加味六味地黄汤治疗少、弱精男性不育症疗效分析

目的观察加味六味地黄汤治疗男性不育少、弱精症的临床疗效,以探讨其对男性生殖功能的作用机制。方法将175例少、弱精男性不育症患者随机分为治疗组87例（口服加味六味地黄汤）和对照组88例（口服克罗米芬胶囊）。两组均连续治疗3个月,分别在用药前后进行精子活动率、精子密度及血清卵泡刺激素（FSH）、抑制素B（IN-HB）检测。FSH测定采用微粒子化学发光法,INHB水平测定应用双抗体酶联免疫吸附法（ELISA法）。观察两组患者的临床疗效。结果①治疗组成功受孕（治愈）26例,精液质量恢复正常（显效）30例,精液质量改善（有效）24例,治疗前后精液质量无明显变化（无效）7例,显效率为64.4%,总有效率为92.0%;对照组治愈15例,显效25例,有效38例,无效10例,显效率和总有效率分别为45.5%、88.6%。治疗组显效率显著优于对照组（χ2=6.32,P〈0.05）。②治疗组治疗后精子密度从（14.7±5.2）×106/mL提高到（46.4±7.8）×106/mL（t=31.60,P〈0.01）,对照组从（15.4±4.3）×106/mL提高到（28.6±9.4）×106/mL（P〈0.01）,治疗后治疗组精子密度高于对照组（t=13.62,P〈0.01）。治疗组治疗后精子活动率从（41.1±8.3）%提高到（68.4±11.3）%（t=18.20,P〈0.01）,对照组精子活动率从（42.4±7.5）%提高到（63.2±10.8）%（P〈0.01）,治疗后治疗组精子活动率高于对照组（t=15.60,P〈0.01）。③治疗组治疗后FSH从（5.38±2.14）mIU/mL提高到（7.76±3.02）mIU/mL（P〈0.05）,INHB从（85.36±28.17）ng/L提高到（120.05±11.32）ng/L（P〈0.05）,对照组FSH从（5.51±2.53）mIU/mL提高到（7.15±2.34）mIU/mL（P〈0.05）,INHB从（79.53±35.28）ng/L提高到（107.48±15.81）ng/L（P〈0.05）;两组治疗后比较,血清FSH水平差异有高度统计学意义（t=6.02,P〈0.01）。结论加味六味地黄汤能有效改善少、弱精症男性不育患者的精子质量,改善患者的生殖功能,可能是通过调节体内FSH、INHB发挥作用的。

Clinical efficacy on Modified Liuwei Dihuang Decoction in the treatment of male infertility oligosermia

Objective To observe clinical efficacy of Modified Liuwei Dihuang Decoction in the treatment of male infertility oligosermia,to explore its mechanism of male reproductive function.Methods 175 cases of male infertility oligosermia and asthenozoospermia according to the accepted standard were enrolled and divided into treatment group(87 cases) and control group(88 cases),the treatment group was received Modified Liuwei Dihuang Decoction therapy,the control group was received Clomiphene Citrate therapy.After 3 mouths of continuous therapy,the sperm motility,sperm density,serum follicle stimulating hormone(FSH) and inhibin B(INHB) were compared to evaluate the clinical effection.FSH levels were measured by microparticle chemiluminescence and INHB levels were carried out using double antibody enzyme-linked immunosorbent assay(ELISA).Results ①In the treatment group with 87 cases,26 cases of successful pregnancy(cure),30 cases of nomorl semen quality(markedly effective),24 cases of semen quality improvement(effective),7 cases before and after treatment no significant changes in semen quality(ineffective),the total effective rate was 92.0%,markedly effective rate was 64.4%.In the control group,15 cases were cured,25 cases markedly effective,38 cases effective,10 cases ineffective,the total effective and improvement rates were 88.6% and 45.5%.Through statiscal analysis,the markedly effective rate of the treatment group was obviously superior to the control group(χ2 = 6.32,P < 0.05).②After treatment,the sperm density of treatment group was improved from(14.7±5.2) ×106/mL to(46.4±7.8) × 106/mL(t = 31.60,P < 0.01),the control group from(15.4±4.3) ×106/mL to(28.6±9.4) ×106/ml(P < 0.01),the treatment group was obviously superior(t = 13.62,P < 0.01).The sperm motility of the treatment group from(41.1±8.3)% to(68.4±11.3)%(t = 18.20,P < 0.01),the control group from(42.4±7.5)% to(63.2±10.8)%(P < 0.01),the sperm motility of the treatment group was superior to the control group(t = 15.60,P < 0.01).③After treatment,the FSH of the treatment group from(5.38±2.14)mIU/mL to(7.76±3.02)mIU/mL(P < 0.05),the INHB from(85.36±28.17)ng/L to(120.05±11.32)ng/L(P < 0.05),the FSH of the control group from(5.51±2.53)mIU/mL to(7.15±2.34)mIU/mL(P < 0.05),the INHB from(79.53±35.28)ng/L to(107.48±15.81)ng/L(P < 0.05),compared the serum FSH levels after treatment,there was significantly different(t = 6.02,P <0.01).Conclusion Therapy of Modified Liuwei Dihuang Decoction could effectively improve sperm motility and reproductive function of male infertility patients with oligosermia and asthenozoospermia,possibly by regulating FSH,INHB of the body play a role.