左卡尼汀在男科疾病中临床应用中国专家共识(附录:精浆或血清肉碱检测方法)

The Chinese Experts’Consensus on the Clinical Application of L⁃carnitine in andrological diseases(Appendix:Method for detecting carnitine in seminal plasma or serum)

左卡尼汀(LC)在精子成熟和能量代谢中发挥着至关重要的作用,具有提高精子质量、保护精子DNA完整性、促进精卵结合等功能。《左卡尼汀在男性不育中临床应用专家共识(2014版)》《男性不育诊治指南(2022版)》等指南共识已明确了LC在男性不育中的重要临床价值,并对其规范性应用给予了一些建议。随着对LC生理作用研究的深入,发现其具有改善线粒体功能和能量代谢、抗氧化和抗凋亡、神经再生与营养及神经递质调节和基因表达的调控等多方面的作用;同时多项临床研究证明,除男性不育之外,LC在阴茎硬结症、迟发性性腺功能减退以及勃起功能障碍等其他多种男科疾病治疗中也发挥作用。为进一步规范LC在各类男科疾病中的临床应用,特制定本共识,详述LC的人体分布、基本生理作用以及在各类男科疾病中的药理作用、临床研究进展及规范化用药,以期为临床用药提供指导和参考。

Objective L⁃carnitine plays a crucial role in sperm maturation and energy metabolism,exerting multiple functions such as improving sperm quality,maintaining sperm DNA integrity,and facilitating sperm⁃egg binding.Guidelines and consensus,including the Expert Consensus on the Clinical Application of L⁃carnitine in Male Infertility(2014 Edition)and the Guidelines for the Diagnosis and Treatment of Male Infertility(2022 Edition),have clarified the clinical value of L⁃carnitine in the treatment of male infertility and provided recommendations on its standardized application.With further study on the physiological effects of L⁃carnitine,it has been found that L⁃carnitine exerts multifaceted effects such as improving mitochondrial function and energy metabolism,possessing the ability of anti⁃oxidation and anti⁃apoptosis,promoting nerve regeneration and nutrition and neurotransmitter regulation,as well as facilitating gene expression regulation.Meanwhile,several clinical studies have demonstrated that in addition to male infertility,L⁃carnitine also plays a role in the treatment of many other andrological diseases,including Peyronie’s disease,late⁃onset hypogonadism,and erectile dysfunction.This consensus is hereby developed to further clarify the clinical application of L⁃carnitine in various andrological diseases,giving detailed information on the distribution of L⁃carnitine in the human body,its basic physiological effects as well as its pharmacological effects,clinical research progress,and standardized medication in various andrological diseases to ultimately provide guidance and reference for clinical medication.