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Intérêt du dosage de l’inhibine B et de l’AMH dans le plasma séminal: étude préliminaire

The significance of inhibin B and AMH in seminal plasma: a preliminary study

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Résumé

Objectifs

Le but de notre étude est tout d’abord d’établir des valeurs de référence pour les concentrations d’inhibine B et d’AMH dans le plasma séminal chez des sujets présentant des paramètres spermatiques normaux et altérés. Une analyse préliminaire sera également effectuée afin d’évaleur l’intérêt de ces dosages comme facteur prédictif de biopsie testiculaire positive en cas d’azoospermie non obstructive.

Patients et Méthodes

Nous avons dosé l’inhibine B et l’hormone anti-müllerienne (AMH) chez 47 patients présentant des paramètres spermatiques normaux, 28 patients avec une oligozoospermie et 68 patients avec une azoospermie. Les dosages ont été réalisés selon une technique immunoenzymatique de type sandwich.

Résultats

Dans les trois groupes, les valeurs d’inhibine B et d’AMH sont très dispersées, mais significativement plus élevées dans les normospermies (inhibine B: 714,36 ±522,66 ng/l, AMH: 97,08±135,15 pmol/l) que dans les oligospermies (inhibine B: 417,5±386,9 ng/l, AMH: 62,02±93,33 pmol/l) et les azoospermies (59,61±2,65 ng/l et 13,12±31,94 pmol/l respectivement) (p<0,001). Il existe une corrélation significative (p=0,0054) entre la concentration d’inhibine B dans le plasma séminal et la numération des spermatozoïdes.

Des spermatozoïdes ont été retrouvés chez 11 patients sur les 21 (52,3%) ayant bénéficié d’une biopsie testiculaire. La valeur prédictive de l’inhibine B séminale sur le résultat de la biopsie testiculaire dans les azoospermies non obstructives a été représentée à l’aide d’une courbe ROC (receiver operating characteristics). L’aire sous la courbe pour cette population est de 0,63. La valeur seuil la plus discriminante sur la positivité de la biopsie est de 30 ng/l (sensibilité 66,6%, spécificité 66,6%).

Conclusion

Notre étude confirme la corrélation entre les concentrations d’inhibine B et d’AMH dans le plasma séminal et la spermatogenèse. L’intérêt de ces deux marqueurs comme facteur prédictif de la biopsie testiculaire dans les cas d’azoospermie non obstructive reste cependant limité. En effet, cette étude montre que ni l’AMH ni l’inhibine B, seule ou associée à la FSH, ne permettent de prédire le succès de la biopsie testiculaire.

Abstract

Objectives

The aim of this study was to establish reference values for seminal inhibin B and AMH concentrations in patients with normal and abnormal sperm parameters. Preliminary analysis was performed to evaluate the predictive value of these markers for retrieving testicular sperm in non-obstructive azoospermic men.

Methods

Seminal inhibin B and AMH concentrations were assayed by an enzyme-linked immunoassay in three groups of men: 47 patients with normal sperm parameters, 28 oligospermic men and 68 patients with azoospermia.

Results

Inhibin B and AMH concentrations varied considerably in the three groups, but were significantly higher in normospermic men (inhibin B: 714.36±522.66 ng/l, AMH: 97.08±135.15 pmol/l) than in oligospermic men (inhibin B: 417.5±386.9 ng/l, AMH: 62.02±93.33 pmol/l) and azoospermic men (59.61±2.65 ng/l et 13.12±31.94 pmol/l, respectively) (p<0.001). A significant correlation (p=0.0054) was observed between seminal inhibin B concentration and sperm production. Testicular biopsy allowed sperm retrieval in 11 out of 21 patients (52.3%). The predictive value of seminal inhibin B was analyzed using receiver operating characteristics (ROC) curve analysis. The best discriminating inhibin B concentration was 30 ng/l with an area under the curve (AUC) of 0.63.

Conclusion

This study confirms the correlation between seminal inhibin B and AMH concentrations and spermatogenesis. However, the significance of these two markers as predictors of the presence of testicular sperm in men with non-obstructive azoospermia is limited. This analysis shows that AMH and inhibin B, either alone or in combination with serum FSH, fail to predict the presence of sperm in men with non-obstructive azoospermia undergoing testicular sperm extraction.

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Correspondence to Rachel Levy.

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Duvilla, E., Aknin-Seifer, I., Trombert-Paviot, B. et al. Intérêt du dosage de l’inhibine B et de l’AMH dans le plasma séminal: étude préliminaire. Androl. 16, 143–154 (2006) doi:10.1007/BF03034846

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Mots clés

  • inhibine B
  • AMH
  • marqueurs séminaux
  • azoospermie non obstructive
  • biopsie testiculaire

Key words

  • inhibin B
  • AMH
  • seminal markers
  • nonobstructive azoospermia
  • testicular biopsy