Meta-Analysis of the Clinical Efficacy of Acupuncture in the Treatment of Male Immune Infertility

Objective: Exploring the therapeutic effects of acupuncture for male immune infertility using Meta-analysis. Methods: The literature related to clinical randomized controlled trials (RCTs) on acupuncture for male immune infertility published from the establishment of the database (journal) to 2021 was searched for RR values or OR values and 95% CI as effect indicators. RevMan 5.3 software was applied for meta-analysis. Results: Acupuncture or combination of acupuncture and herbal medicine (hereafter referred to as acupuncture and medicine) or electro-acupuncture, the total effective rate was significantly better than the control group, and the difference was statistically significant [RR = 1.29, 95% CI (1.20, 1.38), p 0.00001];In addition, the efficiency of the combined acupuncture and medicine treatment was better than that of the herbal medicine group alone, and the difference was statistically significant [RR = 1.05, 95%, CI (0.94, 1.16), P = 0.42];The sperm viability in the combined acupuncture and medicine treatment group was significantly better than that in the herbal medicine treatment group alone, and the differences were all statistically significant [MD = 0.04, 95% CI (?0.20, 0.28), P0.74];Sperm forward motion was significantly better in the combination of acupuncture and medicine than in the herbal medicine alone group, and the differences were all statistically significant [MD = 0.66, 95% CI (?0.04, 1.36), P = 0.06];ACP indexes were significantly higher in the combination of acupuncture and medicine than in the herbal medicine alone group, with a statistically significant difference [MD = 20.47, 95% CI (?65.31, 106.25), P = 0.64];The AsAb content in the seminal plasma of either needle medicine or acupuncture was lower than in the homogeneous prednisone group, and the difference was statistically significant [MD = ?7.00, 95% CI (?11.19, ?2.81), P = 0.001];The index of AsAb content in the serum of either needle medicine or acupuncture was lower than that of prednisone group, and the difference was statistically significant [MD = ?5.00, 95% CI (?9.53, ?0.47), P = 0.03]. Conclusion: Based on current evidence, acupuncture is more effective than Western medicine (prednisone) alone in the treatment of male immune infertility, and is more effective when combined with Chinese medicine.

EFFECT OF ELECTROACUPUNCTURE ON ANTISPERM ANTIBODIES IN MALE INFERTILITY PATIENTS

Aims: To explore the therapeutic effect of electroacupuncture (EA) for treatment of male immune infertility patients and to observe the effect of EA on antisperm antibody (AsAb) positive reaction. Methods: A total of 100 male infertility AsAb positive patients were randomized into EA group (n=50, BL 15, BL 17, 18, 23, etc.) and medication group (n=50, oral administration of prednisone, 5 mg/time, t.i.d.). Serum and sperm AsAb were determined with enzyme immunoassay technique. Results: Following 4 months’ treatment, the cure rates and the total effective rates of EA and medication groups were 40.4% (20 cases/50 cases) and 92.0% (45/50), 10.0% (5/50) and 64.0% (32/50) respectively. The cure rate of EA group was significantly superior to that of medication group (P<0.01). But, no significant difference was found between two groups in the total effective rate (P>0.05). After treatment, AsAb positive rates of both groups particularly that of EA group decreased significantly compared with pre treatment of each group (P<0.05-0.01). Conclusion: EA treatment can work well in the treatment of some immune mediated male infertility patients and possesses a favorable regulation action on AsAb reaction.

Involvement of blood mononuclear cells in the infertility, age-associated diseases and cancer treatment

Blood mononuclear cells consist of T cells and monocyte derived cells. Beside immunity, the blood mononuclear cells belong to the complex tissue control system(TCS), where they exhibit morphostatic function by stimulatingproliferation of tissue stem cells followed by cellular differentiation, that is stopped after attaining the proper functional stage, which differs among various tissue types. Therefore, the term immune and morphostatic system(IMS) should be implied. The TCS-mediated morphostasis also consists of vascular pericytes controlled by autonomic innervation, which is regulating the quantity of distinct tissues in vivo. Lack of proper differentiation of tissue cells by TCS causes either tissue underdevelopment, e.g., muscular dystrophy, or degenerative functional failures, e.g., type 1 diabetes and age-associated diseases. With the gradual IMS regression after 35 years of age the gonadal infertility develops, followed by a growing incidence of age-associated diseases and cancers. Without restoring an altered TCS function in a degenerative disease, the implantation of tissue-specific stem cells alone by regenerative medicine can not be successful. Transfused young blood could temporarily restore fertility to enable parenthood. The young blood could also temporarily alleviate aging diseases, and this can be extended by substances inducing IMS regeneration, like the honey bee propolis. The local and/or systemic use of honey bee propolis stopped hair and teeth loss, regressed varicose veins, improved altered hearing, and lowered high blood pressure and sugar levels. Complete regression of stage Ⅳ ovarian cancer with liver metastases after a simple elaborated immunotherapy is also reported.

Anti-Sperm Antibodies: Risk Factors of Positive Serology among Infertile Men Patients in Kisangani-Democratic Republic of Congo

Introduction: Antisperm antibodies (ASA) prevalence is high in Kisangani. ASA are one of the male factors of infertility that can reduce spermatozoa motility and cervical penetration or prevent acrosomal reaction and even alter embryo development. This study aims to determine the risk factors of ASA positivity among infertile men in Kisangani. Patient and Method: We conducted a case-control study during a period of 2 years in Kisangani on 111 men who consulted for conception and tested for ASA by ELISA. We did a simple pairing that concerned only the type of infertility. For a better balance between the number of cases and controls per stratum to provide better accuracy in the adjusted OR estimate, we performed a 1:1 match. Results: This study showed that businessmen [ORa = 5.0000(1.2452 - 20.0767)] and jobless [ORa = 5.8125(1.1477 - 29.4367)] were at risk of being positive for ASA. Violent blow to testicles [ORa = 6.7391(1.3455 - 33.7545)], cure of hernia [ORa = 4.3478(1.0722 - 17.6299)], Chlamydia infection [ORa = 4.7125(1.3405 - 16.5665)], leucospermia [ORa = 4.1429(1.0406 - 19.7155)] and presence of Staphylococcus aureus [ORa = 3.4444(0.6410 - 18.5082)] were associated to positive ASA. Conclusion: This study shows that factors that may lead to risky sexual behavior and physical or infectious trauma are important risk factors for ASA positivity. It is therefore necessary to search for them systematically during male infertility in order to guide the search for ASA.

Anti-Sperm Antibodies: Prevalence of Ig A and Ig G Positive Serology among Infertile Patients in Kisangani, Democratic Republic of Congo

Introduction: Infertility in a couple is a stressful situation. Among the causes is the presence of antisperm antibodies that play a harmful role in reducing fertility and negatively influencing in vitro fertilization. The aim of this study is to determine their prevalence among infertile patients in Kisangani. Patients and methods: We conducted an analytical cross-sectional study in health facilities in the city of Kisangani. Of the 1379 patients who consulted for conception, 311 were tested for antisperm antibodies by ELISA. Results: Of the 311 patients, 121 tested positive (38.91%). Women were significantly more likely to be positive (p-value = 0.013). Ig G was positive in 32.48% of patients and Ig A in 10.93%. Age was a significant predictor of the number of positive patients (p-value < 0.001). Compared to patients of ≤30 years of age, having 31 to 40 years of age or 41 years of age and older increased respectively 2 and 3 times the risk of being positive. In secondary infertility, women are twice as likely to be positive. Conclusion: The prevalence of antisperm antibodies is very high among infertile patients in Kisangani with predominance among women. Older age increases the risk of positivity. This test should therefore be integrated into infertility investigations as often as possible.

不孕症子宫内膜类器官建立与验证

目的 构建非免疫因素致不孕症和免疫因素致不孕症子宫内膜类器官培养体系,并比较两者免疫细胞因子的差异。方法 标本采自海军军医大学(第二军医大学)第一附属医院生殖医学中心行宫腔镜检查的不孕症患者,获取非免疫因素致不孕症患者(n=3)与反复着床失败(RIF)患者(n=5)子宫内膜组织,通过洗涤、消化、重悬及接板,将组织嵌入基质胶中进行3D培养;在倒置显微镜下观察两组子宫内膜类器官生长情况;利用免疫荧光染色技术检测子宫内膜特异性标志物雌激素受体(ER)、角蛋白和上皮钙黏蛋白表达情况;利用ELISA法测定两组细胞因子水平,并比较两组细胞因子的差异。结果 在子宫内膜类器官体外培养过程中,类器官体积逐渐增大、细胞数量逐渐增多,培养7~10 d的类器官体积达到稳定状态且形状逐渐趋于圆形。在相同时间内,非免疫因素致不孕症子宫内膜类器官数量较RIF子宫内膜类器官多。免疫荧光染色显示类器官中子宫内膜相关标志蛋白ER、角蛋白和上皮钙黏蛋白均表达,提示子宫内膜类器官构建成功。ELISA检测结果显示,两组间干扰素γ、IL-10、TNF-α、IL-4水平和TNF-α/IL-4比值的差异均有统计学意义(P<0.05或P<0.01),TGF-β1、IL-17水平及IL-17/TGF-β1、干扰素γ/IL-10、TNF-α/IL-10比值差异均无统计学意义(均P>0.05)。结论 在体外成功培养获得了具有增殖能力的非免疫因素致不孕症与RIF子宫内膜类器官,为免疫性不孕症的基础研究提供了新模型。

基于CiteSpace的我国免疫性不育的文献计量学及可视化分析

目的了解中国1993年以来免疫性不育研究的发展状况与研究热点,为该领域今后研究提供借鉴。方法检索中国知网1993年至2023年关于免疫性不育研究的文献,筛选后将纳入文献导入CiteSpace软件进行格式转换,对作者、机构、关键词进行共现、聚类和突现分析。结果451篇文献纳入研究,14位作者发文量≥4篇,9个机构发文量≥3篇,关键词形成9个自然聚类,关键词突现显示中医药研究占据主导地位。结论免疫性不育研究取得一定成果,已相对成熟,研究涉及免疫性不育多个层面,内容多与中医药相关。

中医药治疗男性免疫性不育meta分析

目的:运用meta分析方法系统评价中医药治疗男性免疫性不育的有效性和安全性。方法:检索万方数据库、中国生物医学文献数据库、Cochrane Library、维普数据库、PubMed数据库、CNKI(China National Knowledge Infrastructure)数据库,搜集中医药治疗男性免疫性不育的随机对照试验(RCT),并进行方法学质量评价,采用RevMan5.4软件进行统计分析与发表偏倚评估。结果:有25篇RCT文献纳入本项研究,总共纳入病例2563例,其中试验组1407例,对照组1155例。meta分析显示中医药治疗男性免疫性不育总有效率(OR=6.35,95%CI:4.96~8.13,P<0.00001)、精浆抗精子抗体转阴率(OR=4.52,95%CI:2.72~7.51,P<0.00001)、血清抗精子抗体转阴率(OR=2.98,95%CI:2.23~3.96,P<0.00001)、精液浓度(MD=15.56,95%CI:11.32~19.79,P<0.00001)、a级精子百分率(MD=3.85,95%CI:1.91~5.79,P=0.00001)、a+b级精子百分率(MD=13.77,95%CI:7.06~20.48,P<0.0001)、精子存活率(MD=10.32,95%CI:6.78~13.86,P<0.00001)、妊娠率(OR=3.53,95%CI:2.68~4.63,P<0.00001)、不良反应(OR=0.06,95%CI:0.01~0.23,P<0.00001)均显著优于单纯西药治疗。中医药治疗男性免疫性不育的精子畸形率与单纯使用西药组疗效差异不明显(MD=-7.53,95%CI:-15.50~0.44,P=0.06)。结论:中医药治疗男性免疫性不育疗效确切、安全性高,是治疗男性免疫性不育的有效方法。

中医药辨治免疫性不育研究概述

免疫性不育以肾虚为本、湿瘀为标,基本病机在于禀赋不足、戕害肾精、饮食不节等导致肾肝脾虚,感染、环境污染及接触化学毒物导致湿、瘀、热、毒等邪气蕴结精室,日久损伤机体免疫屏障,导致精子被机体免疫系统识别而形成抗精子抗体,引起精子活动率下降,造成不育。总结近20年本病论治概况,认为诸医家辨证运用中药、中西结合、针刺、穴位埋线等手段,整体上重视补肾治本、兼顾肝脾,活血祛湿治标、兼顾热浊,发挥了抗炎、调节免疫、提高精子活动率的作用,凸显了中医优势。

生殖免疫抗体检测在女性不孕不育生殖道感染中的应用价值

目的 检测血清生殖免疫抗体,分析其在不孕不育女性生殖道感染中的应用价值。方法 回顾性分析136例不孕不育症育龄期女性临床资料,其中合并生殖道感染74例(感染组),无生殖道感染62例(未感染组)。比较2组血清抗精子抗体(ASAb)、抗子宫内膜抗体(EMAb)、抗卵巢抗体(AOAb)、抗心磷脂抗体(ACAb)水平差异,使用受试者工作特征(ROC)曲线评估血清ASAb、EMAb、AOAb、ACAb对不孕不育症合并生殖道感染的诊断效能,并记录不同病原感染者血清ASAb、EMAb、AOAb、ACAb检测结果。结果 感染组血清ASAb、EMAb、AOAb、ACAb阳性率及血清含量明显高于未感染组(P<0.05)。ROC曲线分析显示,血清ASAb、EMAb、AOAb、ACAb诊断不孕不育症合并生殖道感染的AUC值分别为0.972、0.945、0.968、0.862(P<0.05)。感染组中,不同病原感染者血清ASAb、EMAb、AOAb、ACAb阳性率比较差异无统计学意义(P>0.05)。结论 ASAb、EMAb、AOAb、ACAb对女性不孕不育症合并生殖道感染具有较高诊断效能,临床应用价值较高。

血清激素联合免疫抗体检测在不孕筛查中的应用观察

目的观察在不孕不育筛查中开展血清激素联合免疫抗体的实际效果。方法选取本院120例不孕患者作为干预组,并在同期纳入120例生育功能正常人群作为参照组,均对其开展血清激素与免疫抗体检测,比较分析两组检测结果。结果干预组血清激素水平高于参照组,差异有统计学意义(P<0.05)。月经周期失调者血清激素水平高于月经周期正常者,差异有统计学意义(P<0.05)。卵巢功能低下者血清激素水平高于卵巢功能正常者,差异有统计学意义(P<0.05)。干预组免疫抗体中抗透明带抗体(ZPAb)、抗子宫内膜抗体(EmAb)抗心磷脂抗体(ACAb)、抗绒毛膜促性腺激素抗体(AhAb)的阳性检出率高于参照组,差异有统计学意义(P<0.05)。继发性不孕免疫抗体中ZPAb、EmAb、ACAb、AhAb的阳性检出率高于原发性不孕,差异有统计学意义(P<0.05)。结论不孕筛查时采用血清激素与免疫抗体检测效果均确切可行,两种联合检测能够有效发挥协同效应,提升临床不孕不育检出率,为后期治疗工作的开展奠定基础,在临床中具有较高的应用价值。

Correlation of body mass index with Th1/Th2 balance, adhesion molecules and insulin signal transduction in infertile patients

Objective: To study the correlation of body mass index with Th1/Th2 balance, adhesion molecules and insulin signal transduction in infertile patients. Methods: A total of 132 patients who received diagnostic curettage due to infertility in Tangshan Maternal and Child Health Hospital between June 2015 and March 2016 were selected as the research subjects and divided into the normal group with BMI<25 kg/m2, the overweight group with BMI 25-30 kg/m2 and the obesity group with BMI > 30 kg/m2 according to BMI, and the levels of Th1/Th2 cytokines in serum as well as the expression of Th1/Th2 transcription factors, adhesion molecules and insulin signal pathway molecules in endometrial tissue were detected. Results:IFN-γ and TNF-α levels in serum of obesity group and overweight group were significantly higher than those of control group while IL-4, IL-5 and IL-13 levels in serum as well as CD44V6, N-cadherin, FAK, ICAM-1, GLUT-4, IRS-1, PI3K and AKT mRNA expression in endometrial tissue were significantly lower than those of control group;IFN-γ and TNF-α levels in serum of obesity group were significantly higher than those of overweight group while IL-4, IL-5 and IL-13 levels in serum as well as CD44V6, N-cadherin, FAK, ICAM-1, GLUT-4, IRS-1, PI3K and AKT mRNA expression in endometrial tissue were significantly lower than those of overweight group. Conclusion: Weight gain can aggravate the Th1/Th2 disorder, reduce the adhesion molecule expression and hinder the insulin signal transduction in infertile patients.

孕通汤组方联合宫腹腔镜对盆腔输卵管性不孕症患者卵巢功能及血清免疫因子的影响

目的探讨孕通汤组方联合宫腹腔镜对盆腔输卵管性不孕症患者卵巢功能及血清免疫因子的影响。方法采用两均数比较的样本含量计算公式计算研究所需样本量,选取2017年7月—2020年6月期间河北省沧州中西医结合医院收治的血瘀型盆腔输卵管性不孕症患者160例,按随机数字表法分为对照组和观察组,每组各80例。对照组采用宫腹腔镜治疗,观察组采用孕通汤联合宫腹腔镜治疗。治疗7 d后,观察比较两组患者的中医证候积分及临床体征积分,治疗前及治疗7 d后卵巢功能指标[雌二醇(Estradiol,E_(2))、促卵泡生成激素(Follicle-stimulating hormone,FSH)、促黄体生成素(luteinizing hormone,LH)],血清免疫因子[CD3^(+)、CD4^(+)、CD4^(+)/CD8+、自然杀伤细胞(Natural killer cell,NK)]的变化,记录术后随访12个月内妊娠情况。结果治疗后观察组总有效率93.75%(75/80)明显高于对照组75.00%(60/80),差异有统计学意义(P<0.05)。治疗7 d后,观察组中医证候积分(6.63±1.72)分与对照组(9.24±1.86)分比较明显减少,差异有统计学意义(P<0.05)。治疗7 d后,观察组LH、FSH水平较治疗前明显降低,E_(2)水平较治疗前明显升高,差异有统计学意义(P<0.05);且观察组LH、FSH水平低于对照组,E_(2)水平高于对照组,差异有统计学意义(P<0.05)。治疗7 d后,观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)及NK均较治疗前明显升高,差异有统计学意义(P<0.05);且观察组高于对照组,差异有统计学意义(P<0.05)。观察组宫内妊娠率42.50%(34/80)较对照组20.00%(16/80)明显升高,差异有统计学意义(P<0.05);两组患者生化妊娠率、异位妊娠率比较,差异无统计学意义(P>0.05)。结论孕通汤组方联合宫腹腔镜手术能进一步提高盆腔输卵管性不孕症的治疗总有效率及宫内妊娠率,改善临床症状及卵巢功能,增强机体免疫功能。

基于数据挖掘中药治疗免疫性不孕的用药规律

目的:基于数据挖掘技术探讨中药复方治疗免疫性不孕的用药特点及其规律。方法:通过计算机检索国家知识基础设施数据库(CNKI)、中文科技期刊数据库(CCD)、中国生物医学文献数据库(CBM)、中国学术期刊数据库(CSPD)、PubMed、Embase数据库和Cochrane图书馆中有关中医药治疗免疫性不孕疾病的文献,构建免疫性不孕的方药数据库,并运用Excel 2019、origin 21、IBM SPSS Statistics 25及IBM SPSS Modeler 14.1等软件进行频数统计、关联规则分析和系统聚类分析。结果:共纳入101首方药,共涉及1 350频次中药使用,药物118味,使用频率大于20次的药物有22味,依次为当归、菟丝子、甘草、丹参、黄芪、赤芍、枸杞子等,中药主要以补虚药、清热药、活血化瘀药为主,其中补虚药又以补肾药为主,药性以温为主,药味以甘为多,药物归经主要归肝、肾、脾经;关联规则分析得出58条核心关联,系统聚类分析得出药组4个。结论:临床上免疫性不孕的基本治疗大法为从肾论治,中药主要以补肾药为主,同时根据患者相关临床症状,随证配伍清热药、活血化瘀药、健脾益气药等药物进行治疗,往往取得不错的疗效。

子宫内膜异位症的研究进展

子宫内膜异位症(endometriosis,EMT)多发于育龄期妇女,以逐渐加重性继发性痛经为主要表现,患病后导致不孕的风险高,且除根治性手术外,期待治疗及药物治疗后复发率高。近年来虽然辅助生殖技术得到了更深入的推广应用,但EMT患者实施辅助生殖技术后,受精卵种植率和妊娠率较非EMT患者低,EMT的治疗仍较为棘手。本文总结了EMT及其免疫学发病机制、EMT合并不孕的免疫学机制,以及程序性死亡受体1(programmed death-1,PD-1)的研究进展,旨在为后续的临床治疗工作提供参考。

丹参多酚酸对免疫性不孕大鼠的治疗作用及对下丘脑-垂体-卵巢轴的影响

目的探讨丹参多酚酸对免疫性不孕大鼠的治疗作用及对下丘脑-垂体-卵巢轴(HPOA)的影响。方法取50只未孕雌性SD大鼠,采用人精液注射免疫的方法建立抗精子抗体阳性的免疫性不孕大鼠模型,将建模成功大鼠采用随机数字表法分为模型组(9只)、强的松组(10只)和丹参多酚酸低剂量组(9只)、中剂量组(10只)、高剂量组(10只),另取10只未孕雌性大鼠为正常对照组。强的松组经腹腔注射给予5 mg/kg强的松,丹参多酚酸低、中、高剂量组分别经腹腔注射给予10、20、40 mg/kg丹参多酚酸,正常对照组和模型组均给予等量生理盐水,每日1次,共14 d。各组雌性大鼠与正常雄性大鼠按3∶1数量比合笼2周,统计各组大鼠受孕率;放射免疫法测定血清中促性腺激素释放激素(GnRH)、卵泡刺激素(FSH)、黄体生成素(LH)以及雌二醇(E2)水平;苏木素-伊红(HE)染色观察大鼠卵巢组织病理改变情况;实时定量逆转录聚合酶链反应(qPCR)和蛋白质免疫印迹法检测大鼠卵巢卵泡刺激素受体(FSHR)、黄体生成素受体(LHR)、雌激素受体α(ERα)mRNA和蛋白表达。结果与正常对照组相比,模型组大鼠受孕率,血清GnRH、FSH、LH、E2含量降低(P<0.05),卵巢内黄体和成熟卵泡明显减少,颗粒细胞层数减少,囊状卵泡较多,FSHR、LHR、ERαmRNA及蛋白表达降低(P<0.05)。与模型组相比,强的松组和丹参多酚酸中、高剂量组大鼠受孕率,血清GnRH、FSH、LH、E2含量升高(P<0.05),囊状卵泡数目减少,颗粒细胞层数增多,有成熟卵泡和黄体生成,FSHR、LHR、ERαmRNA及蛋白表达升高(P<0.05)。结论丹参多酚酸可通过调控HPOA促进卵泡成熟治疗免疫性不孕。

NLRP3信号通路介导的睾丸固有免疫研究进展

NLR家族蛋白结构域-3(NLRP3)是一种胞浆传感器,是睾丸固有免疫模式识别受体家族的重要成员,能激活含半胱氨酸的天冬氨酸蛋白水解酶(caspase)和诱导IL-1β成熟。NLRP3与睾丸固有免疫过激导致的男性不育关系密切。因此,NLRP3有望成为极具价值的男性不育治疗靶标。本文总结了目前对NLRP3参与睾丸固有免疫的相关机制的研究结果,描述了NLRP3在睾丸组织内的广泛分布及功能,对调节睾丸NLRP3信号通路的抑制剂进行了汇总阐述,为NLRP3相关睾丸免疫问题提供更深入的见解。

肠道菌群失调与男性不育相关性的研究进展

男性不育是目前影响人类生殖和健康的严重问题之一。健康的肠道菌群参与了免疫系统的发展和对病原体入侵的保护,并通过分泌多种物质维持人体正常代谢,提高生殖潜力。肠道菌群失调可以促进局部和全身免疫炎性反应,诱发慢性代谢性疾病,影响性激素合成,造成精子生成、成熟或活化异常,与男性生育能力下降密切相关。本文通过探究肠道菌群失调与男性不育的相关性,以期为男性不育的临床诊疗提供新的线索和方向。

性激素水平与PCOS不孕患者免疫调节失衡的相关性及对促排卵治疗后排卵结局的预测价值

目的研究性激素水平与多囊卵巢综合征(PCOS)不孕患者免疫调节失衡及促排卵治疗后排卵数量的相关性。方法选取安徽中医药大学第一附属医院于2020年3月至2022年8月收治的80例PCOS不孕患者作为PCOS患者组,另选取80例同院同期收治的体检健康的女性作为健康对照组。采用化学发光法测定PCOS患者组和健康对照组受试者的性激素水平;采用酶联免疫吸附试验法测定炎性因子,采用流式细胞仪测定免疫因子Th1/Th2水平;采用Pearson相关系数分析性激素水平与炎性因子、Th1/Th2的相关性。接受体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)助孕的PCOS患者根据妊娠结局分为A组(妊娠,n=35)和B组(未妊娠,n=45),均行控制性促排卵治疗,并分析血清抗米勒管激素(AMH)及性激素水平对控制性促排卵结局的预测价值。结果PCOS患者组黄体生成素(LH)、雌二醇(E2)、睾酮(T)、LH/卵泡刺激素(FSH)水平均显著高于健康对照组(P<0.05)。PCOS患者组C反应蛋白(CRP)、γ干扰素(IFN-γ)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、Th1、Th1/Th2水平均显著高于健康对照组(P<0.05)。性激素T、E2、LH/FSH水平与患者炎性因子CRP、IFN-γ、IL-6、TNF-α水平及免疫功能因子Th1/Th2水平均呈现显著正相关性(P<0.05)。A组患者血清FSH、AMH水平均显著高于B组,LH、E2、T、LH/FSH水平均显著低于B组(P<0.05)。AMH、T、E2、LH/FSH的曲线下面积(AUC)为0.760~0.836,灵敏度为65.8%~76.3%,特异度为81.9%~85.1%;性激素联合诊断的AUC为0.892,灵敏度为78.1%,特异度93.6%。结论PCOS不孕患者性免疫调节失衡与性激素水平异常相关,且性激素联合诊断对促排卵治疗后排卵结局具有较高的预测价值。

从“脾虚湿瘀”论免疫性不育病机及治疗

[目的]运用中虚精变理论的“脾虚湿瘀”观点,对男性免疫性不育的病机和治疗进行阐发。[方法]从中虚精变理论“脾虚湿瘀”观点及免疫性不育病因病机出发,探讨二者的理论契合性,并基于“脾虚湿瘀”观点,确立免疫性不育的论治原则及代表方药。[结果]“脾虚湿瘀”观点植根于中虚精变理论,以脾虚为本、湿瘀为标,重视阐发理论的中虚致实部分。免疫性不育病机特点在于本虚标实,本虚主要是脾虚、肝肾亏虚,在虚的基础上化生或合并湿、热、瘀等实邪。从“脾虚湿瘀”分析免疫性不育病机,虚证论治不仅要重视脾虚,亦当兼顾肝肾,实证论治不仅要重视湿瘀,亦须重视热、痰、浊、毒之衍变,这些因素均与免疫性不育的产生密切相关。以“脾虚湿瘀”指导免疫性不育的治疗,要以健脾活血祛湿为要,以当归芍药散为代表方,并注重化裁,其运用的合理性已获得临床研究的支持。[结论]“脾虚湿瘀”观点与免疫性不育病机具有契合性,为本病的临床治疗开辟了新思路。