左卡尼汀治疗特发性少、弱精子症疗效及安全性的系统评价

目的:根据现有临床证据评价左卡尼汀治疗特发性少、弱精子症的疗效及安全性。方法:通过计算机检索建库至2014年4月期间Cochrane图书馆、Pub Med、MEDLINE、EMBASE、CNKI、VIP、CBM、万方数据库,辅以手工检索有关左卡尼汀治疗特发性少、弱精子症的文献,根据纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man5.2软件对数据进行meta分析。结果:纳入7个随机对照试验(RCT),共计751例特发性少、弱精子症患者,排除失访人数后实际纳入678例。meta分析结果显示:左卡尼汀治疗后配偶自然妊娠率高于对照组[RR=3.2,95%CI(1.74,5.87),P=0.000 2];左卡尼汀治疗12~16周和24~26周后精子活动率[WMD=5.21,95%CI(2.78,7.64),P<0.000 1;WMD=9.29,95%CI(1.28,17.29),P=0.02]、前向运动精子百分率[WMD=12.44,95%CI(4.58,20.31),P=0.002;WMD=9.76,95%CI(3.56,15.97),P=0.002]均高于对照组;左卡尼汀治疗12~16周和24~26周后精子浓度与对照组比较差异无统计学意义[WMD=4.91,95%CI(-2.63,12.45),P=0.2;WMD=0.93,95%CI(-3.48,5.34),P=0.68];左卡尼汀治疗12~16周后畸形精子百分率低于对照组[WMD=-2.48,95%CI(-4.35,-0.61),P=0.009],而左卡尼汀治疗24~26周后畸形精子百分率与对照组比较差异无统计学意义[WMD=-4.38,95%CI(-9.66,0.89),P=0.1];左卡尼汀治疗12~16周和24~26周后精液量与对照组比较差异无统计学意义[WMD=-0.13,95%CI(-0.43,0.18),P=0.42;WMD=0.28,95%CI(-0.02,0.58),P=0.07];其中4项研究报告了左卡尼汀治疗期间均无严重不良反应发生。结论:基于当前证据,左卡尼汀可能对特发性少、弱精子症患者配偶的自然妊娠率及患者的精液质量有一定的改善,无明显不良反应。     

碱性成纤维细胞生长因子用于治疗特发性少弱精子症的临床意义(附57例疗效观察)

为了探讨碱性成纤维细胞生长因子（ｂＦＧＦ）对特发性少弱精子症患者的作用,本研究对５７例确诊为将发性少弱精子症的患者用ｂＦＧＦ治疗,分别在治疗前后进行血生殖激素测定和精液质量分析。结果发现治疗后血生殖激素（ＰＲＬ、ＦＳＨ、ＬＨ、Ｔ）水平升高,精子密度及顶体酶活性显著提高（Ｐ〈０．０１）,精子活动力和成活率上升、畸形率下降（Ｐ〈０．０５）,生育能力提高。因此认为ｂＦＧＦ是治疗特发性少弱精子症的有效药物。     

邻苯二甲酸二酯与特发性少弱精子症关系的探讨

目的:通过检测精浆中邻苯二甲酸二酯(DEHP)的含量,探讨DEHP与男性特发性少弱精子症之间的关系。方法:收集潍坊地区3家医院特发性少弱精子症所致不育患者100例,分为A组:常年接触蔬菜大棚塑料薄膜者50例;B组:常年食用塑料包装盒饭者50例;另设立C组(对照):为精液正常之志愿者50例。采用计算机辅助精子分析仪检测精子浓度和活率,采用反相液相高效色谱法测定精浆中DEHP的浓度。结果:1A、B、C3组中DEHP含量分别为(0.72±0.48)、(0.71±0.49)、(0.21±0.18)mg/L,C组与A、B组比较,差异均有统计学意义(P均0.05)。2精浆中DEHP浓度与精子活率呈负相关(A组:r=-0.354,B组r=-0.348,P0.05)。结论:常年接触某些塑料制品的男性不育患者,精浆中DEHP浓度高于正常人群,精浆内DEHP过量蓄积可能是不育的重要因素之一。     

生精丸配伍锌硒宝治疗特发性少弱精子症

精子的质量与人体必需的锌、硒等有关，研究发现，锌的缺乏可导致不育^[1]。锌制剂在治疗男性不育中广泛使用。本文采用锌硒宝、生精丸单独或联合使用治疗特发性少弱精子症，并分析其疗效。     

他莫昔芬联合辅酶Q10治疗特发性少弱精子症临床疗效观察

目的:探讨他莫昔芬(TMX)联合辅酶Q10(CoQ10)治疗对男性特发性少弱精子症患者精液参数的影响。方法:选取特发性少弱精子症患者183例,随机分为TMX+CoQ10(n=63)、TMX(n=61)及CoQ10治疗组(n=59)。治疗方法为,TMX:每次10 mg,2次/d,CoQ10:每次10 mg,3次/d,连续服用3个月为1个疗程。治疗前及治疗3、6个月后对外周血清性激素水平和精子浓度、活力及形态检测分析。结果:与治疗前相比,治疗6个月后,TMX+CoQ10及TMX治疗组血清FSH、LH、T水平明显升高(P<0.05),CoQ10治疗组较治疗前无明显变化(P>0.05);TMX+CoQ10及TMX治疗组精子浓度显著性提高(P<0.05),CoQ10组有所提高但无显著差异(P>0.05),TMX+CoQ10及CoQ10治疗组精子活力及正常形态精子百分率显著性提高(P<0.05),TMX治疗组有所提高但无显著差异(P>0.05)。结论:他莫昔芬联合辅酶Q10治疗特发性少弱精子症患者,可以显著改善精子浓度、活力及形态。     

健脾补肾法治疗特发性弱精子症的临床研究

<正>据统计,不育人群涉及到不同的学历、阶层、地域等。目前中国不孕不育的发病率在20%左右[1],女方原因占50%,男方占30%,男女双方原因占10%[2]。国外的研究报告表明,男性精液质量在过去50年期间不断降低,在我国男性精液质量也呈明显下降的趋势。男性不育的病因很多,其中以特发     

麒麟丸治疗特发性少弱精子症的多中心、随机双盲对照研究

目的:评价麒麟丸治疗男性不育患者中特发性少弱精子症的疗效和临床应用的安全性。方法:以五子衍宗丸为阳性对照药物,进行多中心、随机双盲对照临床研究,共216例男性不育患者入选临床试验,实验组和对照组各108例。试验组患者口服麒麟丸,每次6g,3次/d,对照组患者口服五子衍宗丸,每次6 g,2次/d,两组以12周为1个疗程,治疗结束后以精子活力、精子总数和前向运动精子数量为主要疗效指标,评价麒麟丸治疗效果;通过试验过程中不良事件的随访及检测治疗前后患者血、尿常规及肝肾功能指标评估其安全性。结果:实验组在治疗前、用药后4周、8周和12周的精子活力平均值分别为21.75%、27.54%、29.04%和32.95%,在治疗前、用药后4、8和12周的精子总数平均值分别为156.27×10~6、177.33×10~6、188.18×10~6和205.44×10~6,其中前向运动的精子数量平均值分别为32.08×10~6/ml、46.33×10~6/ml、50.98×10~6/ml和61.1×10~6/ml。经过12周的治疗后,与治疗前相比,两组患者的精子活力、精子总数及前向运动精子数量在治疗4、8和12周后具有显著改善(P<0.01),且随着治疗时间的延长,改善效果更明显;与对照组相同的时段相比,试验组在精液各参数均有显著改善(P<0.01)。结论:麒麟丸较五子衍宗丸能明显提高少弱精子症患者的精液质量,具有较好的疗效和临床安全性。     

生精丸配伍锌硒宝治疗特发性少弱精子症

精子的质量与人体必需的锌、硒等有关,研究发现,锌的缺乏可导致不育[1].锌制剂在治疗男性不育中广泛使用.本文采用锌硒宝、生精丸单独或联合使用治疗特发性少弱精子症,并分析其疗效.     

维生素D治疗特发性少弱精子症的有效性与安全性研究

目的:探讨维生素D(VD)治疗特发性少弱精子症的疗效与安全性。方法:86例少弱精子症不育男性患者纳入本研究,并随机分为治疗组与对照组各43例,治疗组口服VD 200 IU及钙600 mg,每日1次,对照组服用维生素E 100 mg与维生素C 100 mg,每日3次。两组均治疗3个月。比较治疗前后精液常规参数的变化,同时观察不良反应与女方妊娠情况。结果:3个月后,治疗组每次射精前向运动精子数从(9.82±3.72)×106提高为(21.47±6.52)×106;每次射精前向运动精子百分率从(18.41±9.82)%提高为(28.27±4.47)%,差异有统计学意义(P0.05)。对照组治疗前后每次射精前向运动精子数从(9.51±6.31)×106提高为(12.36±4.43)×106;前向运动精子百分率从(17.79±5.25)%提高为(21.35±2.41)%,差异无统计学意义(P0.05)。治疗组女方妊娠7(16.3%)例,对照组女方妊娠1例(2.3%),差异有显著性(P0.05),未见明显不良反应。结论:VD治疗少弱精子症可显著提高每次射精前向运动精子数和前向运动精子百分率,提高患者的精液质量。     

复方玄驹胶囊治疗特发性少弱精子症126例临床效果分析

世界范围内,大约有10％左右的已婚夫妇被不孕不育困扰,而造成男性不育的主要原因是精子密度和活力的下降.1992年丹麦学者Carlsen等[1]分析了1935年至1990年全球23个国家已报道的61篇文献资料中14 947名育龄男性的精液分析统计报告,该研究显示人类精子密度的平均数已经从113×106/ml下降到66×106/ml,降低幅度达到40％以上,但是导致男性精子发生障碍的原因众多,并且有15％左右的患者原因不明,为特发性少弱精子症.     

麒麟丸联合克罗米芬治疗特发性少弱精子症疗效观察

目的:探讨麒麟丸联合克罗米芬治疗男性特发性少弱精子症(IO)的临床疗效。方法:选取IO患者300例,随机分为试验组(麒麟丸+克罗米芬,n=156)和对照组(克罗米芬,n=144)。治疗方法为:麒麟丸每次6 g,3次/d;克罗米芬每次50 mg,1次/d,连续服用12周为1个疗程。治疗前及治疗4、8、12周后对精子浓度、a级精子百分率、(a+b)级精子百分率、精子活动率和外周血清性激素水平检测分析,并以配偶妊娠率为次要疗效指标,评估其临床疗效。结果:治疗4、8、12周后,试验组精子浓度、a级精子百分率、(a+b)级精子百分率、精子活动率以及血清FSH、LH、T水平分别为(17.06±2.24)×106/ml、(15.03±2.39)%、(30.10±5.07)%、(42.04±4.86)%、(7.75±1.38)IU/L、(10.05±1.68)IU/L和(19.19±1.92)nmol/L,(22.10±2.65)×106/ml、(21.08±3.16)%、(38.08±5.64)%、(52.05±5.58)%、(10.83±1.23)IU/L、(13.96±1.68)IU/L和(21.06±1.63)nmol/L,(28.13±3.59)×106/ml、(28.08±4.70)%、(48.04±6.49)%、(65.03±5.13)%、(14.22±0.84)IU/L、(19.01±2.42)IU/L和(24.63±1.06)nmol/L,对照组分别为(15.07±2.48)×106/ml、(13.08±2.51)%、(26.21±3.96)%、(40.29±4.19)%、(7.20±1.17)IU/L、(9.18±1.54)IU/L和(18.34±1.79)nmol/L,(18.11±2.97)×106/ml、(16.04±3.05)%、(30.07±4.80)%、(48.03±4.40)%、(9.10±1.32)IU/L、(11.99±1.71)IU/L和(20.06±1.56)nmol/L,(21.21±3.60)×106/ml、(20.14±4.74)%、(35.28±4.77)%、(56.67±4.99)%、(12.06±1.45)IU/L、(15.86±2.08)IU/L和(22.03±1.49)nmol/L,与治疗前相比,两组精液各参数及外周血清性激素水平均有明显提高(P均<0.01),与对照组相同时段相比,试验组在精液各参数及血清FSH、LH、T水平均有显著提高(P均<0.01)。试验组患者在各个时段的配偶妊娠率均高于对照组,差异有统计学意义(P均<0.01)。对药物的耐受性差异无显著性(P>0.05),未见明显不良反应。结论:麒麟丸联合克罗米芬可显著提高IO患者精液质量和激素水平,未见不良反应,但长期疗效及耐受性尚待进一步的临床研究。     

麒麟丸联合溴隐亭治疗特发性高泌乳素血症少弱精子症的临床研究

目的:观察麒麟丸联合溴隐亭治疗特发性高泌乳素血症(HPRL)少弱精子症的临床疗效。方法:选取因特发性HPRL少弱精子症患者40例,采取随机对照研究的方法,分为两组,每组20例。治疗组患者口服麒麟丸(6 g/次,3次/d)和溴隐亭治疗,对照组单用溴隐亭治疗,两组均以12周为1个疗程,治疗1个疗程后,观察精子浓度、精子活动率以及血清泌乳素(PRL)水平及睾酮(T)变化,并对疗效进行评估。结果:所有研究对象均按要求完成了临床研究,与治疗前相比,两组患者的精子浓度[治疗组:(11.60±3.90)×106/ml vs(28.10±13.50)×106/ml;对照组:(12.03±4.10)×106/ml vs(18.85±8.50)×106/ml]、a级精子百分率[治疗组:(8.75±6.65)%vs(24.35±13.25)%;对照组:(8.70±6.70)%vs(19.65±10.05)%]、(a+b)级精子百分率[治疗组:(28.45±11.35)%vs(45.80±16.55)%;对照组:(27.65±10.65)%vs(35.66±13.25)%]、精子活动率[治疗组:(38.22±16.35)%vs(60.05±20.65)%;对照组:(37.25±15.75)%vs(52.65±18.25)%]指标均有显著的改善(P均<0.01),精液量改变不明显,差异无统计学意义(P﹥0.05)。治疗组、对照组患者治疗后的血清PRL水平分别为(152.00±22.32)、(160.45±26.65)mIU/L,较治疗前[(482.25±65.32)、(477.32±60.25)mIU/L]均有显著的下降(P<0.01);血清T分别为(16.35±5.52)、(11.15±4.65)nmol/L,较治疗前[(3.75±1.10)、(4.05±1.30)nmol/L]均有显著提高(P<0.01);两组间治疗后血清PRL水平、T均无显著差异(P﹥0.05)。结论:麒麟丸联合溴隐亭能治疗特发性HPRL少弱精子症,联合用药较单用溴隐亭疗效更为显著。     

左卡尼汀联合辅酶Q10治疗特发性少、弱精子症临床疗效评估:一项双盲、随机对照研究

目的:探讨左卡尼汀(LC)联合辅酶Q10(Co Q10)治疗特发性少、弱精子症(i OAT)的临床疗效。方法:将262例i OAT患者按照Excel软件随机数字排序分为4组,LC组:62例,口服左卡尼汀口服溶液10 ml/次,2次/d;Co Q10组:63例,口服Co Q10片剂,20 mg/次,3次/d;联合用药组:63例,按照上述剂量联合服用LC和Co Q10;对照组组:74例,服用不含抗氧化作用的安慰剂(维生素B1)。治疗3个月后比较各组治疗前、后精子浓度、活动率、前向运动精子百分率、DNA碎片百分率、顶体反应发生率及妊娠结局。结果:联合用药组的活动率及前向运动精子百分率均显著高于其他各组及自身治疗前(P0.05);精子DNA碎片百分率则显著低于对照组和自身治疗前(P0.05);临床妊娠率显著高于对照组(30.0%vs 6.8%,P0.008)。各组间的精子顶体发生率及流产率无统计学差异(P0.05)。结论:LC联合Co Q10可显著提高i OAT患者的精子质量,并能改善i OAT患者的临床结局。     

Joint lavage for treating recurrent knee involvement in patients with juvenile idiopathic arthritis

OBJECTIVE: To retrospectively evaluate the benefits of knee joint lavage with intraarticular glucocorticoid injection in patients who have juvenile idiopathic arthritis with knee involvement unresponsive to repeated intraarticular glucocorticoid injections. PATIENTS: Seventeen knees in 10 children (eight girls and two boys) were treated from 1997 to 2000. Mean age was 14 years 9 months and mean disease duration was 7.2 years. The diagnoses were juvenile oligoarthritis (n = 6, including two with extended disease), systemic arthritis (n = 2), juvenile spondyloarthropathy (n = 1), and juvenile dermatomyositis (n = 1). Repeated intraarticular triamcinolone hexacetonide injections had been performed in all the patients, the mean number of injections being 2.2 per patient within the last 30 months. Plain radiographs were normal in six of the eight patients. Mean erythrocyte sedimentation rate was 21.7 mm/h and mean C-reactive protein level was 20.6 mg/l. Joint fluid was obtained from 10 knees and had a mean cell count of 12?660 mm(-3). Second-line therapy was with methotrexate alone or combined with cyclosporine or azathioprine. Oral glucocorticoids and/or nonsteroidal antiinflammatory drugs were used for symptom relief. TREATMENT PROCEDURE: Lavage was performed under strict aseptic conditions with simple analgesia, on a day-hospital basis. After aspiration of the joint, lavage was performed with saline, and a delayed-action glucocorticoid was injected. The knee joint was immobilized in the extended position for 48 h. Efficacy criteria were presence of effusion, presence of pain, and presence of a systemic treatment-sparing effect. RESULTS: Freedom from effusion and pain was noted in all 17 knees after 1 month, in eight (47%) knees after 6 months, and in seven (41%) knees after 12 months. The patients with the longest lasting improvements had systemic polyarthritis. After joint lavage, second-line treatment was reduced in two patients and oral glucocorticoid therapy was stopped in two others. None of the variables studied (age, sex, disease duration, inflammatory syndrome, or joint fluid cytology) predicted a good response. No adverse effects were recorded. CONCLUSION: These preliminary results show that joint lavage with glucocorticoid injection is safe in children. The improvements were modest, but the patients had a history of arthritis refractory to multiple triamcinolone hexacetonide injections. Thus, joint lavage may have a place in the treatment pyramid just before synovectomy.     

内镜联合腹腔镜治疗门静脉高压症

目的 探讨经内镜食管曲张静脉套扎联合手助腹腔镜脾切除术治疗门静脉高压症的疗效及其安全性.方法 回顾性分析我们于2001年6月～2006年10月采用内镜下食管曲张静脉套扎术及手助腹腔镜脾切除术治疗肝硬化门静脉高压症38例的临床资料.结果 每例平均套扎治疗2～5次.套扎后食管静脉曲张完全消失27例,静脉曲张由重度降为轻度11例.手助腹腔镜脾切除术无严重并发症发生,无中转开腹及死亡病例.术后1.5周复查,血小板由术前的(35～70)×109/L升至(86～320)×109/L.平均随访18个月,无上消化道出血病例.结论 对于门静脉高压脾功能亢进者行内镜食管曲张静脉套扎术联合手助腹腔镜脾切除术具有微创的优点,是一种安全、有效的治疗方法.     

含雌激素的冷冻保护剂对少弱精子玻璃化冻存效果的研究

目的 比较添加雌激素的冷冻保护剂对少弱精子的冻存效果.方法 将40例少弱精子患者的精液标本分别采用甘油、甘油-卵黄-柠檬酸钠（GYC）、甘油＋雌激素（甘油＋ E2）、甘油-卵黄-柠檬酸钠＋雌激素（GYC＋ E2）四种冷冻保护剂（CPM）冷冻,比较冻融前后精子活率、活力（a＋b级）、正常精子形态百分率、精尾低渗肿胀率（HOSR）.结果 四种CPM对少弱精子的冷冻效果存在差别,精子活率、活力、正常形态百分率、精子尾部低渗肿胀率在冻后都有不同程度下降（P〈0.05）,但甘油＋E2、GYC＋ E2 能显著提高冻存后精子的活率及活力（a＋b级）.结论玻璃化冻存对精子存在损伤,含雌激素的冷冻保护剂可以提高低质量精液的冻存效果.     

Comparison of conventional in vitro fertilisation and intracytoplasmic sperm injection outcomes in patients with moderate oligoasthenozoospermia

The method of choice for assisted reproductive technology treatment in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) is usually based on the evaluation of male infertility factors. Decisions for couples with moderate oligoasthenozoospermia (OA) are often empirical because uniform treatment criteria are lacking. This study aimed to evaluate the effect of patients with moderate OA treated with conventional IVF and ICSI. A total of 199 couples with moderate OA undergoing their first IVF/ICSI cycle were included in the study. The patients were divided into two groups according to the type of insemination: conventional IVF group (n = 97) and ICSI group (n = 102). All patients were randomised to be inseminated either by conventional IVF or ICSI. The fertilisation rate, embryo quality, implantation rate and clinical pregnancy rate were examined. No differences in the fertilisation, implantation and pregnancy rates were observed between conventional IVF and ICSI groups (P > 0.05). However, the number of good‐quality embryos was significantly higher in the ICSI group than in the IVF group (P < 0.05). Couples with moderate OA did not influence on the overall clinical outcomes between IVF and ICSI treatments, and a negative influence by ICSI on blastocyst development was not confirmed.     

Pentoxifylline improves hemoglobin levels in patients with erythropoietin-resistant anemia in renal failure

It was hypothesized that pentoxifylline might improve the response to recombinant human erythropoietin (rh-Epo) in anemic renal failure patients. Sixteen patients with ESRD and rh-Epo-resistant anemia, defined by a hemoglobin of <10.7 g/dl for 6 mo before treatment and a rh-Epo dose of > or =12,000 IU/wk, were recruited. They were treated with oral pentoxifylline 400 mg o.d. for 4 mo. Ex vivo T cell generation of tumor necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma) from the patients was assessed before treatment and 6 to 8 wk after therapy. A total of 12 of 16 patients completed the study. Before therapy, the 12 patients' mean hemoglobin concentration was 9.5 +/- 0.9 g/dl. After 4 mo of pentoxifylline treatment, the mean hemoglobin concentration increased to 11.7 +/- 1.0 g/dl (P = 0.0001). Baseline ex vivo T cell expression of TNF-alpha decreased from 58% +/- 11% to 31% +/- 23% (P = 0.0007) after therapy. Likewise, IFN-gamma expression decreased from 31% +/- 10% to 13% +/- 10% (P = 0.0002). Pentoxifylline therapy may significantly improve the hemoglobin response in patients with previously rh-Epo-resistant anemia in renal failure. This may occur due to inhibition of proinflammatory cytokine production, which could interfere with the effectiveness of rh-Epo.