十子二仙汤改善精索静脉曲张术后精子顶体完整率及DNA完整率的临床研究

Effects of Shi Zi ErXian Decoction on sperm acrosomal integrity and DNA integrity in patients after varicocelectomy

目的观察精索静脉曲张高位结扎术后配合十子二仙汤改善肾阳虚型弱精子症患者精子DNA断裂指数（DFI）和顶体完整率的临床效果。方法在实验前，取配偶怀孕后半年内正常精液标本20例，测定精子顶体完整率及DFI做预试验，其数值拟做疗效参考指标。肾阳虚型弱精子症伴精索静脉曲张患者60例。随机分为治疗组（十子二仙汤治疗）和对照组（左旋肉毒碱治疗），每组各30例，分别收集所有患者术前1周和术后3个月的精液标本，进行1个周期（3个月）的观察治疗。治疗1个周期后，对疗效不明显（DFI≥15％，顶体完整率〈90％）的患者，停药1周后，互换治疗方案，即原治疗组采用左旋肉毒碱治疗，原对照组采用十子二仙汤治疗，并作二期治疗1周期观察。结果经过1个周期的治疗，治疗组和对照组患者精子密度、精子活力、DFI和顶体完整率较治疗前都有了改善。其中，精子密度，治疗组和对照组改善程度差异不明显（P〉0．05）。精子活率、精子活力、DFI和顶体完整率，治疗组改善程度优于对照组（P〈0．05）。互换治疗方案后，二期观察显示十子二仙汤在改善DFI和顶体完整率上，效果仍然优于左旋肉毒碱（P〈0．05）。结论精索静脉曲张高位结扎术后配合十子二仙汤能有效改善肾阳虚型弱精子症患者精子DNA完整性和顶体完整率。

Objective To investigate the effects of Shi Zi Er Xian Decoction on sperm acrosomal integrity and DNA integrity in patients with kidney yang deficiency after varicocelectomy. Methods Pretesting of the integi＇ity of sperm acrosomal integrity and DNA of 20 normal sperm samples were carried out as reference data. In total 60 varicocele patients with kidney yang deficiency collected from the Reproductive Center of our hospital from April 2008 to January 2011 were randomly divided into the treatment group （30 cases, given Shi Zi ErXian Decoction） and control group （30 cases, given L-carnitine）. The semen samples were collected 1 week before surgery and 3 months after surgery. All the treatments lasted for 3 months without stop. Three months later, the patients who did not reslaond well to the treatment （ DFI 〉1 15 and acrosomal integrity〈90% ） underwent drug withdrawal for one week. Then, the treatment programs were exchanged, lasting for one course again. Results After one course of treatment, the sperm density, motility, DFI and acrosomal integrity of both groups were all improved. The sperm motility, DFI and acrosomal integrity of the treatment group were better than those of the control group （P〈0.05）, but the sperm density had no significant difference between them（P〉0.05）. After the treatment programs were exchanged, better effect was found in the group given the Shi Zi Er Xian Decoction than that in the control group（P〈0.05）. Conclusion The Shi Zi Er Xian Decoction is able to reduce sperm DFI in patients with kidney yang deficiency and improve acrosomal integrity.