益精方治疗弱精子症的临床随机对照研究

Yijingfang for the treatment of asthenospermia:A randomized controlled clinical trial

目的:观察益精方治疗弱精子症的临床疗效。方法:450例患者以信封法随机分为治疗组(益精方组)300例和对照组(五子衍宗丸+左卡尼汀口服液组)150例,经精液常规检查诊为弱精子症,治疗组服用益精方,每天1剂,温水冲服,分2次服用,对照组服用五子衍宗丸+左卡尼汀口服液,五子衍宗丸9 g,口服,每日2次,左卡尼汀口服液,10 ml,口服,每日2次,均治疗3个月,于治疗前及治疗后的第1个月(第27~33天)、2个月(第57~63天)和3个月(第87~93天)分别检测患者的精液常规,比较治疗前后精子浓度、前向运动精子百分率(PR)、精子总活力(PR+NP)等精液参数的变化。结果:两组患者治疗前精液常规检查结果无显著差异(P>0.05)。治疗组治疗1、2、3个月时,精子浓度分别为49.66±10.91、55.21±11.46、74.90±13.07(×10~6/ml),PR分别为23.81±2.56、26.12±2.34、32.17±1.62(%),PR+NP分别为34.17±3.43、36.59±3.36、47.08±2.97(%),精液体积分别为3.15±1.06、3.12±0.90、3.27±0.78(ml),液化时间分别为31.68±3.14、30.38±3.44、30.86±2.42(min),组内比较显示,治疗后精子浓度、PR、PR+NP较治疗前差异显著(P<0.001),精液体积、液化时间差异不明显(P>0.05)。对照组治疗1、2、3个月时,精子浓度分别为40.53±8.32、47.51±12.73、56.14±11.98(×10~6/ml),PR分别为25.17±2.64、27.23±2.25、31.89±2.27(%),PR+NP分别为33.89±2.26、37.38±4.79、40.35±3.06(%),精液体积分别为3.16±1.78、3.15±0.96、3.12±0.65(ml),液化时间分别为29.36±4.25、28.21±3.26、28.33±3.59(min),组内比较显示,治疗后精子浓度、PR、PR+NP较治疗前差异显著(P<0.001),精液体积、液化时间差异不明显(P>0.05)。组间比较显示,治疗组精子浓度及PR+NP增长率较对照组有显著差异(P<0.001),PR增长率两组间差异不明显(P>0.05)。结论:益精方可在生精周期多个阶段调控精子的发生,提高弱精子症患者的PR及PR+NP比例,是一种有效的治疗弱精子症的方剂。

Objective： To investigate the clinical therapeutic effects of Yijinjang, a Chinese medicinal liquid, on asthenosper- mia. Methods： We randomly divided 450 asthenospermia patients into a treatment group （n = 300） and a control group （n = 150） , the former treated with Yijing）Cang once half a dose, bid, and the latter with Wuziyanzong Pills （9 g, bid） ＋ L-carnitine oral liquid （ 10 ml, bid） , both for 3 months. Before and at 1, 2, and 3 months after medication, we compared the semen volume, sperm concentration, percentages of progressively motile sperm （PMS） and total motile sperm （TMS）, and semen liquefaction time between the two groups of patients. Results ： No statistically significant difference was observed in the semen parameters between the treatment and control groups before medication （P 〉 0.05 ）. In comparison with the baseline, the treatment group showed significant differences at 1, 2, and 3 months after medication in sperm concentration （ [35.96 ± 8.50] vs [49.66 -＋ 10.91], [55.21 ± 11. 461, [74.90 ± 13.07] ×106/ml, P 〈0.01）, PMS（[19.72 ± 2.06] vs [23.81 ± 2.56], [26.12 ± 2.34], and [32.17 ± 1.62] %, P 〈0.01） and TMS （[28.86 ± 2.70] vs [34.17 ± 3.43], [36.59 ± 3.36], and [47.08± 2.97] %, P 〈0.01）, but not in the semen volume （[3.35± 0.99] vs [3.15 ± 1.06], [3.12 ± 0.90], and [3.27 ± 0.78] ml, P 〉0.05） or semenliq- uefaction time （[32.31± 8.15] vs [31.68 ± 3.14], [30.38 ± 3.44], and [30.86 ± 2.42] rain, P 〉0.05）; the control group exhibited similar results at the three time points in sperm concentration （ [ 36.85 ± 6.88 ] vs [40.53 ± 8.32 ], [47.51 ± 12.73], and I56.14± 11.98] ×106/ml, P 〈0.01）, PMS （[20.26 ± 2.73] vs [25.17 ±2.64], [27.23 ± 2.25], and [31.89±2.271%, P 〈0.01）, and TMS （[30.03 ± 2.67] vs [33.89±2.26], [37.38±4.79], and [40.35±3.06] %, P 〈0.01）, but not in the semen volume （[3.03 ± 1.09] vs [3.16±1.78], [3.15±0.96], and [3.12 ±0.65] ml, P 〉0.05） or semen liquefaction time （[30.25 ± 5.20] vs [29.36 ±4.25], [28.21 ±3.26], and [28.33 ±3.59] min, P 〉0.05）. There were statistically significant differences between the treatment and control groups in the increase rates of sperm concentration and TMS after medication （P 〈 0.01 ） but not in that of PMS （ P 〉 0. 05 ）. Conclusion ： Yijingfang is an effective drug for the treatment of asthenospermia, which can regulate the spermatogenesis, increase the percentage of PMS, and improve the total sperm motility of the patients.