加味五子衍宗汤对男性不育症患者精液质量和线粒体功能的影响

Effect of Modified Wuzi Yanzong Decoction on Semen Quality and Mitochondrial Function of Male Infertility Patients

目的:观察加味五子衍宗汤治疗男性不育症的临床疗效,以及对精液质量和线粒体功能的影响。方法:将164例男性不育症患者按随机数字表法分为对照组78例和观察组86例。对照组使用左卡尼汀治疗,观察组在对照组治疗的基础上联合加味五子衍宗汤治疗,具体用药如下:菟丝子30 g,五味子20 g,枸杞子20 g,车前子15 g,覆盆子15g。辨证加减:气滞血瘀者加当归15 g,党参20g;肾气不足者加淫羊藿20 g,肉苁蓉15 g,山萸肉10 g,黄芪10 g,水煎300 m L,每天1剂。两组患者均连续治疗3个月。观察两组患者精液量、精子浓度、a+b级精子和a级精子比例、精子线粒体膜电位(mitochondrial membrane potential,MMP)、精子线粒体琥珀酸脱氢酶(succinate dehydrogenase,SDH)的变化,并进行中医证候评分,并评价临床疗效。结果:两组患者临床疗效比较,观察组有效率为77.91%,对照组有效率为62.82%,差异有统计学意义(P<0.05)。两组患者中医证候评分比较,观察组治疗前为(17.27±2.18)分,治疗后为(6.24±0.79)分;对照组治疗前为(17.12±2.33)分,治疗后为(10.38±1.22)分。两组患者同组治疗前后比较,差异有统计学意义(P<0.05)。治疗后两组患者比较,差异有统计学意义(P<0.05)。两组患者精子质量比较,精液量观察组治疗前为(2.45±0.80)m L,治疗后为(3.42±1.26)m L;对照组治疗前为(2.36±0.84)m L,治疗后为(2.87±0.98)m L。同组治疗后比较,差异有统计学意义(P<0.05)。治疗后两组患者比较,差异有统计学意义(P<0.05)。精子浓度观察组治疗前为(29.63±10.94)×106m L^(-1),治疗后为(61.28±18.90)×106m L^(-1);对照组治疗前为(29.44±10.52)×106m L^(-1),治疗后为(53.62±14.58)×106m L^(-1)。同组治疗后比较,差异有统计学意义(P<0.05)。治疗后两组患者比较,差异有统计学意义(P<0.05)。精子活力比较,a+b级精子观察组治疗前为(28.29±9.42)%,治疗后为(56.84±15.30)%;对照组治疗前为(28.16±9.37)%,治疗后为(48.33±12.48)%。同组治疗后比较,差异有统计学意义(P<0.05)。治疗后两组患者比较,差异有统计学意义(P<0.05)。a级精子观察组治疗前为(16.25±5.25)%,治疗后为(30.74±10.59)%;对照组治疗前为(16.20±5.18)%,治疗后为(21.46±7.83)%。同组治疗前后比较,差异有统计学意义(P<0.05)。治疗后两组患者比较,差异有统计学意义(P<0.05)。两组患者MMP和SDH比较,MMP观察组治疗前为(43.02±6.88)%,治疗后为(78.85±11.40)%;对照组治疗前为(42.56±6.82)%,治疗后为(65.87±9.39)%。同组治疗前后比较,差异有统计学意义(P<0.05)。治疗后两组患者比较,差异有统计学意义(P<0.05)。SDH观察组治疗前为(38.58±7.29)%,治疗后为(77.57±12.83)%;对照组治疗前为(38.14±7.20)%,治疗后为(64.55±10.64)%。同组治疗前后比较,差异有统计学意义(P<0.05)。治疗后两组患者比较,差异有统计学意义(P<0.05)。结论:加味五子衍宗汤治疗男性不育症患者临床疗效显著,作用机制可能是通过改善MMP和SDH,使线粒体功能恢复,从而改善精子活动功能,提高精子活力。

Objective： To study the effect of modified Wuzi Yanzong Decoction on male infertility and its influence on the quality of semen and the function of mitochondria. Method： 164 male infertility patients in our hospital from March 2015 to January 2017 were randomly divided into a control group of 78 cases and an observation group of 86 cases. The control group was treated with L-carnitine treatment,patients in the observation group was treated with modified Wuzi Yanzong Decoction in addition to that of the control group. The specific usage is as follows： Dodder 30 g,Schisandra 20 g,Medlar 20 g,Plantago 15 g,Raspberry 15 g. Dialectical addition and subtraction： Qi stagnation plus Angelica 15 g,Codonopsis 20 g; Kidney Deficiency plus Epimedium 20 g,Cistanche 15 g,dogwood 10 g,Astragalus 10 g. Both of groups were treated for 3 months. The semen volume,sperm density,sperm a ＋ b and a percentage of sperm,sperm mitochondrial membrane potential（MMP）,sperm mitochondrial succinate dehydrogenase（SDH） score changes and TCM syndrome,and evaluate its efficacy between two groups were observed before and after treatment. Results： The clinical curative effect of the two groups were compared,the effective rate of the observation group was 77. 91%,and the effective rate of the control group was 62. 82%,the difference of which was statistically significant（P 〈0. 05）. The score of TCM syndrome in the two groups was（17. 27 ± 2. 18） points before treatment and（6. 24 ± 0. 79） points after treatment in the observation group,while that was（17. 12 ± 2. 33） points before treatment and（10. 38 ± 1. 22） after treatment points in the observation group. There were significant differences between the two groups both before and after treatment（P 〈0. 05）. After treatment,the difference between the two groups was statistically significant（P 〈0. 05）. The sperm quantity was（2. 45 ± 0. 80） m L before treatment and（3. 42 ± 1. 26） m L after treatment in the observation group,and that was（2. 36 ± 0. 84） m L and 2. 87 ± 0. 98） m L. There were significant differences between the two groups both before and after treatment（P 〈0. 05）. After treatment,the difference between the two groups was statistically significant（P 〈0. 05）. The sperm concentration in the observation group was（29. 63 ± 10. 94） ×106 m L^-1 before treatment and（61. 28 ± 18. 90） × 106 m L^-1 after treatment,while that was（29. 44 ± 10. 52） × 106 m L^-1 before treatment and（53. 62 ± 14. 58） × 106 m L^-1 after treatment in the control group. There were significant differences between the two groups both before and after treatment（P 〈0. 05）. After treatment,the difference between the two groups was statistically significant（P 〈0. 05）. The sperm motility of a ＋ b grade sperm of the observation group was（28. 29 ± 9. 42） before treatment and（56. 84 ± 15. 30） after treatment,while that of the control group was（28. 16 ± 9. 37） before treatment and（48. 33 ± 12. 48） after treatment. There were significant differences between the two groups both before and after treatment（P 〈0. 05）. After treatment,the difference between the two groups was statistically significant（P 〈0. 05）. The a-level sperm of the observation group was（16. 25 ± 5. 25） before treatment and（30. 74 ± 10. 59） after treatment,while that of the control group was（16. 20 ± 5. 18） before treatment and（21. 46 ± 7. 83） after treatment. There were significant differences between the two groups both before and after treatment（P 〈0. 05）. After treatment,the difference between the two groups was statistically significant（P 〈0. 05）. The MMP in the observation group was（43. 02 ± 6. 88） % before treatment and 78. 85 ± 11. 40% after treatment in the MMP group,while that was（42. 56 ± 6. 82） % and（65. 87 ± 9. 39） % respectively after the treatment）. There were significant differences between the two groups both before and after treatment（P 〈0. 05）. After treatment,the difference between the two groups was statistically significant（P 〈0. 05）. The SDH was（38. 58 ± 7. 29） % before treatment and（77. 57 ± 12. 83） % after treatment in the observation group,while that was（38. 14 ± 7. 20） % before treatment and（64. 55 ± 10. 64） % after treatment the control group. There were significant differences between the two groups both before and after treatment（P 〈0. 05）. After treatment,the difference between the two groups was statistically significant（P 〈0. 05）. Conclusion： The curative effect of modified Wuzi Yanzong Decoction is better than that of the western medicine in treatment of male infertility. Its possible mechanism may be the improvement of the mitochondrial membrane potential and succinate dehydrogenase,the mitochondrial function as well as the increase of the sperm and the sperm quality.