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。     

精子核成熟性与少、弱、畸形精子症关系初探

目的探讨少、弱、畸形精子症以及精子头部形态缺陷和精子核成熟性的关系。方法2005年3月至2005年7月329例不孕不育患者(其中少精子症患者50例、弱精子症52例、畸形精子症83例)分别采用精液常规检查、精液改良巴氏染色检查以及精液苯胺蓝染色检查。结果①少精子症组患者精液苯胺蓝染色阳性率的中位数为12%(P=0.035),弱精子症组为8%(P=0.947),畸形精子症组为10%(P=0.033)。②少精子症患者精液苯胺蓝染色阳性率与锥形头畸形呈正相关(r=0.635),畸形精子症患者精液苯胺蓝染色阳性率与大头、小头呈正相关(r=0.368、0.304),而和梨形头畸形呈负相关(r=-0.396)。结论少精子症患者和畸形精子症患者中核未成熟精子比例增加,精子头部形态中大头、小头和锥形头畸形与核未成熟精子正相关。     

克罗米芬联合己酮可可碱治疗特发性少、弱精子症的临床研究

目的探讨克罗米芬＋己酮可可碱治疗特发性少、弱精子症的临床效果。方法选取门诊少、弱精子症患者300例,随机分为两组,A组（n=156）口服克罗米芬（50mg,q.d）＋己酮可可碱缓释片（400mg,b.i.d）＋VitE（100mg,t.i.d）;B组（n=144）只服用VitE（100mg,t.i.d）,共3个月,比较两组间各自用药前后的精液参数。进一步将A组患者分成少精子症（n=69）和弱精子症（n=87）2组,比较两者联合药物治疗前后精液各参数。结果（1）联合药物治疗3个月后,A组的精子活率、a级活动精子率、（a＋b）级活动精子率等参数明显增加（P〈0.05）,但精液量、精子密度和活动精子总数无明显差异（P〉0.05）;B组精液各参数没有明显变化。（2）少精子症组联合药物治疗后精子密度、精子活率、活动精子总数明显提高（P〈0.05）;而弱精子症组仅精子活率明显提高（P〈0.05）,精子密度和活动精子总数没有明显变化（P〉0.05）。结论克罗米芬＋已酮可可碱能显著提高特发性少精子症患者的精子密度、精子活率、活动精子总数,以及特发性弱精子症的精子活率。     

金冷法治疗少、弱精子症的疗效及安全性临床观察

目的:金冷法可通过低温和中药外用(透皮吸收)两种途径作用于睾丸。本研究目的旨在评价金冷法治疗少、弱精子症的疗效及安全性。方法:将符合纳入标准的39例少、弱精子症的男性不育患者用金冷内裤(金冷法)治疗,每天早、晚各1次,每次30 min,共3个月。观察治疗前后精液参数指标变化以及患者配偶的妊娠结局。结果:按要求完成治疗36例,其中31例精液质量有改善,总有效率为86.1%。少弱精子症组精子密度、前向运动精子百分率、精子活动率、精子总数、活动精子总数等精液参数指标在治疗后均有显著改善(P均<0.05),弱精子症组前向运动精子百分率、精子活动率、活动精子总数等精液参数指标在治疗后均有显著改善(P均<0.05)。治疗期间及治疗后随访2个月有5例配偶怀孕。治疗期间无明显不良反应发生。结论:金冷法治疗少、弱精子症具有疗效确切、使用方便、安全性好的特点,可作为男性少、弱精子症不育患者的一种新的治疗选择推广应用。     

精浆和血清生殖激素与精液质量的关系

目的为了评估精液质量不同的男性精浆和血清生殖激素的浓度与精子浓度及活动力的关系,探索精浆与血清生殖激素的关系。方法对301名男性进行精液检查,按照精液的质量参数将受试对象分成4组:精液正常组(n=176),弱精子症组(n=66),少精子症组(n=40)和非梗阻性无精子症组(n=19)。采用电化学发光免疫法测定各组受试对象血清卵泡刺激素(FSH)、黄体生成素(LH)、泌乳素(PRL)、孕酮(P)、睾酮(T)和雌二醇(E2)六项生殖激素和精浆PRL、T、P和E2四项生殖激素的浓度,比较组间差异并进行相关性分析。结果精液正常组和弱精子症组血清FSH和E2的浓度显著低于少精子症组和非梗阻性无精子症组(P0.05),精液正常组血清LH和P的浓度显著低于弱精子症、少精子症和非梗阻性无精子症的人群(P0.05);而精液正常、弱精子症和少精子症三组精浆PRL的浓度则高于非梗阻性无精子症组(P0.05)。除了非梗阻性无精子症组,受试者血清FSH的浓度与其精子浓度呈负相关(r分别为-0.350、-0.273和-0.448,P0.05)。精液正常组精浆PRL的浓度和精子的浓度之间呈正相关(r=0.269,P0.05);在少精子症组中,亦有相同趋势的相关性(r=0.432,P0.05)。结论精浆PRL及血清FSH的浓度能够反映精子浓度或活动力,在男性不育的病因分析中具有一定的指导价值。     

弱精子症患者精子外周致密纤维2基因及蛋白的表达

目的:探讨弱精子症患者精子中外周致密纤维2(ODF2)mRNA及蛋白的表达水平,比较ODF2在健康男性与弱精子症患者中的表达差异。方法:根据WHO第5版,收集身体健康无疾病正常男性精液(n=15)和弱精子症患者精液(n=45)共60份,利用计算机辅助精液分析系统(CASA)进行精子统计,将弱精子症分为轻、中、重度3组,采用实时定量PCR和Western印迹对4组标本进行ODF2基因的表达量研究。结果:与正常组相比,轻度弱精子症组精子中ODF2基因表达无明显统计学差异(1.1120±0.5255 vs 0.6880±0.3720,P0.05);中度弱精子症组ODF2基因表达降低,有显著的统计学差异(1.1120±0.5255 vs 0.4833±0.1863,P0.05);重度弱精子症组ODF2基因表达明显降低,有极显著的统计学差异(1.1120±0.5255 vs 0.448 3±0.3408,P0.01)。Western印迹中ODF2的OD值(ODF2/β-actin)在正常组和轻、中、重度弱精子症组分别为:0.4587±0.0521、0.3261±0.0714、0.1454±0.0536和0.1227±0.0457,与正常组相比,轻度弱精子症组无明显统计学差异(P0.05),中度弱精子症组有显著的统计学差异(P0.05),重度弱精子症组有极显著的统计学差异(P0.01)。结论:ODF2基因及蛋白在弱精子症患者精子中的表达下调与精子活动力下降有密切联系,呈正相关性,提示ODF2基因可能参与精子活力的调控。     

男性不育症患者精子DNA损伤与精子形态学主要参数的比较研究

目的 探讨并分析男性不育患者精子DNA损伤的发生率以及精子DNA损伤与精子形态相关参数之间的关系及其临床意义.方法 选取2013年1月至2015年1月就诊于本院生殖中心门诊的男性不育患者(有正常性生活,未采取避孕措施,同居一年以上未能使配偶怀孕)104例.根据精液分析结果将患者分为四组:对照组、少精子症组、弱精子症组以及梗阻性无精子症(obstructive azoospermia,OA)组.采用精子染色质扩散实验(SCD)分析精子DNA完整性和Diff-Quik染色进行精子形态学检测.结果 经统计学分析表明弱精子症组、OA组患者DFI与对照组、少精子症组相比差异有显著统计学意义(P＜0.01);除弱精子症组正常精子形态率与OA组相比差别无统计学意义外(P＞0.05),其余任何两组间正常精子形态率比较差异均有统计学意义(P＜0.05);精子DNA损伤指数(DFI)与畸形精子率成正相关的关系(r=0.622,P＜0.01,n=104),与头部畸形精子率之间存在明显的正相关(r=0.796,P＜0.01,n=104).结论 弱精子症组、OA组患者DFI明显高于少精子症组和对照组.精液常规异常患者精子正常形态率均低于对照组.精子DNA损伤可能是导致精子形态异常,尤其是精子头部异常的主要原因之一.     

精活速治疗少弱精子症疗效观察

目的:探讨精活速治疗少弱精子症的有效性。方法:120例特发性轻中度少、弱精子症患者入选本研究;口服精活速,1袋/次,2次/d,连续3个月;分别于治疗前及治疗后第1、2、3个月末,采用计算机辅助精液分析检测治疗前后每次射精后精液的各项参数变化(精子浓度、精子总活力、前向运动精子百分率、正常形态精子百分率),每次随访均记录患者有无明显不良反应。结果:治疗3个月后,入组患者的精液质量有了较明显的改善。精液中精子浓度、精子总活动率、前向运动精子百分率和精子形态正常百分率,在服用精活速治疗3个月后均有了较明显的改善(P<0.05),观察的3个月期间内,未见明显不良反应。结论:精活速治疗轻中度少弱精子症患者症疗效显著,无明显不良反应。     

重组人睾丸精子结合蛋白对人精子运动参数的影响

目的:探讨重组人睾丸精子结合蛋白(TSBP)对体外培养人精子运动参数的影响。方法:将22例生育男性的精液经Percoll密度梯度离心后,分别与0.01mg/ml及0.1mg/ml的重组His6-TSBP在体外共同孵育1h或3h,同时设立对照组,Western印迹检测重组His6-TSBP与精子膜的结合情况,计算机辅助精液分析(CASA)系统测定重组His6-TSBP对精子运动参数的影响。将12例弱精子症患者的精液按同样方法处理,检测重组His6-TSBP对弱精子症患者精子运动参数的影响。结果:0.1mg/ml重组His6-TSBP与生育男性精子作用1h可以提高体外培养精子的前向运动百分率(a+b级精子百分率),培养3h后前向运动百分率和活率均有所提高,差异具有显著性(P<0.05);0.01mg/ml重组His6-TSBP对检测各指标均无显著性影响。0.1mg/ml重组His6-TSBP与弱精子症患者精子作用3h可以提高精子前向运动百分率(P<0.05),但对活率无显著影响。结论:0.1mg/ml的重组His6-TSBP在体外可以提高生育男性精子的前向运动百分率和活率及弱精子症患者精子的前向运动百分率。     

复方玄驹胶囊联合维生素E对不育患者精子染色质损伤的影响

目的:初步探讨复方玄驹胶囊联合维生素E治疗方案对轻度少精子症和/或弱精子症患者精子染色质损伤的临床疗效。方法:50例精液异常的男性不育患者随机分为实验组(n=24)和对照组(n=26),分别予以复方玄驹胶囊+维生素E和单纯维生素E治疗3个月,运用计算机辅助精液分析系统(CASA)及精子染色质结构分析(SCSA)方法分析两组患者治疗前后精液常规参数和精子DNA损伤指数(DFI),比较治疗前后精液常规参数及精子DFI的变化。结果:实验组治疗后前向运动精子率为(21.55±8.68),对照组为(21.47±11.53),两组相比差异没有统计学意义(P>0.05)。在实验组中治疗前DFI为34.09±10.32,治疗后DFI为29.57±12.19,与治疗前相比显著下降(P<0.05)。结论:复方玄驹胶囊联合维生素E治疗可有效改善不育患者精液质量,对精子染色质损伤有一定的改善作用。     

精子发生相关新基因KLHL-10在无精子症及少弱精子症患者中突变筛查分析

目的:探讨精子发生相关新基因KLHL-10突变与无精子症及少、弱精子症之间的关系。方法:收集临床上不明原因的、非阻塞性无精子症及少、弱精子症患者(分别为11例、196例和118例)共325份外周血标本以及100份正常生育男性的外周血标本,抽提其DNA,采用PCR技术、变性高效液相色谱技术以及测序等手段对全部DNA样本进行KLHL-10基因的突变筛查。结果:在少精子症患者组及正常生育男性组中各发现1例及3例在1号外显子有C88→A的新的杂合突变,系同义突变;在少精子症患者组、弱精子症患者组及正常生育男性组中各检出3例、1例及4例在2号外显子有C424→A的新的杂合突变,也系同义突变;尚未发现有该基因的错义突变或微缺失。结论:KLHL-10基因错义突变或微缺失不是引起本组无精子症及少、弱精子症患者的主要致病原因,该基因在男性不育症的诊断价值有待进一步确定。     

Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density?

OBJECTIVE: Varicocele is the most common treatable cause of male infertility and is associated with progressive decline in testicular function. Varicocelectomy, a commonly performed operation, is indicated in infertile males with varicoceles who have oligospermia, asthenospermia, teratospermia or a combination of these factors. It is not clear if varicocelectomy is indicated if the patients have normal sperm density associated with asthenospermia or teratospermia. METHODS: We reviewed 167 patients with varicocele-associated male infertility over a 7-year period (December 1999-November 2005). Pre- and post-varicocelectomy seminal fluid analyses, assessed using the World Health Organization criteria, were obtained at intervals of 4-6 months. Wilcoxon signed rank tests were used to evaluate for statistical significance and P < or = 0.05 was considered significant. RESULTS: The mean age of the patients and their spouses were 35 and 28 years, respectively. The mean duration of infertility was 3.2 years (range, 1.5-7.5). Oligospermia, teratospermia, asthenospermia, oligospermia, asthenospermia and teratospermia (OAT) syndrome and azoospermia were found preoperatively in 106 (63.5%), 58 (34.7%), 154 (92%), 118 (71%) and 15 (9%) patients, respectively. Overall, significant improvements in semen volume (P < 0.001), sperm density (P < 0.001), sperm motility (P < 0.001) and sperm vitality (P < 0.001) were obtained after varicocelectomy. There was, however, no significant improvement in sperm morphology after varicocelectomy (P = 0.220). When patients with preoperative oligospermia (sperm density, <20 million/mL) were considered separately, varicocelectomy led to significant improvement in all the semen parameters except the sperm morphology (P = 0.183). Conversely, when varicocele patients with a sperm density of > or =20 million/mL (normospermia) associated with asthenospermia and/or teratospermia were considered separately, they did not show significant improvement in any of the semen parameters after varicocelectomy (P > 0.05). In addition, azoospermic patients did not show significant improvement in any of the semen parameters (P > 0.05) CONCLUSION: No significant improvement in semen parameters may be obtained in patients with clinical varicocele and preoperative normospermia. It is possible that only patients with preoperative oligospermia may benefit from varicocelectomy. Larger multi-institutional studies are needed to determine more definitively if asthenospermia or teratospermia in normospermic subfertile males with clinical varicoceles are in fact indications for varicocelectomy.     

少弱精子冷冻保存在宫腔内人工授精中的应用

目的:探讨精液冷冻保存在少弱精子症患者行宫腔内人工授精(IUI)周期中的应用效果。方法:2008年3月至2009年6月103对原发性不孕夫妇,共计152个IUI治疗周期,其中精液正常者53个周期(组1),少弱精子者52个周期(组2),少弱精子经精液冷冻保存后结合新鲜精液者47个周期(组3)。检测治疗前后精液常规、精液处理后前向活动精子总数,随访3组患者治疗期间配偶妊娠结局。结果:精液处理前组3精液体积、精子活率、a级精子均低于组2,差异极显著(P<0.01);组3处理后前向活动精子总数高于组2,但差异无显著性(P>0.05)。3组间生化妊娠率和临床妊娠率均无显著性差异。结论:精液冷冻保存可以增加少弱精子症患者前向活动精子总数,精液冷冻保存技术可以在一定程度上提高其IUI妊娠率。精液冷冻保存与IUI相结合,可能是治疗少弱精子症一种较为理想的方法。     

The effect of "Jingzhizhu" capsule on male fertility

Objective: To study the effect of "Jingzhizhu" capsule on male fertility, especially sperm density, motility and morphology. Methods: (1) Assess the semen quality of the 50 patients with oligospermia and/or asthenospermia after taking "Jingzhizhu" for one month; (2) Observe the fecundity, pathology and ultrastructure of testes and epididymes of mice after feeding "Jingzhizhu"; (3) Test the acute toxicity on mice. Results: "Jingzhizhu" capsule can significantly improve semen quality of the patients with oligospermia and/or asthenospermia, reverse the pathological change of testes and epididymes of mice. Toxicity test showed no toxic change. Conclusions: "Jingzhizhu" is safe and effective for male infertility.     

Metenkephalin in Seminal Plasma of Infertile Men

Background: Enkephalin is one of the opioids, which is expressed widely in reproductive organs. However, the function of enkephalin in male reproduction is not completely understood. The effect of metenkephalin on sperm motility remains especially controversial. In this study we examined the level of metenkephalin in seminal plasma from men with normal sperm production and patients with asthenospermia, oligospermia, and azoospermia to investigate the role of metenkephalin in seminal plasma on sperm function. We also investigated the effect of metenkephalin on sperm motility in vitro.
Methods: Sixty nine infertile patients (31 oligospermic, 21 asthenospermic, and 17 azoospermic) were included in this study. The level of metenkephalin in seminal plasma of these men was measured and the effect of the peptide on the motility of human sperm was examined in vitro. Seventeen men with normal seminograms were a control group.
Results: The level of metenkephalin in the seminal plasma of semen from asthenospermic men was significantly lower than that from the controls ( P < 0.05). No significant correlations between the level of metenkephalin and the mean pathing or progressive velocity of sperm, or serum hormone levels were observed. In the in vitro study, which used semen from the controls, treatment of sperm with metenkephalin (50–200 pg/mL) maintained sperm motility for 4 hours. On the other hand, motility of sperm incubated without metenkephalin began to decrease at 3 hours. Metenkephalin levels of 50 pg/mL in seminal plasma is considered to be necessary for maintaining sperm motility.
Conclusion: These results suggest that metenkephalin in seminal plasma is an important clue in the investigation of decreased sperm motility.     

"精之助"胶囊对生殖功能影响的研究

目的　研究“精之助”胶囊对生殖功能尤其是对精子密度、活动力及形态的影响。方法　 (1)对 5 0例少精子症及 (或 )弱精子症患者应用“精之助”一个月 ,观察精液指标变化情况 ;(2 )对小白鼠进行药效学实验 ,观察一般情况、产仔情况、睾丸及附睾组织学及超微结构变化等 ;(3)对小白鼠进行急性毒性实验。结果　“精之助”胶囊可显著改善少精子症及 (或 )弱精子症患者精液指标 ,逆转小白鼠睾丸、附睾超微结构病理变化。急性毒性实验证明该中药制剂无毒性。结论　“精之助”胶囊是男性不育的安全、有效的中药制剂     

Hypofertility in males due to a secretion anomaly of the seminal vesicles and its treatment

Between 1981 and 1986, 5,000 males with infertility were treated. Eight (0.16%) of them had hypospermia, a decrease in seminal fructose, asthenospermia without oligospermia considered as a secretion anomaly of the seminal vesicles. Artificial Insemination with the Husband's sperm (AIH) combined with vesiculo-prostatic plasma from a vasectomized donor was performed successfully in 3 couples. In this series, failures were associated with an important fertility factor in the female. AIH combined with vesiculo-prostatic plasma from a vasectomized donor is considered as an effective treatment of male hypofertility caused by vesicular dysfunction.     

中国生育男性DNA聚合酶γ基因CAG三核苷酸重复及与特发性男性不育的相关性研究

目的:分析中国特发性男性不育患者与正常男性DNA聚合酶γ(Polg)基因CAG三核苷酸重复,探讨CAG三核苷酸重复序列多态性与男性不育的关系。方法:应用PCR结合基因扫描(GeneScan)分型技术,对104例正常对照与55例弱精子症患者、57例少精子症患者、34例无精子症患者进行Polg基因分型。结果:弱精子症患者10/not10基因型比例大于其他各组,但统计学分析差异无显著性。结论:首次提示Polg基因CAG三核苷酸重复数目在欧洲和中国正常男性中可能存在人种差异,而10/not10基因型与精子运动障碍的关系需进一步研究。     

生育及不育男性血清及精浆抑制素-B水平分析

目的 :探讨生育及不育男性血清及精浆抑制素 B(inhibinB ,INHB)水平是否存在差异 ,了解血清及精浆INHB水平与精子发生的关系。　方法 :生育组 (n =2 0 )、少精子症组 (n =2 0 )、弱精子症组 (n =2 2 )和非阻塞性无精子症 (NOA)组 (n =2 0 )男性于上午 8∶0 0～ 10∶0 0留取精液和血液标本 ,进行精液常规分析 ,血清INHB、FSH、LH、T含量 ,精浆INHB、酸性磷酸酶、果糖、α 葡糖苷酶含量和活性测定。　结果 :血清、精浆INHB水平与血FSH均呈显著负相关 (r =- 0 .5 36 ,P <0 .0 0 1vsr =- 0 .2 88,P =0 .0 1) ,血清、精浆INHB水平与精子密度均呈显著正相关 (r=0 .49,P <0 .0 0 1vsr =0 .48,P <0 .0 0 1) ,血清INHB水平在生育组男性与少精子症组、NOA组男性间(分别为P <0 .0 5和P <0 .0 1)、弱精子症组与NOA组男性间 (P <0 .0 1)及少精子症组与NOA组男性间 (P <0 .0 5 )差异均有显著性 ,而精浆INHB变动范围较大 ,其水平仅在生育组男性与NOA组男性间及弱精子症组与NOA组男性间差异有显著性 (分别为P <0 .0 1和P <0 .0 5 )。精浆INHB水平与精浆α 葡糖苷酶活性呈正相关 (r=0 .377,P =0 .0 0 1)。血清INHB水平与精浆INHB水平间无相关性。　结论 :血清、精浆INHB水平均可反映睾丸的精子发生情况 ,精浆INHB水平还与