中频穴位电刺激联合他莫昔芬片治疗少弱精子症患者的临床研究

Mid-frequency transcutaneous electrical acupoint stimulation combined with tamoxifen for the treatment of oligoasthenozoospermia

目的:探讨中频穴位电刺激联合他莫昔芬片治疗少弱精子症的临床效果及其可行性与安全性。方法:120例少弱精子症患者随机分为他莫昔芬片口服治疗组(他莫昔芬组)、中频穴位电刺激治疗组(穴位电刺激组)与联合治疗组,每组40例。连续治疗8周,记录各组治疗前后的精液体积、精子总数及浓度、总活力、前向运动(PR)精子百分率及血清生殖激素(FSH、LH、T)水平,对比分析3组患者治疗前后的精液参数及生殖激素水平。结果:所有患者均完成本研究,治疗前后3组精液体积无明显改善(P>0.05)。与治疗前对比,3组均可改善生殖激素(FSH、LH、T)水平(P<0.05);他莫昔芬组可以显著提高精子总数[(42.65±5.78)×10~6vs(25.16±2.05)×10~6,P<0.05]及精子浓度[24.31±2.59)×10~6/ml vs(12.15±2.51)×10~6/ml,P<0.05],而精子总活力及PR精子百分率无明显改善[(22.61±5.75)%vs(21.78±8.81)%;(16.76±5.86)%vs(15.87±7.81)%,P均>0.05];穴位电刺激组可以增加精子总活力率[(32.43±4.97)%vs(24.81±8.27)%,P<0.05]及PR精子百分率[(27.17±5.09)%vs(19.71±9.15)%,P<0.05],而精子总数及精子浓度无明显改善[(25.87±4.96)×10~6vs(23.23±3.14)×10~6;(14.12±2.47)×10~6/ml vs(11.27±2.24)×10~6/ml,P均>0.05];联合治疗组不仅可以提高精子总数[(51.14±3.69)×10~6vs(26.17±5.05)×10~6,P<0.05]及精子浓度[(27.28±1.98)×10~6/ml vs(12.78±2.41)×10~6/ml,P<0.05],而且可以显著提高精子总活力[(37.12±5.33)%vs(23.89±9.05)%,P<0.05]及PR精子百分率[(31.09±7.12)%vs(17.14±8.04)%,P<0.05],并且显著优于他莫昔芬组和穴位电刺激组(P<0.05)。联合治疗组总有效率(97.5%)显著高于他莫昔芬组(72.5%)和穴位电刺激组(75.0%),P<0.05。结论:中频穴位电刺激联合他莫昔芬片口服可以明显改善特发性少弱精子症患者的精液质量和生殖激素水平,有一定的临床推广意义。

Objective： To explore the feasibility,safety and clinical effect of mid-frequency transcutaneous electrical acupoint stimulation（ TEAS） combined with oral tamoxifen（ TAM） in the treatment of oligoasthenozoospermia. Methods： We randomly and equally assigned 120 patients with idiopathic oligoasthenozoospermia to receive oral TAM,mid-frequency TEAS,or TAM ＋ TEAS,all for 8 weeks. Before and after treatment,we recorded the semen volume,total sperm count,sperm concentration,sperm motility,percentage of progressively motile sperm（ PMS）,and the levels of follicle-stimulating hormone（ FSH）,luteotrophic hormone（ LH） and testosterone（ T） in the peripheral serum and compared these parameters among the three groups of patients. Results： Compared with the baseline,none of the patients showed significant improvement in the semen volume（ P 〈0. 05） but all exhibited remarkably elevated levels of serum FSH,LH and T after treatment（ P 〈0. 05）; TAM significantly improved the total sperm count（ [25. 16 ±2. 05] vs [42. 65 ± 5. 78] × 10~6,P 〈0. 05） and sperm concentration（ [12. 15 ± 2. 51]vs [24. 31 ± 2. 59] × 10~6/ml,P 〈0. 05）,but not total sperm motility（ [21. 78 ± 8. 81] vs [22. 61 ± 5. 75] %,P 〈0. 05） or PMS（ [15. 87 ± 7. 81] vs [16. 76± 5. 86] %,P 〈0. 05）; TEAS markedly increased total sperm motility（ [24. 81 ± 8. 27] vs [32. 43 ± 4. 97] %,P 〈0. 05）and PMS（ [19. 71 ± 9. 15]vs [27. 17 ± 5. 09]%,P 〈0. 05）,but not the total sperm count（ [23. 23 ± 3. 14]vs [25. 87 ± 4.96] × 10~6,P 〈0. 05） or sperm concentration（ [11. 27 ± 2. 24]vs [14. 12 ± 2. 47] × 10~6/ml,P 〈0. 05）; TAM ＋ TEAS,however,improved not only the total sperm count（ [26. 17 ± 5. 05] vs [51. 14 ± 3. 69]× 10~6,P 〈0. 05） and sperm concentration（ [12. 78 ± 2. 41]vs [27. 28 ± 1. 98] × 10~6/ml,P 〈0. 05）,but also total sperm motility（ [23. 89 ± 9. 05] vs [37. 12 ± 5.33]%,P 〈0. 05） and PMS（ [17. 14 ± 8. 04] vs [31. 09 ± 7. 12]%,P 〈0. 05）. The total effectiveness rate was significantly higher in the TAM ＋ TEAS group than in the TAM and TEAS groups（ 97. 5% vs 72. 5% and 75. 0%,P 〈0. 05）. Conclusion：Mid-frequency TEAS combined with tamoxifen can significantly improve semen quality and increase sex hormone levels in patients with idiopathic oligoasthenozoospermia.