Chlorambucil in Behçet's Disease: A Reappraisal

Ten patients with Beh?et's disease were treated with chlorambucil alone. At the therapeutic drug level of 0.2 mg/kg, seven patients developed oligospermia and three patients developed azoospermia. A 30-year-old patient underwent a testicular biopsy two years after the cessation of therapy. Histopathology revealed evidence of testicular atrophy. Fifteen (75%) out of 20 eyes had a visual acuity of 20/200 or less following therapy. It is concluded that chlorambucil should not be used as the first line of therapy in Beh?et's disease and that its long term benefits in patients with Beh?et's disease should be reevaluated.     

生长素在少精子症中的应用探讨

[目的]探讨基因重组人生长素(rhGH)在少弱精子症中的应用价值。[方法]66例诊断为特发性少精子症患者,随机分为A、B两组:A组31例,使用rhGH治疗,2次/周肌注,每次4.5IU.共用16周;B组35例,给予金施尔康(多种维生素制剂)1次/d口服,共16周。治疗前后作精液分析。[结果]66例参加有效率统计,A组有效率42.0％,B组25.4％。差异有显著性(X2=4.686,P<0.05。[结论]rhGH能有效地改善辜丸生精内环境,促进精子的生成。     

自拟七子补肾生精汤联合他莫昔芬、维生素E治疗少弱精子症疗效观察

目的观察自拟七子补肾生精汤联合他莫昔芬片、维生素E软胶囊治疗少弱精子症的临床疗效及安全性。方法选择2013年6月至2014年11月在邢台不孕不育专科医院男性不育科就诊的不育症患者184例,按不同用药分为两组:治疗组92例用自拟七子补肾生精汤水煎+口服他莫昔芬、维生素E口服;对照组92例用五子衍宗丸+他莫昔芬、维生素E口服。疗程均为3个月,观察治疗前后两组患者精液参数及疗效。结果经过3个月治疗,治疗组患者精子浓度[(36.81±4.26)m L]、精子活力[PR值(50.63±5.73)%]较治疗前[(8.57±4.51)m L、(24.92±3.76)%]显著提高(P0.05);对照组患者治疗后精子浓度[(18.43±5.12)m L]、精子活力[PR值(36.23±4.04)%]较治疗前[(8.29±4.85)m L、(22.15±4.82)%]也有提高(P0.05),但治疗组临床疗效明显优于对照组(P0.05)。两组治疗中未发生明显不良反应。结论补肾生精汤联合他莫昔芬、维生素E治疗少弱精子症的疗效显著且安全性良好。     

中药配合宫腔内人工授精治疗男性少精不育症的临床研究

目的观察中药配合精子洗涤治疗男性少精不育症的临床疗效。方法将112例男性少精不育症患者随机分为2组,对照组56例予精子洗涤,宫腔内人工受精的治疗方法 ,治疗组56例在对照组治疗基础上加用中药人参五子衍宗汤加减口服治疗。2组均治疗6个月后判定疗效,并观察治疗前后精液量、精子密度的指标变化。结果 2组总有效率比较差异有统计学意义(P0.05),治疗组疗效优于对照组。2组治疗后精液量、精子密度均较本组治疗前升高(P0.05),治疗组治疗后精液量、精子密度较对照组升高(P0.05)。结论中药配合精子洗涤,宫腔内人工授精能显著改善男性少精不育症精液量、精液密度,治疗效果优于单纯精子洗涤。     

复方精氨酸胶囊治疗男性少弱精症疗效观察

目的:探讨复方精氨酸胶囊治疗男性少弱精症的有效性和安全性.方法:将80例男性少弱精症不育患者随机分为试验组及安慰剂组,各40例.分别给予复方精氨酸胶囊和安慰剂,共服药60 d.于停药后第10 d评价有效性和安全性.结果:试验组有效率(63.64%,21/33)明显高于安慰剂组(31.43%,11/35),2组间差异有统计学意义(P＜0.01).2组患者在治疗过程中无严重不良事件发生.结论:复方精氨酸胶囊能有效治疗少弱精症,短期用药无严重不良反应.     

Acupuncture for oligospermia and asthenozoospermia: A systematic review and meta-analysis

Background:Acupuncture is widely used for oligospermia and asthenozoospermia in China, but its effect is unclear. We aimed to determine the effectiveness and safety of acupuncture in treating oligospermia and asthenozoospermia.Methods:An electronic search for randomized controlled trials evaluating acupuncture treatment in patients with oligospermia and asthenozoospermia published from database inception to October 2018 was conducted in PubMed, EMBASE, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database (VIP Database), the Wan-Fang Database, the China National Knowledge Infrastructure and the Cochrane Library. We established search terms related to 3 areas (oligospermia, asthenozoospermia, and acupuncture). Two authors independently screened all identified citations and extracted the data. The methodological quality of the included trials was assessed using the Cochrane criteria.Results:Seven studies with a total of 527 subjects were screened according to inclusion and exclusion standards, and most of the studies had significant methodological weaknesses. Seven randomized controlled trials tested the effects of acupuncture compared with placebo acupuncture and conventional medications in patients with oligospermia and asthenozoospermia. The results of this study suggest that acupuncture alone has no clear superiority in improving sperm motility (standard mean difference [SMD] = 1.13, 95% confidence interval [CI]: −0.64 to 2.89), the sperm concentration (SMD = 0.32, 95% CI: 0.27–0.92) or semen volume compared with placebo acupuncture. No significant difference was found between acupuncture alone and conventional medications in improving sperm motility (SMD = −0.53, 95% CI: −2.54 to 1.48), the sperm concentration (SMD = −1.10, 95% CI: −1.48 to −0.72) or semen volume. However, adjuvant acupuncture may enhance the effect of medications on improving sperm motility (SMD = 4.10, 95% CI: 1.09–7.12) and the sperm concentration (SMD = 1.07, 95% CI: 0.739–1.40), but the study heterogeneity was too high to establish robust conclusions.Conclusion:These results suggest that the current evidence does not support acupuncture as an effective treatment for oligospermia and asthenozoospermia; therefore, acupuncture is not currently recommended as a treatment for these conditions. However, owing to the high risk of bias among the included studies, the evidence is limited, and more large-scale, high-quality clinical trials are needed in the future.Trial registration number:PROSPERO CRD42018083885     

少精不育患者的雄性激素受体基因突变分析

目的了解雄性激素受体（ＡＲ）基因突变对少精不育症发生所起的作用。方法利用聚合酶链反应技术（ＰＣＲ）对３０例少精不育患者精液标本的ＡＲ基因８个外显子分别进行扩增。扩增产物经琼脂糖凝胶电泳和聚丙烯胺的ＣＤＧＥ电泳分析,检测基因片段的插入,缺失和点突变。结果３０例患者中,外显子Ａ即基因转录激活区发生点突变３例,插入突变４例共７例,突变率为２３３％。外显子Ｈ发生缺失突变１例,约占３３％,外显子Ｇ处发生点突变１例,约占３３％,总突变率为３００％。结论雄性激素受体基因外显子Ａ即基因转录激活区的突变是造成少精不育的重要原因。     

染色体变异、畸变与男性生殖激素水平和精子生成的关系

目的：探讨染色体变异、畸变与男性生殖激素水平和精子生成的关系。方法对147例男性不育和复发性流产患者进行染色体核型、生殖激素和精液分析,并对其结果进行对比分析。结果染色体畸变组血清 FSH、LH 水平和无精子症发生率分别高于染色体变异组和正常组（P ＜0.05,P ＜0.01）,血清 T 水平显著低于染色体变异组和正常组（P ＜0.05）。Y 染色体变异组血清 FSH 水平和少精子症发生率显著高于常染色体变异组（P ＜0.05）,两组无精子症发生率差异无统计学意义（P ＞0.05）。性染色体畸变组血清 FSH、LH 水平和无精子症发生率显著高于常染色体畸变组（P ＜0.05）,血清 T 水平显著低于常染色体畸变组（P ＜0.05）。结论染色体变异、畸变与生殖激素紊乱和生精功能障碍密切相关,性染色体变异和畸变导致男性血清 FSH、LH水平显著升高、T 水平显著降低可能是导致少精子症和无精子症的发病机制之一。     

少、弱、畸形精子症患者血铅、镉浓度的测定

目的通过对男性少、弱、畸形精子症患者血铅、镉的测定,探索职业、环境、嗜好、生活习惯对男性生殖的影响。方法经检查确诊为少、弱、畸形精子症的79例患者,检测其血铅、镉含量和进行精液分析,将其结果与精液正常的34人对比,并作统计学分析。结果79例患者中,血铅(Pb)≥100μg/L或镉(Cd)≥5μg/L共53例,占总患者的67.1%;正常组中仅5例Pb>100μg/L,占14.7%,两者比较差异显著(P<0.05)。结论重金属铅、镉对精液质量影响显著。     

聚精丸治疗少精子症的实验研究

目的:观察聚精丸对少精子症患者精子超微结构和生精细胞凋亡的影响,探讨聚精丸对精子生成的作用机制。方法:50例少精子症患者口服聚精丸5g/次,3次/d,3个月为1个疗程,连续服用1~4个疗程,分别于治疗前、治疗1、3、6、12个月后,通过透射电镜和流式细胞仪(FCM)观察精子超微结构和生精细胞的凋亡、生精细胞倍体比例的变化。结果:①精子超微结构治疗6个月后顶体基质密度有所增加,治疗12个月后顶体膜形态完整性有明显改善;核的病理改变和尾部异常改变不明显。②生精细胞凋亡治疗后细胞碎片和凋亡细胞减少,治疗3个月后与治疗前比较差异有显著性(P<0.05),治疗12个月后与治疗前比较差异有极显著性(P<0.01)。③生精细胞倍体比例经聚精丸治疗3个月后,单倍体成熟精子增多,与治疗前比较差异有极显著性(P<0.01);脱落的精母细胞减少,与治疗前比较差异有显著性(P<0.05)。结论:聚精丸可改善少精子症患者精子顶体基质密度和顶体膜结构形态的病理性改变,提高顶体膜和顶体酶的质量;降低生精细胞及精子凋亡速率,提高单倍体精子的百分率,降低二倍体细胞的百分率。