括预测队列30例和独立多机构验证队列30例。
- 特发性非梗阻性无精子症定义为两次精液分析无精子且无既往生育史、无梗阻证据、无既往泌尿生殖手术、无已知遗传异常、术前1年内未使用经验性药物治疗。
- 敏感性分析排除促卵泡激素<7.6 IU/L者及病理示生精低下者。
主要发现
- 取精成功者促性腺激素水平显著更低，睾酮/促卵泡激素比值更高。
- 在所有激素指标中，睾酮/促卵泡激素比值区分能力最强（AUC=0.81）。
- 排除病理示生精低下者后，该比值显著性仍保持。
- 外部验证中，睾酮/促卵泡激素比值是唯一保持统计学显著的变量（AUC=0.74）。
- 分区分析揭示两步模型（T/FSH>20且LH<10）预测取精成功敏感度93%、特异度81%。
关键数值与推荐
- 睾酮/促卵泡激素比值预测取精成功的AUC在预测队列为0.81，外部验证队列为0.74。
- 两步模型阈值：T/FSH>20且LH<10，敏感度93%、特异度81%。
临床怎么用
- 对于特发性非梗阻性无精子症患者，术前可计算睾酮/促卵泡激素比值以辅助预测显微取精成功概率。
- T/FSH>20且LH<10提示取精成功可能性较高，可帮助临床咨询与决策。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To evaluate novel preoperative hormonal predictors of sperm retrieval success in men with idiopathic nonobstructive azoospermia (NOA) undergoing microsurgical testicular sperm extraction (mTESE). DESIGN: Multi-institutional retrospective cohort study conducted between 2014 and 2024. SUBJECTS: A total of 60 men with strictly defined idiopathic NOA from multiple sites participating in the MOBYUS Male Infertility Research Consortium were included, comprising a prediction cohort (n = 30) and an independent multi-institutional validation cohort (n = 30). Idiopathic NOA was defined by azoospermia on two separate semen analyses without prior paternity, evidence of obstruction, prior genitourinary surgery, documented genetic abnormalities, or use of empirical medical therapy within 1 year before surgery. Sensitivity analyses were performed by excluding men with follicle-stimulating hormone (FSH) levels <7.6 IU/L and men with hypospermatogenesis on pathology. EXPOSURE: Preoperative FSH, luteinizing hormone (LH), and total testosterone (T) levels measured within 1 year before mTESE. Hormone-derived ratios, including T/FSH, T/LH, and LH/FSH, were subsequently analyzed. MAIN OUTCOME MEASURES: Successful sperm retrieval at mTESE served as the primary outcome. Predictive performance was evaluated using logistic regression to assess hormonal predictors, area under the receiver operating characteristic curve (AUC), and partition analysis to identify optimal clinical thresholds for sperm retrieval prediction. RESULTS: Men with successful sperm retrieval had significantly lower gonadotropin levels and higher T/FSH ratios. Among all hormonal metrics, T/FSH demonstrated the strongest discriminative ability (AUC = 0.81). The significance remained after excluding men with hypospermatogenesis noted on testicular pathology. In external validation, T/FSH was the only variable that maintained statistical significance (AUC = 0.74). Partition analysis further revealed a two-step model (T/FSH >20 and LH <10) that achieved 93% sensitivity and 81% specificity for predicting sperm retrieval success. CONCLUSION: This multi-institutional study demonstrates that the T/FSH ratio is a reproducible and clinically meaningful predictor of sperm retrieval success in men with idiopathic NOA. Across two independent and diverse cohorts, this ratio consistently outperformed single-hormone predictors and remained the only externally validated preoperative predictor of mTESE success.
引用
- Siva J, Naelitz BD, Vallabhaneni S, et al. Testosterone-to-follicle stimulating hormone ratio predicts sperm retrieval success in men with idiopathic nonobstructive azoospermia. Fertil Steril. 2026. PMID: 42082073. doi:10.1016/j.fertnstert.2026.04.023
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。