Clinical and pathological correlation of the microdeletion of Y chromosome for the 30 patients with azoospermia and severe oligoasthenospermia

Aim: To review the accumulated 30 patients with different area of Y chromosome microdeletions, focusing on their correlation with the clinical and pathological findings. Methods: A total of 334 consecutive infertile men with azoospermia (218 patients) and severe oligoasthenospermia (116 patients) were screened. Complete physical and endocrinological examinations, general chromosome study and multiplex polymerase chain reaction assay to evaluate the Y chromosome microdeletion were performed. Ten patients received testicular biopsy. Then the clinical and pathological findings were analyzed with reference to the areas of Y chromosome microdeletion. Results: There is a decline of the percentage of sperm appearing in semen in the group that the gene deletion region from AZFc to AZFb. The clinical evidence of the impairment (decreased testicular size and elevated serum FSH) is also relevantly aggravated in this group. However, the pathology of testicular biopsy specimen was poorly correlated with the different deletion areas of the Y chromosome, which may be due to the limited number of specimens. Conclusion: The clinical correlation of spermatogenic impairment to the different AZF deletion regions may provide the information for the infertile couples in pre-treatment counseling.

Establishment of an oligoasthenospermia mouse model based on TAp73 gene suppression

Background:Oligoasthenospermia is one of the main causes of male infertility.Researchers usually use chemical drugs to directly damage germ cells to prepare oligoasthenospermia models,which disregards the adhesion and migration between spermatogenic cells and Sertoli cells.TAp73 is a critical regulator of the adhesin of germ cell;thus,we sought to explore a novel oligoasthenospermia model based on TAp73 gene suppression.Methods:Mice in the Pifithrin-αgroup were injected intraperitoneally with 2.5 mg/kg Pifithrin-α(TAp73 inhibitor)daily for 30 consecutive days.Reproductive hormone levels and epididymal sperm quality,as well as the network morphology of Sertoli cells were tested.Results:Sperm density,motility,and the relative protein and mRNA expression of TAp73 and Nectin 2 were obviously decreased in the Pifithrin-αgroup compared with the normal control group.No significant distinction was observed in the relative mRNA and protein expression of ZO-1.Furthermore,the tight junctions(TJs)and api-cal ectoplasmic specialization(ES)were destroyed in the Pifithrin-αgroup.Conclusion:The above results indicate that we successfully established a new oli-goasthenospermia mouse model.This study provides a foundation for further explo-ration of the roles of TAp73 genes during spermatogenesis and provides new research objects for further oligospermia research and future drug discovery.

Based on the expression of HSP60 and HSP90, to explore the effect of Xuduan Zhongzi prescription on semen quality of oligoasthenospermia model rats

Objective:To investigate the effect of Xuduan Zhongzi prescription on the expression of HSP60 and HSP90 in testicular spermatogenic cells and semen quality of oligozoospermia and asthenospermia model rats.Methods:A total of 40 SPF male rats were randomly divided into 10 blank control group and 30 model group.After successful modeling,the model group was divided into model control group,levocarnitine group and Xuduan Zhongzi prescription group with 10 rats in each group.The rats in levocarnitine group and Xuduan Zhongzi prescription group were given corresponding drugs by gavage according to the equivalent measurement of humanbody,the blank control group and model control group were given the same amount of normal saline by gavage,and the rats in each group were killed after 8 weeks of continuous administration.Take the left epididymis of each group for sperm quality detection,take the left testis of each group,observe the histomorphological changes by HE staining,and detect the expression of HSP60 and HSP90 in testicular tissue by immunohistochemistry and Western blot.Results:HE staining showed that compared with the blank control group,the convoluted tubules in the model group were significantly atrophic,degenerated and irregularly arranged,the spermatogenic epithelium showed a large number of vacuoles,Sertoli cell degeneration,obvious inflammatory infiltration in stromal cells,stromal cell proliferation,scattered rows of epithelial cells,a large number of exfoliation and degeneration,and sperm were rare.After the intervention of Xuduan Zhongzi prescription,the above lesions were significantly improved,the structure of seminiferous tubules was relatively regular and orderly,denser than that of the model group,sertoli cells and stromal cells increased significantly,the seminiferous epithelium was thicker than that of the model group,with rich layers,and a large number of sperm could be seen in the lumen.Immunohistochemistry and Western Blot showed that the expression of HSP60 and HSP90 increased significantly after the intervention of Xuduan Zhongzi prescription in model rats(P<0.01).The sperm quality test results showed that compared with the blank control group,the sperm concentration and activity rate in the model group decreased significantly,(P<0.01).After continuous seed cutting,the sperm concentration and activity rate of model rats were significantly increased,(P<0.01).Conclusion:Xuduan Zhongzi prescription may inhibit the apoptosis of testicular spermatogenic cells in oligoasthenospermia model rats by increasing the expression of HSP60 and HSP90,so as to improve sperm quality.

Pharmacological mechanisms of Yishen Xingyang capsule in the treatment of oligoasthenospermia in rats

Objective:To investigate the therapeutic effects and pharmacological mechanisms of Yishen Xingyang capsule(YXC)in oligoasthenospermia(OA)rats.Methods:Forty-eight male SpragueeDawley rats were randomly divided into eight groups of six rats each:normal control(NC);model control(MC);three different positive drug(PD);and low-,medium-,and high-dose YXC groups.A rat model of OA was established by administering glucosides of Tripterygium wilfordii Hook.F(GTW).After YXC administration,penile erectile function was observed.The epididymis,blood,and testes of the rats were harvested for analysis of sperm quality,sex hormone levels,mitochondrial membrane potential,and the transforming growth factor(TGF)-b1/Smad signaling pathway.Results:Compared with that in the MC group,penile erectile function in the YXC groups and three PD groups increased(all P<.01).Moreover,sperm quality in the YXC groups and three PD groups improved(all P<.001).The levels of testosterone,follicle stimulating hormone,and luteinizing hormone in the three PD and YXC groups increased(all P<.05).The mitochondrial membrane potential in the three PD and YXC groups significantly improved(all P<.001).Furthermore,the YXC and three PD groups showed decreased TGF-b1 expression(all P<.05)compared with the MC group.The high-dose YXC group and three PD groups improved Smad2 and Smad4 expression(all P<.05).Conclusion:YXC improved penile erectile function and sperm quality in OA rats,and the underlying mechanism included increase in sex hormones,inhibition of sperm apoptosis,and regulation of the TGFb1/Smad signaling pathway.Meanwhile,this study provides a new effective drug option for the treatment of OA,which is beneficial to male reproductive health and social harmony.

An exploration on the protective mechanism of Xuduan Zhongzi prescription against epididymis oxidative damage in oligoasthenospermia model rats based on Nrf2-NQO1/γ-GCS signaling pathway

Objective:To investigate the protective mechanism of Xuduan Zhongzi prescription against epididymal oxidative damage in oligoasthenospermia model rats.Methods:Forty SD rats were randomly divided into blank group,model group,Xuduan Zhongzi prescription group(10g/kg)and L-carnitine group(0.1g/kg).Except blank group,all induced oligoasmospermia.The blank group and model group were given normal saline intragastric administration,the Xuduan Zhongzi prescription group was given Xuduan Zhongzi prescription solution intragastric administration,and the L-carnitine group was given L-carnitine intragastric administration.HE staining was used to observe the epididymis structure after 8 weeks.The concentration and activity rate of epididymis sperm were measured by sperm quality.MRNA and protein expression levels of Nrf2,NQO1 andγ-GCs in epididymis were detected by RT-qPCR and immunohistochemistry.Results:①HE staining:in the blank group,the epididymis tubes were arranged tightly and regularly,the tissue structure was complete,the epithelial cells were arranged orderly,and the lumen sperm were numerous and evenly distributed.The epididymis of model group showed structural atrophy,loose arrangement,enlarged mesenchyme,increased cell debris and significantly reduced sperm cells.Compared with the model group,the lumen lesions of epididymis in Xuduan Zhongzi prescription group and L-carnitine group were significantly improved,and the amount of normal sperm in lumen was increased and the distribution was uniform.②Results of sperm quality comparison among each group:sperm density and sperm motility rate:compared with blank group,sperm density and sperm motility rate in other groups were significantly decreased(P<0.05),and sperm density and sperm motility rate in model group were significantly decreased(P<0.05);Compared with model group,the sperm density and motility rate in Xuduan Zhongzi prescription group and L-carnitine group were significantly increased(P<0.05).③RT-qPCR and immunohistochemistry:Compared with the blank group,the mRNA and protein levels of Nrf2,NQO1 andγ-GCs in epididymal rats in model group were significantly decreased(P<0.05),while the mRNA and protein levels of Nrf2,NQO1 andγ-GCs were significantly increased in L-carnitine group and Continua seed formula group(P<0.05).Conclusion:Xuduan Zhongzi prescription can reduce oxidative stress damage and improve sperm quality of oligoasthenospermia.The mechanism may related to promoting the activation of Nrf2-NQO1/γ-GCS pathway in epididymis of oligoasthenospermia rats,and up-regulate the expressions of Nrf2,NQO1 andγ-GCS proteins.

Novel discovery of schisandrin A regulating the interplay of autophagy and apoptosis in oligoasthenospermia by targeting SCF/c-kit and TRPV1 via biosensors

Oligoasthenospermia is the primary cause of infertility.However,there are still enormous challenges in the screening of critical candidates and targets of oligoasthenospermia owing to its complex mechanism.In this study,stem cell factor(SCF),c-kit,and transient receptor potential vanilloid 1(TRPV1)biosensors were successfully established and applied to studying apoptosis and autophagy mechanisms.Interestingly,the detection limit reached 2.787×10^(-15)g/L,and the quantitative limit reached 1.0×10^(-13)g/L.Furthermore,biosensors were used to investigate the interplay between autophagy and apoptosis.Schisandrin A is an excellent candidate to form a system with c-kit similar to SCF/c-kit with a detection constant(K_(D))of 5.701×10^(-11)mol/L,whereas it had no affinity for SCF.In addition,it also inhibited autophagy in oligoasthenospermia through antagonizing TRPV1 with a K_(D) of up to 4.181×10^(-10)mol/L.In addition,in vivo and in vitro experiments were highly consistent with the biosensor.In summary,high-potency schisandrin A and two potential targets were identified,through which schisandrin A could reverse the apoptosis caused by excessive autophagy during oligoasthenospermia.Our study provides promising insights into the discovery of effective compounds and potential targets via a well-established in vitro-in vivo strategy.

填精育嗣方治疗肾精亏损型少弱精子症的临床研究

目的:观察填精育嗣方对肾精亏损型少弱精子症患者的有效性和安全性。方法:纳入中国中医科学院西苑医院肾精亏损型少弱精子症患者69例,采用随机数字表法随机分为试验组和对照组,试验组应用填精育嗣方治疗,对照组应用左卡尼汀口服溶液治疗,疗程均为12周;试验期间脱落及剔除5例,最终可供评估有效病例64例,试验组32例,对照组32例;观察两组治疗前后精液参数、中医证候评分及性激素水平。结果:与治疗前相比,两组精子密度、PR、PR+NP均提高,DFI降低,差异具有统计学意义(P<0.05),组间比较,两组精子密度、PR、PR+NP提高、DFI降低,但差异无统计学意义(P>0.05)。与治疗前相比,对照组中医证候评分、睾酮水平无显著提升(P>0.05);试验组中医证候评分、睾酮水平提高,差异有统计学意义(P<0.05),与对照组比较差异具有统计学意义(P<0.05)。两组治疗中未见严重不良反应,治疗后安全性指标未见异常。结论:填精育嗣方可提升肾精亏损型少弱精子症患者精子密度、活动率及睾酮水平,降低DFI,并改善中医证候评分,且安全性良好。

少精弱精方联合枸橼酸氯米芬和维生素E对少精弱精症患者的临床疗效

目的 考察少精弱精方联合枸橼酸氯米芬和维生素E对少精弱精症患者的临床疗效。方法 102例患者随机分为对照组和观察组,每组51例,对照组给予枸橼酸氯米芬和维生素E,观察组在对照组基础上加用少精弱精方,疗程3个月。检测临床疗效、精液参数(精子存活率、精液量、精子密度、精子向前活动率、a级精子、a+b级精子)、血清性激素(睾酮、黄体生成素、促卵泡生成素)、精液凋亡因子(Caspase-3、Caspase-8)、不良反应发生率变化。结果 观察组总有效率高于对照组(P<0.05)。治疗后,2组精液参数、睾酮升高(P<0.05),黄体生成素、促卵泡生成素、精液凋亡因子降低(P<0.05),以观察组更明显(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 少精弱精方联合枸橼酸氯米芬和维生素E可安全有效地改善少精弱精症患者血清性激素水平,降低精液凋亡因子水平,提高临床疗效、精子质量和活力。

车叶草苷对少弱精症大鼠抗氧化应激及抗细胞凋亡的作用机制研究

目的:探讨车叶草苷(ASP)对少弱精症大鼠抗氧化应激及抗细胞凋亡的作用机制。方法:通过灌胃奥硝唑建立少弱精症大鼠模型,将SD大鼠按照随机数字表法分为对照组、模型组、车叶草苷组(60 mg/kg)和通路抑制剂(第3周腹腔注射2 mg/kg)+车叶草苷组,每组10只。检测大鼠精子参数;酶联免疫吸附试验法检测血清丙二醛(MDA)、谷胱甘肽(GSH)、超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)水平;实时萤光定量聚合酶链式反应法检测睾丸组织B细胞淋巴瘤2(Bcl-2)、B细胞淋巴瘤2相关X蛋白(Bax)和核因子E2相关因子2(Nrf2)基因水平;蛋白质免疫印迹法检测睾丸组织Kelch样ECH关联蛋白1(Keap1)、Nrf2和血红素加氧酶1(HO-1)水平。结果:与对照组比较,模型组精子活力、精子浓度、GSH-Px、GSH、SOD、Bcl-2、Keap1、Nrf2、HO-1水平下降(P<0.05),MDA和Bax水平上升(P<0.05);与模型组比较,车叶草苷组精子活力、精子浓度、GSH-Px、GSH、SOD、Bcl-2、Keap1、Nrf2、HO-1水平上升(P<0.05),MDA和Bax水平下降(P<0.05)。结论:ASP能有效改善少弱精症大鼠精子活力、精子浓度,减少睾丸组织细胞的凋亡,改善氧化应激损伤,Keap1/Nrf2信号通路的激活可能是其作用机制。

高氏流派从痰湿瘀阻论治少弱精子症

少弱精子症是临床常见病,也是男性不育的重要原因。目前中医治疗多从补肾入手,取得一定疗效。榆林高氏中医妇科流派认为,少弱精子症的发病与饮食、情志、劳逸失调密切相关。饮食不节,痰湿内盛,情志不畅,气滞血瘀,劳逸失调,损伤肾精。病位主要在脾,涉及肝、肾。病性“实多虚少”,以痰、湿、瘀实邪多见,肾虚精亏者较少。痰湿瘀阻为该病的主要病机,治法为“祛湿化痰,活血通络”,以自拟“生精汤”为主方,药物组成为陈皮、清半夏、茯苓等。此方特色鲜明,疗效突出,为中医临床提供更多思路和方法。

疏肝补肾毓麟汤通过Keap1/Nrf2/GPX4通路抑制睾丸细胞铁死亡改善肝郁肾虚型少弱精子症小鼠的精子质量

目的探讨疏肝补肾毓麟汤改善肝郁肾虚型少弱精子症小鼠生精功能和精子质量的作用及其可能机制。方法60只雄性KM小鼠,随机分为空白组、模型组、疏肝补肾毓麟汤高、中、低剂量组和司他丁-1(Ferrostatin-1,Fer-1)组(Fer-1是铁死亡抑制剂)。除空白组外,其余组以1.25 g·kg^(-1)腺嘌呤灌胃(Intragastrical administration,ig.)+慢性束缚刺激构建肝郁肾虚型少弱精子症小鼠模型。给予相应药物干预后:精密天平称取小鼠体质量、睾丸质量、附睾质量计算睾丸指数、附睾指数;苏木素-伊红(Hematoxylin-eosin staining,HE)染色观察睾丸组织病理变化并对睾丸生精功能进行评分;全自动精子分析仪检测精子密度和活动率;苯胺蓝染色法观察精子成熟度;布鲁斯蓝染色法观察睾丸组织铁沉积;免疫组化(Immunohistochemistry,IHC)检测睾丸组织谷胱甘肽过氧化物酶4(Glutathione peroxidase 4,GPX4)、溶质载体家族7成员11(Recombinant Solute Carrier Family 7 Member 11,SLC7A11)蛋白表达;生化法检测睾丸组织超氧化物歧化酶(Superoxide dismutase,SOD)、过氧化氢酶(Catalase,CAT)、丙二醛(Malondialdehyde,MDA)含量;蛋白免疫印迹法(Western Blot,WB)检测睾丸组织Kelch-样ECH相关蛋白1(Kelch-like ECH-associated protein-1,Keap1)、核因子E2相关因子2(Nuclear factor E2-related factor 2,Nrf2)、GPX4、SLC7A11蛋白表达。结果与空白组比较,模型组小鼠睾丸指数、附睾指数、睾丸生精功能、精子密度及活动率、精子成熟度均显著下降(P<0.05,P<0.01);经疏肝补肾毓麟汤及Fer-1干预后,上述指标均有显著改善(P<0.05,P<0.01),且睾丸组织铁沉积显著降低,Keap1表达显著降低,Nrf2、SLC7A11、GPX4表达显著升高(P<0.05,P<0.01)。结论疏肝补肾毓麟汤能明显改善肝郁肾虚型少弱精子症,其机制可能与调控Keap1/Nrf2/GPX4信号通路抑制睾丸细胞铁死亡有关。

中医辨证少弱精子症理论体系浅析

少弱精子症是临床常见疾病,其病因病机复杂多变。中医在诊治少弱精子症方面底蕴深厚,内容夯实。本文通过分析中医药治疗少弱精子症的古籍与文献,多方面、多角度地总结归纳中医辨治少弱精子症的理论体系,以期为治疗少弱精子症提供有益的思路与方法。

应用微阵列技术分析五子衍宗丸干预少弱精症小鼠睾丸组织的长链非编码RNA表达

目的研究五子衍宗丸干预少弱精症相关的睾丸长链非编码RNA(long noncoding RNA,lncRNA),初步探讨该方调控lncRNA在其干预少弱精症中的潜在作用机制。方法采用白消安法建立少弱精症动物模型,使用五子衍宗丸干预14天后,应用小动物精子自动检测仪测定附睾精子数量和活力及与雌鼠交配受孕率评估生育力。分别抽提正常组、模型组、药物组各6例睾丸组织的RNA,应用转录组测序技术分析并筛选五子衍宗丸调控的差异表达lncRNA,实时荧光定量(quantitative real-time PCR,qRT-PCR)技术对差异表达lncRNA数据验证。通过生物信息学对获得的药物调控lncRNA结合前期报道该方调控mRNAs的实测值,进行关联分析,建立该方调控lncRNA靶向mRNAs的共表达网络,筛选网络lncRNA靶向的核心mRNAs,对核心mRNAs进行KEGG信号通路分析,构建该方调控lncRNA靶向信号通路网络,分析五子衍宗丸调控lncRNA干预少弱精症的信号通路。结果五子衍宗丸可显著提高少弱精症精子质量、雌鼠受孕率,并明显调控296条睾丸lncRNA,其中上调215条,下调81条,qRT-PCR验证lncRNA测序结果可靠。通过lncRNA-mRNAs的关联分析筛选到药物调控的核心lncRNA(102条)和mRNAs(81条),该方调控lncRNA靶向信号通路网络显示,在102条lncRNA中,有80条lncRNA靶向2条及以上信号通路,信号通路中有40条对应2条及以上lncRNA,这些lncRNA靶向的信号通路涉及到睾丸细胞的生长、分化、代谢、凋亡、信号传导等整个细胞周期过程,并且主要富集在范科尼贫血通路、细胞周期、剪接体、叉头状转录因子通路、p53通路、同源重组等通路上。结论本研究提供了五子衍宗丸干预少弱精症的睾丸lncRNA表达谱,这些lncRNA参与了药物修复睾丸生精损伤,提示其可能在药效中起到了重要作用,是五子衍宗丸潜在的干预靶点。

国医大师林天东基于“肾主生殖,脾主运化”理论治疗少弱精子症经验

少弱精子症为临床常见病、多发病,是导致男性不育的主要因素之一,可直接或间接影响广大男性的生育能力及生殖健康。国医大师林天东从医50余年,擅长治疗男科、妇科疾病,尤善治不孕不育。国匡大师林天东对于治疗少弱精子症导致的不育症,颇有心得,并积累了丰富且独到的临床经验。林天东教授认为少弱精子症导致的不育症主要病机为脾肾功能失司、肾精亏虚、脾阳虚损,脾阳和肾阳无法互相补养,导致肾气失于温煦,肾精失于濡养,精血化生乏源,精液液化失常从而导致发病。治疗上以补肾益精、温脾益气、种嗣衍宗为法,创立了八味强精汤,意在健脾益肾衍宗,临床收效颇佳,附验案一则加以阐明。

基于HIF-1α/EGFR/MAPK1信号通路探讨龟鹿二仙胶对少弱精子症大鼠的保护作用

目的探讨龟鹿二仙胶调控缺氧诱导因子-1α(hypoxia inducible factor-1α,HIF-1α)/表皮生长因子受体(epidermal growth factor receptor,EGFR)/和丝裂原活化蛋白激酶(mitogen-activated protein kinase 1,MAPK1)信号通路对少弱精子症(oligoasthenozoospermia,OAS)大鼠的保护作用。方法将48只SD雄性大鼠随机分为正常组,模型对照组,龟鹿二仙胶低剂量(0.65 g/kg)组、中剂量(1.25 g/kg)组、高剂量(2.5 g/kg)组和左卡尼汀组,每组8只。除正常组外,其他组均采用腺嘌呤灌胃给药进行造模。造模成功后进行灌胃给药进行干预,连续给药4周,记录大鼠一般情况,给药4周后进行取材处理。腹主动脉采血,ELISA法检测血清睾酮(testosterone,T)、雌二醇(estradiol,E2)、促卵泡激素(follicle-stimulating hormone,FSH)、促黄体生成激素(luteinizing hormone,LH)和催乳素(prolactin,PRL);分离肾组织,计算肾指数;分离右侧附睾,运用自动精子分析仪检测各组大鼠精子浓度和精子活力;HE染色观察睾丸组织病理改变;用试剂盒检测大鼠睾丸组织活性氧(reactive oxygen species,ROS)、超氧化物歧化酶(superoxide dismutase,SOD)和谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)水平;免疫组化检测大鼠睾丸组织HIF-1α、EGFR和MAPK1的蛋白表达。结果与模型对照组相比,不同剂量的龟鹿二仙胶均可显著增加大鼠的体质量(P<0.01),降低大鼠的肾指数(P<0.01),提高精子浓度和精子活力(P<0.01),改善大鼠的精子质量,并能有效减轻模型大鼠睾丸组织损伤程度,其中与龟鹿二仙胶低剂量组相比,龟鹿二仙胶高剂量组大鼠体质量、精子密度和精子活力均显著上升(P<0.05)。ELISA结果显示,与模型对照组相比,不同剂量龟鹿二仙胶能显著升高T和E2水平(P<0.05),且显著降低FSH、LH和PRL水平(P<0.05)。ROS、SOD和GSH-Px检测结果显示,与模型对照组相比,龟鹿二仙胶低、中、高剂量组ROS水平显著降低(P<0.05),龟鹿二仙胶中、高剂量组和左卡尼汀组SOD和GSH-Px活性显著升高(P<0.05)。免疫组化结果显示,与模型对照组相比,龟鹿二仙胶中、高剂量组和左卡尼汀组大鼠睾丸组织HIF-1α、EGFR、MAPK1水平显著降低(P<0.05)。结论龟鹿二仙胶可能是通过HIF-1α/EGFR/MAPK1信号通路调节氧化应激来改善OAS。

极度少弱精子症、无精子症与精液正常患者辅助生殖助孕结局的配对病例对照研究

目的研究极度少弱精子症患者、无精子症手术取精患者与精液正常患者的辅助生殖助孕结局。方法采用回顾性病例配对研究,病例来源于2014年5月至2022年12月在宁夏医科大学总医院生殖医学中心接受辅助生殖技术助孕的患者,选择首次进入周期的新鲜胚胎移植周期,根据男方术前精液检查筛选出极度少弱精子症患者215例为极度少弱精子症组,无精子症手术取精患者134例为无精子症手术取精组。根据研究组中夫妇双方的年龄、体质量指数(BMI)及女方的卵巢储备功能、促排卵情况等参数,选择在同一时期、首次进入周期并新鲜胚胎移植的精液分析参数正常的夫妇,按照1∶2的比例进行配对,分别筛选出430例、268例为对照组,配对比较分析极度少弱精子症组与对照组、无精子症(附睾、睾丸抽吸取精)组与对照组两组的一般情况、获卵数、MII卵率、正常受精率、正常卵裂率、优质胚胎率、囊胚培养形成率、植入率、临床妊娠率、活产率、单胎率、双胎率、单胎早产率、流产率、异位妊娠率及男女性别比例等。结果极度少弱精子症组与对照组、无精子症手术取精组与对照组的一般资料比较结果显示,男女双方患者的平均年龄、BMI、窦卵泡数(AFC)、女方基础性激素水平、抗缪勒管激素(AMH)、Gn使用总量及天数、HCG日子宫内膜厚度及E2水平比较,极度少弱精子症组、无精子症手术取精组与对照组差异均无统计学意义(P均>0.05),极度少弱精子症组、无精子症手术取精组的不孕年限均长于其对照组(P均<0.05)。极度少弱精子症组、无精子症手术取精组中MII卵率基本相近,正常受精率、正常卵裂率及优质胚胎率均高于对照组(P均<0.05),囊胚培养形成率低于对照组。极度少弱精子症组、无精子症手术取精组的植入率、活产率均高于其对照组,且在无精子症手术取精组中临床妊娠率高于对照组(P均<0.05),其余单胎率、双胎率、单胎早产率、流产率、异位妊娠率及男女性别比例等结果差异均无统计学意义(P均>0.05)。结论在首次新鲜胚胎移植周期中,男性精液常规分析中精子数量和活力及精液来源不影响辅助生殖助孕的临床妊娠结局。

戴宁基于“肾虚精浊”辨治男性不育少弱精子症经验

[目的]探析戴宁教授基于“肾虚精浊”辨治男性不育少弱精子症的学术经验。[方法]通过整理戴宁教授临床诊治少弱精子症的医案,结合其临证所述,在充分认识疾病病机和用药特点的基础上,对其学术经验进行总结,并举典型医案论证。[结果]戴宁教授认为“肾虚精浊”是少弱精子症的主要病机,其中肾虚不充、精室失养为疾病之根本,湿瘀浊蕴、精液不纯为疾病之关键,治疗上主以调肾清精法,体现在“调肾生精,提升精子质量”“清精化浊,消除精室阻塞”“序贯用药,灵活运用通补”“针药并用,合治以图效捷”等方面,内涵丰富,疗效卓著。所举医案中,患者因精索静脉曲张引发少弱精子症,故婚后一年半无子,辨为肾虚肝郁血瘀证,用化瘀赞育汤以补肾疏肝活血,综合治疗半年余,患者之妻成功受孕。[结论]戴宁教授对少弱精子症的病机具有独到认识,辨证精准,用药经验丰富,对本病的临床诊治具有极大启发。

五子衍宗丸治疗男性少弱精子症的Meta分析

目的系统评价五子衍宗丸治疗少弱精子症的有效性。方法检索CNKI、Wanfang Database、VIP、CBM、Pubmed、Cochrane Library、Embase数据库中五子衍宗丸治疗少弱精子症的随机对照试验,检索时限为自建库-2022年7月31日,对文献进行筛选、资料提取,评估偏倚风险,采用RevMan 5.3软件进行Meta分析。结果最终共纳入16项研究,包含1960例患者,依据干预措施进行亚组分析,Meta分析结果显示,五子衍宗丸组治疗后在精子密度[MD=5.28,95%CI(1.55,9.02),P=0.006]、A级精子[MD=6.69,95%CI(5.01,8.38),P<0.00001]、A+B级精子[MD=10.57,95%CI(7.28,13.85),P<0.00001]、配偶妊娠率[RR=1.25,95%CI(1.13,1.39),P<0.00001]、总有效率[RR=1.46,95%CI(1.3,1.63),P<0.00001]均显著高于西药组;联合用药组治疗后在精液量[MD=0.88,95%CI(0.71,1.04),P<0.00001]、精子密度[MD=7.19,95%CI(1.92,12.46),P=0.007]、A级精子[MD=7.9,95%CI(4.59,11.2),P<0.00001]、A+B级精子[MD=8.52,95%CI(3.99,13.04),P=0.0002]、配偶妊娠率[RR=1.79,95%CI(1.31,2.44),P=0.0003]、总有效率[RR=1.23,95%CI(1.12,1.35),P<0.00001]均显著高于西药组。结论五子衍宗丸单用或联合西药在改善精子密度、A级精子、A+B级精子、配偶妊娠率、总有效率指标上优于西药。

补肾强精方联合针刺治疗男性少弱精子症疗效观察

目的:观察补肾强精方联合针刺治疗男性少弱精子症的临床疗效。方法:122例按照随机数字表法分为两组各61例,两组均用针刺治疗,研究组加用补肾强精方治疗。结果:研究组总有效率、精液量、精子浓度、精子活力、FSH、LH水平、睾酮浓度均高于对照组(P<0.05),中医证候积分研究组低于对照组(P<0.05)。结论:补肾强精方联合针灸治疗男性少弱精子症效果较好。

国家专利数据库中治疗少弱精子症的中药规律研究

目的 对国家专利数据库中治疗少弱精子症的中药复方配伍规律进行数据挖掘,为少弱精子症的治疗及新药开发提供参考依据。方法 检索“中国专利公布公告网”从2000年1月1日至2023年10月1日公开的治疗少弱精子症的中药复方专利数据,运用Excel12.1.0建立中药数据库,基于古今医案云平台(V2.3.7)中的数据挖掘功能对纳入的中药复方进行中药使用频次分析,并在此基础上进行中药性味归经、功效分析,通过药物关联分析筛选出核心药对,通过聚类分析得出中药复方治疗少弱精子症的用药分类,通过复杂网络分析筛选出中药治疗少弱精子症的核心处方。结果 共纳入符合标准的中药复方189首,涉及中药280味,使用总频次2 305次。中药使用频次居前的有菟丝子、枸杞子、淫羊藿、当归、覆盆子等。在药物性味归经上,药物以温性为主,药味以甘味为主,归经以肾、肝、脾经为主。中药功效以强筋骨、补肾阳等使用频次较高。在药物关联分析中,核心药对有“枸杞子-菟丝子”“菟丝子-淫羊藿”等。药物聚类分析可将使用频次>25次的22味高频中药聚类成5类。复杂网络分析筛选出治疗少弱精子症的核心组方由“五子衍宗丸”加味组成。结论 中药治疗少弱精子症多从“肾气不足,肾精亏虚”核心病机着手,以“补肾生精”为核心治法,注重肾、肝、脾三脏调治,常用强筋骨、补肾阳之品,筛选出由“五子衍宗丸”加味组成的核心处方。