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.

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, focus-ing 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. (Asian JAndrol 2004 Dec; 6:369-375)

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.

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。

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。

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。

Network Pharmacology-Based Study of Chinese Herbal Qixiong Formula in Treating Oligoasthenospermia

Objective:The objective is to study the network pharmacology of Qixiong formula(QXF)and explore the mechanism of QXF in the treatment of oligoasthenospermia.Materials and Methods:Using Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),a Bioinformatics Analysis Tool for Molecular mech ANism of Traditional Chinese Medicine(BATMAN-traditional Chinese medicine),and an encyclopaedia of traditional Chinese medicine(ETCM)databases as well as data from relevant studies,the effective components and targets of QXF were obtained.Genes associated with oligospermia were screened using Gene Cards,OMIM,Dis Ge Net,Drug Bank,and GAD databases.The intersection target was obtained by mapping the target to the gene,and the protein interaction network was created using the STRING database to screen the core target of QXF in the treatment of oligospermia.The intersection target was enriched using gene ontology(GO)and the Kyoto Encyclopedia of genes and genomes(KEGG)pathway analysis with the DAVID database.The network of the disease drug target pathway was drawn using Cytoscape software.Results:Overall,536 active components of QXF and 40 core targets for the treatment of oligoasthenozoospermia were obtained.The analysis of GO and KEGG showed that QXF is mainly involved in oxidative stress,cell motility,nutritional response,and other biological processes.Through the regulation of FOXO,p53,PI3 K/Akt,MAPK,mammalian target of rapamycin,Foxo,Wnt,and other signaling pathways,QXF played a role in the treatment of oligoasthenospermia.Conclusion:QXF has multi-component,multi-target,and multi-channel characteristics,providing a new way to study the mechanism of QXF in the treatment of oligoasthenospermia.

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。

Change of Accessory Genital Glands Markers in the Patients with Oligoasthenospermia

Objective To evaluate the effect of the accessory gential gland on the male fertility.Methods The relevant seminal parameters of 32 normal donors and 35 patients with olioasthenospermia were measured by seminal routine analysis,sperm morphology and accessory gentital glands markers.Results The percentage of normal spermatozoa,the function of sperm penetration through cervical mucus and the enzyme activity of neutral α-1,4-glucosidase significantly declined as compared with the control.There was a significant negative relationship between the semen volume and the sperm motility for the oligoasthenospermia(r=-0.415,P<0.05),and a significant positive relationship between the sperm count and the percentage of normal sperm(r=0.393,P<0.05).Conclusion The abnormal function of epididymis exists in patients with oligoasthenospermia.Sperm function for the oligoasthenospermia declines with an increase of the percentage of the abnormal sperm.The poorer the spermatogenises function of the testis is,the higher the percentage of the abnormal sperm appears.

调治天癸方治疗特发性少弱精子症的临床观察

目的观察调治天癸方治疗特发性少弱精子症的临床疗效。方法选取2020年6月至2021年6月湖南中医药大学第一附属医院男性病科门诊就诊的80例特发性少弱精子症患者作为研究对象,随机分为调治天癸组和五子衍宗组,每组40例,分别用调治天癸方与五子衍宗软胶囊干预12周,治疗前后观察精液常规、精子DNA碎片指数(DFI)的改善情况及配偶的受孕情况。结果治疗前两组患者的精子密度、前向运动精子率(PR)及DFI均无明显差异。治疗结束后,两组患者精子密度、PR、DFI均较治疗前有所改善(P<0.05),且调治天癸组精子质量及DFI的改善情况优于五子衍宗组(P<0.05)。调治天癸组有7位患者配偶妊娠,总有效率87.50%,五子衍宗组有4位患者配偶妊娠,总有效率67.50%,两组总有效率比较,差异具有统计学意义(P<0.05)。结论调治天癸方可提高特发性少弱精子症患者的精子密度、PR,减少精子DNA碎片化,且无明显不良反应。

自拟加味五子衍宗汤联合克罗米芬治疗少弱精子症的疗效分析

目的探究自拟加味五子衍宗汤联合克罗米芬治疗少弱精子症的临床疗效。方法选取2022年1—6月就诊于江西省妇幼保健院男性不育门诊的肾气亏虚型少弱精子症患者60例,按随机数字表法分为观察组和对照组,各30例。对照组给予克罗米芬治疗,观察组在相同剂量克罗米芬的基础上口服自拟加味五子衍宗汤,比较2组治疗前后精液参数(精子浓度、精子活动率、前向运动精子率)及血清生殖激素[卵泡生成素(FSH)、黄体生成素(LH)、垂体泌乳素(PRL)和睾酮(T)]变化和疗效。结果治疗前,2组精子浓度、精子活动率及血清LH、PRL水平比较差异均无统计学意义(P>0.05)。治疗后,2组精子浓度、精子活动率、前向运动精子率和血清T水平较治疗前均有改善(P<0.05),且观察组明显高于对照组(P<0.05);观察组治疗总有效率为80.00%,明显高于对照组的56.67%(P<0.05)。结论加味五子衍宗汤联合克罗米芬可提高少弱精症患者精液质量,调节生殖激素水平。

加味五子衍宗方凝胶制剂贴敷治疗少弱精子症的实验研究

[目的]研究加味五子衍宗方(Jiawei Wuzi Yanzong Prescription,JWYP)凝胶制剂对少弱精子症小鼠睾丸生精细胞和支持细胞损害的修复作用,探讨JWYP凝胶制剂经皮渗透贴敷的疗效及其作用机制。[方法]将JWYP超细粉碎微粒与凝胶均匀混合,配制成凝胶贴敷制剂。24只雄性BALB/c小鼠随机分为经皮渗透组、灌胃染毒组、贴敷治疗组和对照组,经皮渗透组以荧光素钠(fluorescein sodium,FS)作为荧光染色剂,均匀混合标记JWYP凝胶制剂并贴敷于小鼠腹壁,扩散4~8 h后荧光显微镜观察其活体荧光成像;灌胃染毒组采用邻苯二甲酸(2-乙基己基)酯[di-(2-ethylhexyl)phthalate,DEHP]灌胃染毒法建立小鼠少弱精子症模型,将DEHP溶于食用大豆油并以20 mg/(kg·d)的剂量连续灌胃30 d染毒;贴敷治疗组将配制好的JWYP凝胶制剂贴敷于小鼠腹壁,每周5 d贴敷给药,连续4周,贴敷给药期间同步予以DEHP连续灌胃染毒;对照组小鼠同期以标准饲料添加食用大豆油同步喂养。检测各组小鼠睾丸的湿重和体积,采用光镜和透射电镜观察各组小鼠睾丸细胞的组织学形态结构,并同步检测小鼠睾丸细胞线粒体呼吸链复合物(mitochondrial respiratory chain complex,MRC)活性。[结果]经皮渗透组小鼠腹壁皮下及腹膜腔内均显示有较强的荧光分布。与对照组比较,灌胃染毒组小鼠睾丸湿重和体积差异无统计学意义(P>0.05),贴敷治疗组小鼠睾丸湿重差异无统计学意义(P>0.05),睾丸体积明显增大(P<0.05)。光镜和透射电镜观察显示,与对照组比较,灌胃染毒组小鼠睾丸生精细胞层形态结构基本正常,但细胞排列松散,管腔内无成熟精子生成,生精细胞空泡样变性退化,支持细胞的胞质内可见凋亡小体样结构;贴敷治疗组小鼠睾丸生精细胞层形态结构正常,支持细胞细胞排列密集,管腔内可见成熟精子,胞质内富含线粒体、溶酶体等细胞器。灌胃染毒组小鼠睾丸细胞MRC-Ⅰ、Ⅲ、Ⅳ的活性检测值明显低于对照组(P<0.05),贴敷治疗组小鼠睾丸细胞MRC-Ⅲ、Ⅳ的活性检测值明显高于灌胃染毒组(P<0.05)。[结论]JWYP凝胶制剂可通过贴敷给药的方式经皮渗透至小鼠皮下组织和腹腔,对DEHP连续灌胃染毒所致少弱精子症小鼠的睾丸损害具有治疗效果,其作用机制可能与增加细胞内线粒体和溶酶体等细胞器的数量,提高MRC活性,进而促进小鼠睾丸生精细胞和支持细胞的增殖再生有关。

少弱精子症的中医药治疗进展

将近年来中医药治疗少弱精子症相关的文献进行整理,归纳出中医治疗少弱精子症的常用治疗方法,包括中成药、中药汤剂及中药联合针灸治疗等,以供同道参考借鉴。

消癥煎治疗湿热瘀阻型精索静脉曲张伴少弱精子症的疗效及对睾丸微循环的影响

目的 观察消癥煎治疗精索静脉曲张伴少弱精子症的临床疗效及对睾丸微循环的影响,探讨其作用机制。方法 选取2021年1月至2022年1月河南省中医院诊治的92例精索静脉曲张(单纯左侧)伴少弱精子症患者作为研究对象。采用随机数字表法分为观察组和对照组,每组46例。观察组给予消癥煎加减治疗,对照组给予迈之灵片治疗。连续治疗12周后,比较两组总有效率、精索静脉超声指标、睾丸动脉血流参数、精液质量及中医证候积分情况。结果 治疗后,两组平静呼吸时精索静脉最大内径(DR)、乏氏试验时最大内径(DV)、持续返流时间(TR)均较治疗前下降,差异具有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。治疗后,两组睾丸包膜动脉的收缩期峰值流速、阻力指数、搏动指数较治疗前减小,前向运动精子率(PR)、精子总活力[PR+非前向运动精子率(NP)]、精子密度较治疗前提高,差异具有统计学意义(P<0.05),且治疗后组间比较差异具有统计学意义(P<0.05)。观察组总有效率为83.61%(38/46),高于对照组的60.87%(28/46),差异具有统计学意义(P<0.05)。结论 消癥煎能提高湿热瘀阻型精索静脉曲张伴少弱精子症患者的精子活力和精子密度,缩窄曲张精索静脉管径,降低睾丸包膜动脉血流阻力,改善临床症状。

广嗣育麟汤治疗肾精亏虚型少弱精子症临床观察

目的 观察广嗣育麟汤对肾精亏虚型男性少弱精子症患者的影响。方法 120例少弱精子症患者冲服广嗣育麟汤免煎颗粒,疗程12周。观察和比较治疗前后患者精液常规检查、配偶受孕情况、中医证候评分及胞内磷脂酰肌醇激酶(PI3K)、磷酸化蛋白激酶B(p-AKT)、B淋巴细胞瘤-2基因(Bcl-2)蛋白及mRNA的表达。结果 临床总有效率为92.7%(101/109);治疗后患者的精液液化状态、精液量、精子浓度、精子活动力均较治疗前明显提高,差异有统计学意义(P<0.05);治疗后中医证候评分较治疗前降低(P<0.05);治疗后的PI3K、p-AKT、Bcl-2蛋白及mRNA的表达明显上升(P<0.05)。结论 广嗣育麟汤治疗肾精亏虚型少弱精子症患者具有较好的疗效,值得临床推广,深入研究。

基于数据挖掘的中药复方治疗少弱精子症用药规律研究

目的:运用数据挖掘技术,分析现代文献中运用中药复方治疗少弱精子症的用药规律。方法:检索国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、中国生物医学文献数据库(CBM)中运用中药复方治疗少弱精子症的临床研究文献,采用中医传承辅助软件(V3.0)进行统计分析。结果:纳入286首方剂,涉及248味中药,统计分析结果显示,少弱精子症最常见的证型是肾精亏损证;治疗少弱精子症的中药以温性药、平性药为主;药味以甘味药、苦味药居多;多归肾经、肝经、脾经;使用频次大于49次的药物有20味;同时出现在一个方剂中频次最高以及关联性最大的组合有6个;得到衍化新方3首。结论:治疗少弱精子症常用单味药物有枸杞子、菟丝子、淫羊藿、熟地黄、黄芪、当归、覆盆子、山药、五味子、车前子等;临床常以“对药”及“角药”形式配伍;常用方剂是五子衍宗丸。核心药物组合方1具有补肾填精,益气养血之功效;方2具有补肾填精,滋阴补血之功效;方3具有补肾填精,益气补血之功效。可供临床参考使用。

中医药治疗特发性少弱精子症的研究进展

精液质量下降是男性不育症的主要表现,其中少弱精子症是临床的主要类型。针对无明确病因的特发性少弱精子症,西医以经验性治疗为主并且存在不良反应,而立足整体观念的中医药在治疗男性不育症方面具有一定优势。其中,中医药不仅积累经验并且发挥创新立说:中成药和中药汤剂均能有效改善特发性少弱精子症的精子质量及性激素水平等;单纯针灸和针药结合治疗均可取得良好的临床疗效。本文总结了近年来中医药治疗特发性少弱精子症的临床经验及观察,从理论创新、中成药、自拟方、针灸和针药结合治疗等中医药方面进行较为全面的综述,以期为临床中医药治疗特发性少弱精子症提供思路。