挑治补泻手法对精索静脉曲张性不育症患者精子质量及精浆生化的影响

Pricking-reinforcing-reducing therapy improves semen quality and seminal plasma biochemical indexes in patients with varicocele infertility

目的:探讨挑治补泻手法对精索静脉曲张性不育症患者精子质量及精浆生化的影响。方法:160例精索静脉曲张性不育症患者随机分为试验组和对照组各80例,试验组采用挑治补泻手法,对照组口服生精胶囊,治疗前后分别检查精液参数、精子形态学、存活率、精子顶体酶活性、精浆中性-α葡糖苷酶、精浆锌。结果:治疗前试验组患者的精子浓度、总数、前向运动精子百分率、正常形态精子百分率、存活率、精子顶体酶活性分别为(16.81±7.83)×10^(6)/ml、(42.01±19.57)×10^(6)、(15.37±11.03)%、(1.62±1.51)%、(28.11±18.95)%、(28.11±14.64)U/L,对照组分别为(16.80±7.54)×10^(6)/ml、(41.99±18.84)×10^(6)、(14.68±10.27)%、(1.62±1.13)%、(28.23±18.38)%、(27.19±14.07)U/L。治疗3个月后,以上指标组内比较均有显著性差异(P<0.05),试验组分别为(38.88±30.54)×10^(6)/ml、(97.20±76.35)×10^(6)、(32.60±12.46)%、(2.35±1.83)%、(61.44±20.02)%、(65.74±31.81)U/L,对照组分别为(25.60±14.71)×10^(6)/ml、(88.19±39.56)×10^(6)、(27.67±12.27)%、(1.87±1.20)%、(59.12±22.48)%、(67.94±17.95)U/L。治疗后组间比较,精子浓度、前向运动精子百分率、顶体酶活性有显著性差异(P<0.05),精子总数、正常形态精子百分率、存活率无显著性差异(P>0.05)。试验组疗效高于对照组。治疗前试验组中性α-葡糖苷酶、精浆锌分别为(14.42±5.90)U/L、(2.11±1.22)mmol/L,对照组为(14.44±5.61)U/L、(2.09±1.10)mmol/L,治疗后试验组(28.43±19.76)U/L、(2.89±1.23)mmol,对照组为(26.66±17.69)U/L、(2.82±1.08)mmol/L。治疗前后两组组内比较均有显著性差异(P<0.05),治疗后组间比较,无显著性差异(P>0.05)。结论:挑治补泻手法能明显提高精子浓度、精子总数、前向运动精子百分率、存活率、精子顶体酶活性,与治疗不育症常用的药物生精胶囊比较,其改善精液精子浓度、前向运动精子百分率、顶体酶活性等生育重要参数有明显优势,表明挑治补泻手法对精索静脉曲张性不育症有良好作用。其作用机制与提高精浆中性-α葡糖苷酶、锌的含量,为精子的基本代谢、成熟、获能、运动提供充足的能量有关。

Objective:To investigate the effect of pricking-reinforcing-reducing therapy(PRRT)on the semen quality and seminal plasma biochemical indexes of varicocele(VC)infertility patients.Methods:We randomly and equally assigned 160 patients with VC infertility into a PRRT and a control group,the former treated by PRRT and the latter with oral ShengjingCapsules.Before and after treatment,we obtained the semen parameters,sperm morphology,sperm survival rate,sperm acrosin activity,seminal plasma neutralαglucosidase and seminal plasma zinc in the patients and compared them between the two groups.Results:Before treatment,there were no statistically significant differences between the PRRT and control groups in sperm concentration([16.81±7.83]vs[16.80±7.54]×10^(6)/ml,P>0.05),total sperm count([42.01±19.57]vs[41.99±18.84]×10^(6),P>0.05),percentages of progressively motile sperm(PMS)([15.37±11.03]%vs[14.68±10.27]%,P>0.05)and morphologically normal sperm(MNS)([1.62±1.51]%vs[1.62±1.13]%,P>0.05),sperm survival rate([28.11±18.95]%vs[28.23±18.38]%,P>0.05)and sperm acrosin activity([28.11±14.64]vs[27.19±14.07]U/L,P>0.05).After three months of treatment,all the patients showed evident increases in the above parameters(P<0.05),even higher in the PRRT than in the control group,more significantly in sperm concentration([38.88±30.54]vs[25.60±14.71]×10^(6)/ml,P<0.05),PMS([32.60±12.46]%vs[27.67±12.27]%,P<0.05)and sperm acrosin activity([65.74±31.81]vs[67.94±17.95]U/L,P<0.05),though not significantly in total sperm count([97.20±76.35]vs[88.19±39.56]×10^(6),P>0.05),MNS([2.35±1.83]%vs[1.87±1.20]%,P>0.05)and sperm survival rate([61.44±20.02]%vs[59.12±22.48]%,P>0.05).Compared with the baseline,after treatment,the patients in the PRRT group also exhibited elevated levels of neutralα-glucosidase([14.42±5.90]vs[28.43±19.76]U/L,P<0.05)and seminal plasma zinc([2.11±1.22]vs[2.89±1.23]mmol/L,P<0.05),and so did the controls([14.44±5.61]vs[26.66±17.69]U/L,P<0.05)and([2.09±1.10]vs[2.82±1.08]mmol/L,P<0.05).No statistically significant difference,however,was observed between the two groups after treatment(P>0.05).Conclusion:PRRT can significantly improve semen quality in patients with VC infertility,even more effective than ShengjingCapsules in improving sperm concentration,PMS,sperm survival rate,and sperm acrosin activity,which may be related to its effect of elevating the levels of seminal plasma neutral-αglucosidase and zinc providing sufficient energy for basic sperm metabolism,maturation,energy acquisition and motility.