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。     

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。     

Network Pharmacology‑Based Study of Chinese Herbal Qixiong Formula in Treating Oligoasthenospermia

Objective: The objective isto study the network pharmacology of Qixiong formula (QXF) and explore the mechanism of QXF in the treatment of oligoasthenospermia. Materials and Methods: Using Traditional Chinese Medicine Systems Pharmacology Database andAnalysis Platform (TCMSP), aBioinformaticsAnalysisToolfor Molecular mechANism ofTraditionalChinese Medicine (BATMAN-traditionalChinese medicine), and an encyclopaedia of traditional Chinese medicine (ETCM) databases as well as data from relevant studies, the effective components and targets of QXF were obtained. Genes associated with oligospermia were screened using GeneCards, OMIM, DisGeNet, DrugBank, and GAD databases. The intersection target was obtained by mapping the target to the gene, and the protein interaction network was created using the STRING database to screen the core target of QXF in the treatment of oligospermia. The intersection target was enriched using gene ontology (GO) and the Kyoto Encyclopedia of genes and genomes (KEGG) pathway analysis with the DAVID database. The network of the disease drug target pathway was drawn using Cytoscape software. Results: Overall, 536 active components of QXF and 40 core targets for the treatment of oligoasthenozoospermia were obtained. The analysis of GO and KEGG showed that QXF is mainly involved in oxidative stress, cell motility, nutritional response, and other biological processes. Through the regulation of FOXO, p53, PI3K/Akt, MAPK, mammalian target of rapamycin, Foxo, Wnt, and other signaling pathways, QXF played a role in the treatment of oligoasthenospermia. Conclusion: QXF has multi-component, multi-target, and multi-channel characteristics, providing a new way to study the mechanism of QXF in the treatment of oligoasthenospermia.     

自拟益精汤治疗少弱精子症的疗效观察

目的:研究益精汤治疗男性少弱精子症的临床疗效。方法:将80例少弱精子症患者随机分为两组,治疗组40例,采用益精汤进行治疗,对照组40例,采用维生素E治疗,12周为1个疗程。分别于治疗前后对患者进行综合疗效评价、精液参数分析及精子正常形态判定。结果:经过12周的治疗,治疗组较对照组患者精液检测各项指标的改善差异有显著性(P<0.01)。治疗组上述指标较治疗前改善,差异有显著性(P<0.01)。结论:益精汤能提高精子的密度、活力及活动率。     

四子种王胶囊对男性少弱精子症患者性激素的影响

目的：观察四子种王胶囊对男性少弱精子症患者性激素的影响。方法：选择80例少弱精子症患者,给予四子种王胶囊5彬次,2次／日,早晚服用。连服3个月为1个疗程。观察治疗前后血清睾酮、黄体生成素及卵泡刺激素水平。结果：治疗前血清睾酮水平（8．41±2．02）nmol／L,黄体生成素水平（4．29±0．94）IU／L,卵泡刺激素水平为（5．08±0．90）IU／L;治疗后分别为（9．83±1．37）nmol／L,（5．95±0．93）IU／L,（5．42±0．51）IU／L。治疗后与治疗前相比差异有统计学意义（P〈0．05）。结论：四子种王胶囊能有效提高少弱精子症患者的血清T、LH及FSH水平,从而提高精子生成及成熟。     

Medical therapy of oligoasthenospermia associated with left varicocele

OBJECTIVE: To ascertain whether a nonsteroidal anti-inflammatory drug (cinnoxicam) or surgical varicocelectomy are suitable therapies for oligoasthenospermia associated with varicocele. PATIENTS AND METHODS: Patients who were oligoasthenospermic and had a varicocele were blindly randomized into three groups and the varicocele graded using echo-colour Doppler ultrasonography. In group 1, seven men had grade V, four grade IV and 30 grade III varicoceles; in group 2 eight had grade V, 10 grade IV and 43 grade III; in group 3 six had grade V, eight grade IV and 40 grade III. Group 1 underwent surgery, group 2 received cinnoxicam (one 30 mg suppository every 4 days for 12 months) and group 3 received a placebo (one glycerine suppository every 4 days for 12 months). Sperm was analysed at intervals to follow the response in the three groups, and any side-effects considered. RESULTS: Surgery significantly increased sperm values in men with grade III-V varicocele within 4 months, the highest values being obtained at 8 and 12 months. Cinnoxicam significantly improved sperm quality after 2 months in men with grade III varicocele, but the results were best at 4 months and stable at 12 months; stopping therapy caused a decline to the baseline values. Cinnoxicam did not change the sperm quality of men with grade IV or V varicocele. The placebo was inactive, and there were no side-effects of active treatment. CONCLUSIONS: Cinnoxicam is a safe and reliable therapeutic option for men with oligoasthenospermia associated with a grade III varicocele, but surgery is better for those with grade II, IV and V.     

小剂量氯米芬与左卡尼汀联合治疗特发性少弱精症

目的:探讨小剂量氯米芬联合左卡尼汀治疗特发性少弱精子症的疗效和安全性。方法:根据WTO标准选择特发性少弱精子症患者60例,给予小剂量氯米芬(25mg),每日1次;左卡尼汀口服液1.0g,每日2次。两种药物连服3个月为1疗程,根据情况,维持治疗1～2个疗程。分别于治疗前、治疗后3个月及6个月行计算机辅助精液分析。治疗开始后2周、4周及3个月,用放射免疫法测定血清睾酮(T)卵泡刺激素(FSH)。治疗中分别有8例患者和5例患者的血清睾酮水平和FSH水平超出正常值高限,随即减低氯米芬剂量至25mg,隔日1次。治疗中了解配偶妊娠情况及不良反应发生情况。结果:随访3～6个月,有10例患者因各种原因(2例女方妊娠)提前退出。服药后,患者的睾酮及卵泡刺激素迅速升高,接近正常上限水平。治疗后患者的精子密度及前向运动精子百分率较治疗前增加显著(P<0.05),治疗后女方妊娠者为11例。治疗期间,所有患者均未报告明显的不良反应。结论:小剂量氯米芬联合左卡尼汀治疗特发性少弱精子症能有效提高患者精子密度及前向运动精子百分率,增加妊娠率,无明显不良反应。     

Establishment of an oligoasthenospermia mouse model based on TAp73 gene suppression

BackgroundOligoasthenospermia is one of the main causes of male infertility. Researchers usually use chemical drugs to directly damage germ cells to prepare oligoasthenospermia models, which disregards the adhesion and migration between spermatogenic cells and Sertoli cells. TAp73 is a critical regulator of the adhesin of germ cell; thus, we sought to explore a novel oligoasthenospermia model based on TAp73 gene suppression.MethodsMice in the Pifithrin‐α group were injected intraperitoneally with 2.5 mg/kg Pifithrin‐α (TAp73 inhibitor) daily for 30 consecutive days. Reproductive hormone levels and epididymal sperm quality, as well as the network morphology of Sertoli cells were tested.ResultsSperm density, motility, and the relative protein and mRNA expression of TAp73 and Nectin 2 were obviously decreased in the Pifithrin‐α group compared with the normal control group. No significant distinction was observed in the relative mRNA and protein expression of ZO‐1. Furthermore, the tight junctions (TJs) and apical ectoplasmic specialization (ES) were destroyed in the Pifithrin‐α group.ConclusionThe above results indicate that we successfully established a new oligoasthenospermia mouse model. This study provides a foundation for further exploration of the roles of TAp73 genes during spermatogenesis and provides new research objects for further oligospermia research and future drug discovery.     

生精胶囊治疗少弱精子症的临床疗效观察

目的:研究生精胶囊治疗男性少弱精子症的临床疗效。方法:少弱精子症患者270例,随机分为2组,治疗组135例口服生精胶囊,每次1.6g,3次/d,共12周;对照组135例应用维生素E,每次50mg,3次/d,共12周;分析两组治疗前及治疗后患者配偶受孕及精液检测各项指标的变化。结果:经过12周的治疗,治疗组较对照组患者配偶受孕情况及精液检测各项指标的改善差异有显著性(P<0.01)。治疗组上述指标较治疗前改善,差异有显著性(P<0.01)。结论:生精胶囊能提高精子的密度、活力及活动率,用药安全,不良反应少,对治疗少弱精子症有良好的临床疗效。     

不同来源的精子ICSI治疗周期妊娠结局分析

目的:比较不同来源的精子进行ICSI治疗后受精率、胚胎种植率、临床妊娠率等临床指标有无差异。方法:回顾性分析2006年1月~2008年12月本院生殖中心进行的431个ICSI治疗周期,按精子来源分为A组(重度少弱精子症组)287个周期、B组(梗阻性无精子症附睾穿刺组)109个周期、C组(梗阻性无精子症睾丸穿刺组)35个周期,比较各组女方平均年龄、男方平均年龄、不孕病史、平均MII卵数、受精率、卵裂率、胚胎利用率、平均移植胚胎数量、种植率、妊娠率、流产率等指标的差异。结果:A组与B、C两组在种植率、妊娠率方面差异有统计学意义(18.46%vs25.23%、28.76%;31.23%vs42.16%、39.39%,P<0.05);B、C两组之间各数据差异无统计学意义(P>0.05),受精率、卵裂率、流产率3组之间差异无统计学意义。结论:重度少弱精子症患者射出精子进行ICSI治疗后胚胎种植率、临床妊娠率低于梗阻性无精子症患者。