生精胶囊治疗男性勃起功能障碍疗效观察

男性勃起功能障碍(ED)是指性交时阴茎不能有效地勃起导致性交不满足[1].ED是男性最常见的一种性功能障碍,据不完全统计,在男性人群中,ED发生率达15％.中成药生精胶囊有补肾益精、滋阴壮阳功效,在治疗男性不育症有较多报道;而在治疗ED少有报道.笔者运用生精胶囊治疗ED取得较满意疗效,现将观察结果报道如下.资料和方法一、临床资料我们于2009年6月至2010年11月选择温州医学院附属第二医院和温州医学院附属第一医院门诊中以ED就诊的患者共50例,接受生精胶囊治疗.患者年龄23～63岁,平均(37.56±9.82)岁;病程6个月至10年,平均(2.21±1.35)年.病例入选标准:参照国际ED诊断原则,即男子在性刺激下,不能持续地达到或维持足够硬度的阴茎勃起以完成满意性交,且病程在3个月以上[1],国际勃起功能评分问卷(IIEF-5)≤2 1分,诊断为ED.排除病例标准:有先天性性器官发育不良,尿道狭窄或畸形,泌尿系感染、结核;伴有严重心血管疾病,肝肾功能不全和糖尿病者; 内分泌测定结果异常者;彩色多普勒超声阴茎血流动力学异常或夜间勃起测定结果异常者;脊柱损伤;配偶不能充分配合者.     

配偶同步参与在治疗男性不育症中的作用

目的 观察配偶同步参与在治疗男性不育症中的作用.方法 84例少弱精子症患者随机分成干预组(43例)和对照组(41例).两组患者均给予相同药物治疗,在这同时,干预组患者配偶被要求来站监测排卵并接受性生活指导及心理支持治疗.治疗前后观察指标包括:精子密度、精子活力、患者配偶妊娠率.结果 两组患者治疗前后精子密度、前向运动精子指标比较差异均具有统计学意义(P＜0.01),而两组治疗后精子密度、前向运动精子指标比较差异无统计学意义(P＞0.05).6个月治疗后,干预组患者配偶妊娠率为39.53％,对照组患者配偶妊娠率为24.39％,差异有统计学意义(P＜0.05).结论 配偶同步参与诊疗可以改善受孕条件,把握受孕时机,对于缩短男性不育症诊疗时程、提高治愈率有重要作用.     

男性不育症诊治中的若干问题

男性不育症是男科的常见病，多数医生能对其做出诊断，并给予治疗。但是，由于生殖问题的复杂性和我们认识的局限性，不育症的治疗效果并不满意。在不育症诊断和治疗的思路、方法和方式中仍有许多值得探讨和改进之处。     

精泰来治疗男性免疫性不育的疗效和安全性

目的 :评估精泰来治疗男性免疫性不育的有效性和安全性。　方法 :198例病人随机进入精泰来组和强的松组 ,进行 6个月治疗和 6个月随访共 12个月的随机平行对照试验。　结果 :抗精子抗体转阴率精泰来组为83.2 % ,强的松组 6 4.8% ;怀孕率分别为 48.7%和 18.0 %。两组比较有明显差异 (P <0 .0 5 )。不良反应的发生率精泰来与强的松分别为 15 .1%和 2 0 .4%。　结论 :精泰来可有效治疗男性免疫性不育 ,并有较好的耐受性。     

生精胶囊在男性不育症中的临床应用中国专家共识

<正>生精胶囊为治疗男性不育症的常用药物,自2005年上市以来,在临床上得到广泛应用,有助于促进生精功能、改善精子质量、提高辅助生殖成功率。2016年中华医学会男科学分会《中国男科疾病诊断与治疗指南与专家共识》推荐生精胶囊作为治疗男性不育症的药物~([1])。随着基础及临床研究不断深入,为指导临床医生合理、规范地使用生精胶囊,在男性不育症治疗中发挥更好的作用,中国中医药信息学会男科分会组织国内专家共同制定本共识,为临床医生规范用药提供指导和参考。本     

男性不育症相关基因研究进展

男子在有规律性生活且未避孕的条件下,一年内未使健康配偶妊娠,即考虑患有不育症。男性不育症(Male Infertility)严重影响现代男性健康和家庭幸福,据WHO统计表明：育龄夫妇中约15%不能生育,其中男性因素约占50%。     

男性不育症相关基因的研究进展

伴随着人类文明的发展进步,受各种因素影响,人类自身的生殖能力发生巨大变化,据统计,不孕不育发生率约10％～12％,男方因素约占50％,其中约30％为特发性男性不育[1],涉及到染色体数量的异常和(或)精子发生发育相关基因的突变等.本文就近一段时间国内外对男性不育相关基因的研究进行综述.一、Y染色体AZF基因自1996年Vogt等将Y染色体长臂上主导精子发生、发育的区域分为AZFa,AZFb,AZFc以来[2],对这3个区域以及后来发现的AZFd基因的研究即进入了崭新的时期,尽管到目前为止有关这些基因的问题尚未完全清晰,但Y染色体AZF微缺失检测已经是继核型分析之后遗传学方面诊断男性不育的重要技术手段[3].     

补肾清热类中药复方治疗免疫性男性不育的系统评价

目的评价补肾清热类中药复方治疗男性免疫性不育的疗效和安全性。方法制定高敏感检索策略，全面检索截止2006年7月23日补肾清热类中药复方治疗男性免疫性不育的临床研究文献，运用改良后Jadad量表评价纳入文献的方法学质量并提取有效数据进行Meta-分析，用RevMan4．2软件完成统计和系统评价。结果共10篇文献包含1625名患者符合纳入标准。均为低质量。Meta分析结果表明，在提高患者配偶妊娠率，中药复方优于强的松（RR2．47，95％CI1．45—4．21），中药复方联合强的松优于单用强的松（RR2．30，95％CI1．58—3．33）：在降低患者抗精子抗体滴度，中药优于强的松（滴度降低1／2，RR1．82，95％CI1．21-2．75）、（滴度降低1/3，RR1．29，95％CI1．05-1．59）。10篇试验中3篇报告了不良事件的结局，严重副作用有结核病和胃溃疡。结论在提高男性免疫性不育患者配偶妊娠率方面，补肾清热类中药复方可能优于强的松，中药合用强的松优于单用强的松；在降低患者抗精子抗体滴度，中药优于强的松。然而，由于现有试验的方法学质量普遍较低，且该类补肾清热类中药复方使用的变异性大，目前尚无足够证据支持其治疗应用，尚需更多高质量的临床随机对照试验。     

Y-microdeletions: a review of the genetic basis for this common cause of male infertility

The human Y-chromosome contains genetic material responsible for normal testis development and spermatogenesis. The long arm (Yq) of the Y-chromosome has been found to be susceptible to self-recombination during spermatogenesis predisposing this area to deletions. The incidence of these deletions is estimated to be 1/4,000 in the general population but has been found to be much higher in infertile men. Currently, Y-microdeletions are the second most commonly identified genetic cause of male infertility after Klinefelter syndrome. This has led to testing for these deletions becoming standard practice in men with azoospermia and severe oligospermia. There are three commonly identified Y-microdeletions in infertile males, termed azoospermia factor (AZF) microdeletions AZFa, AZFb and AZFc. With increased understanding and investigation of this genetic basis for infertility a more comprehensive understanding of these deletions has evolved, with several other deletion subtypes being identified. Understanding the genetic basis and pathology behind these Y-microdeletions is essential for any clinician involved in reproductive medicine. In this review we discuss the genetic basis of Y-microdeletions, the various subtypes of deletions, and current technologies available for testing. Our understanding of this issue is evolving in many areas, and in this review we highlight future testing opportunities that may allow us to stratify men with Y-microdeletion associated infertility more accurately     

精索静脉曲张与男性不育

精索静脉曲张(VC)是导致男性不育的最常见原因之一,手术是治疗VC的主要方法。近来,关于VC导致不育的病理机制研究较多,尤其是细胞分子机制的研究进展较快,主要包括生精细胞凋亡异常和氧化应激。同时,对于VC手术指征和各种术式优劣性的认识也渐趋统一。本文介绍VC导致不育的细胞分子机制及临床治疗决策的研究进展。     

无精子症因子缺失与男性不育相关性研究进展

Y染色体上含有与男性性腺发育和精子发生及分化密切相关的基因。无精子症因子(AZF)是位于Y染色体长臂远端的精子发生调控基因,它的缺失会导致精子发生障碍进而引发男性不育。目前大多数人将AZF分为AZFa、AZFb、AZFc三个区域,也有人认为AZFb和AZFc之间应该增加一个新的区域并命名为AZFd。不同分区的缺失会引起不同的表型。其中,AZFc缺失作为目前最常见的缺失类型被广泛的研究。AZFc缺失包括了AZFc全缺失和AZFc部分缺失,AZFc部分缺失主要为gr/gr缺失和b2/b3缺失。gr/gr缺失在某些地区或人种中引起男性生精障碍的作用已经被证实,b2/b3缺失对生精障碍的影响目前尚无定论,但是它在单倍群N中的普遍分布这一现象也引发了人们的深入思考。本文对AZF不同区域尤其是AZFc区的基本结构、候选基因、缺失情况以及与精子发生的关系作一综述,旨在为临床产前诊断及男性不育治疗提供理论依据。     

Surgical techniques for the management of male infertility

Evaluation and surgical treatment of male infertility has evolved and expanded, now leading to more precise diagnoses and tailored treatments with diminished morbidity and greater success. Surgeries for male infertility are divided into four major categories: (i) diagnostic surgery; (ii) surgery to improve sperm production; (iii) surgery to improve sperm delivery; and (iv) surgery to retrieve sperm for use with in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI). While today we are more successful than ever in treating male infertility, pregnancy is still not always achieved likely due to factors that remain poorly understood. Clinicians treating infertility should advocate for couple-based therapy, and require that both partners have a thorough evaluation and an informed discussion before undergoing specific surgical therapies.     

精索静脉曲张所致不育的免疫学研究

目的研究精索静脉曲张(VC)所致不育与抗精子抗体(AsAb)的关系。方法240例男性不育患者分为VC组和对照组,行精液常规和AsAb检测。结果VC组AsAb阳性率为37.9%,对照组阳性率为25%,两组间有显著性差异(P<0.05);VC组中AsAb阳性率与临床分级密切相关(P<0.005),与精子密度亦明显相关(P<0.01)。结论免疫因素可能是导致VC不育的原因之一。     

解脲支原体感染与男性不育

用双抗体夹心ＥＬＩＳＡ法检测解脲支原体，并与经典的培养法作了比较。３９例生育男性精浆解脲支原体ＥＬＩＳＡ法和培养法的阳性率分别为１０．３％和７．７％，１６４例不育者精浆解脲支原体两法阳性率分别为３５．４％和３１．７％，生育者与不育者解脲支原体阳性率差异非常显著（Ｐ＜０．００５）；ＥＬＩＳＡ法与培养法符合率为８６．５％。精子畸形率超过３０％及精子密度偏低（＜０．２亿／ｍｌ）的不育者，解脲支原体阳性率分别高达６９．２％和５６．５％。解脲支原体感染可导致精子形态与功能异常，从而引起男性不育。     

谷胱甘肽S-转移酶基因多态性与男性不育

男性不育的发生是遗传因素与环境因素相互作用的过程,机体对内外源性化学物质的代谢和解毒能力影响个体对男性不育的易感性。谷胱甘肽S-转移酶(GSTs)属于机体Ⅱ相解毒酶系统,其参与细胞对外源性化学物质和人工合成有机物质解毒的各个生理阶段。研究发现,GSTs基因多态性与男性不育有一定的相关性。在同一地区人群中,GSTs基因多态性对男性不育的易感性具有相似性,也存在不一致性;在不同地区人群中,GSTs基因多态性对男性不育的易感性不一致,也存在相似性。因此,GSTs基因多态性对男性不育患者的易感性在不同人群中存在差异。     

Difference in physiogenomics between male and female infertility

Infertility is an important condition in reproductive medicine. According to this work, there is only one identified physiogenomic relationship on chromosome 5 (CAMK4) for male but there are four identified physiogenomic relationships on chromosome 12 (CD9), chromosome 19 (BSG), chromosome 2 (ADCY3) and chromosome 4 (AFP). Although it has been determined for a long time, there is no clear cut genetic difference between male and female infertility. Systemic approach on the pathophysiology and genomics might provide useful information to better understand the pathogenesis of infertility. In this work, physiogenomics analysis for infertility in male and female was performed.     

Evaluation of serum level of Osteocalcin hormone in male infertility

The suggested concept of “bone as an endocrine organ” had shed the light on the role of osteocalcin, an osteoblast secreted hormone, in regulation of testosterone production. This study aimed to assess the association between the active undercarboxylated form of osteocalcin (ucOC) and semen parameters and hormonal levels in infertile male patients. The study was carried on 34 infertile male patients and 20 fertile healthy control males. Semen analysis and serum level of testosterone, LH and FSH were performed in addition to serum level of ucOC in cases and controls. The results revealed significant differences between cases and controls in all measured semen and hormonal parameters. In addition, significant higher level of ucOC in cases than control group (p = .019). On the other hand, ucOC was not related significantly to any of the measured hormones or semen parameters. There was no significant correlation between ucOC and sperm concentration, total motility, morphology (p = .594, .640, .940 respectively) and similarly between ucOC and testosterone level or LH level (p = .275, .954 respectively). The significant higher level of ucOC in infertile cases cannot be used as a predictor of male reproductive parameters.