补中益气汤合左卡尼汀治疗精索静脉曲张少弱精症的临床研究
|
摘要
目的:观察补中益气汤合左卡尼汀治疗精索静脉曲张(varicocele.VC)少弱精症的临床疗效及对精液参数的影响,探讨该病的基本病机,并研究分析本方法提高精子密度、精子活力的可能机制。
方法:本研究将符合纳入标准的50例患者,按照随机的原则分成治疗组25例及对照组25例,分别予以观察研究,其中治疗组均采用补中益气汤结合左卡尼汀,对照组仅口服左卡尼汀,疗程3个月。主要观察临床疗效,并在治疗前后分别测定精子密度和精子活力等。对所有受检者精液采用计算机辅助精子质量分析(CASA)。所有资料应用SPSS13.0软件包进行处理,进行T检验、X~2检验及Ridit分析等统计学处理。
结果:治疗组的总有效率为90.91%,优于对照组的71.43%,经Ridit分析,治疗组疗效优于对照组治疗组,两组之间具有显著性差异(P＜0.05)。治疗后精子活率比较,经F检验,治疗组与对照组之间有显著性差异(P＜0.05),治疗组也优于对照组。治疗后精子密度、A级及A+B级精子活力比较,经F检验,治疗组与对照组之间有极显著性差异(P＜0.01),治疗组优于对照组。同时,经X~2检验,治疗后两组临床症状改善率相比较,有极显著性差异(P＜0.01),治疗组优于对照组。此外,治疗前后组内比较精子密度、精子活率及精子活力,经T检验,治疗组、对照组都有极显著的差异意义(P＜0.01),说明两组均对改善精液质量有效。
结论:补中益气汤联合左卡尼汀治疗精索静脉曲张少弱精症有良好临床疗效,不仅可以改善精索静脉曲张的临床症状,而且更能显著提高精子密度、精子活力等。由此推测精气血的生成与运行障碍是其基本病机;此外,左卡尼汀是非常有潜力的治疗男性少弱精症的药物,较为安全,值得推广。但是其作用及其转运机制等尚未完全阐明,有待进一步深入研究。
[Objective]To observe the therapeutic effect of Buzhong Yiqi Decoction combining L-carnitine for varicocele cases associated with oligozoospermia or with asthenospermia.To discuss the pathological mechanism of it and to explore the possible mechanism of improving the sperm density and motility.
[Methods]50 cases of varicocele infertility according to the accepted standard were enrolled and divided into two groups randomly:the treatment group(25cases)received Buzhong Yiqi Decoction combining L-carnitine therapy; while the control group with 25 cases received only L-carnitine.After three monthes of therapy,to evaluate the clinical effection and compare the sperm density,sperm vitality and sperm motility.The semen characteristics were carried out by the computer-aided semen analysis(CASA)technique.All the data were analysised by SPASS13.0.
[Results]The general effective rate of treatment group was 90.91%,through Ridit analysis,the treatment group was obviously superior to the control group.Compared with the control group in terms of vitality of sperm,through F test,the treatment group was superior(P<0.05).There were significant differences between the treatment group and the control group referring the sperm density and(A,A+B)grade sperm percentage(P<0.01),the treatment group was obviously superior.On the other hand,through X~2 test,the clinical symptom were markedly improved in contrast to before(P<0.01).In terms of density, vitality and movable ratio,through T test,there were differences between post-treatment and pre-therapy of the treatment group and the control group (P<0.01),both of the team were effective on improving the sperm density and motility.
[Conclusion]Therapy of Buzhong Yiqi Decoction combining L-carnitine varicocele infertility could not only release varicocele symptom,but also better the quality of semen,and improve the density,vitality and movable ratio of sperm.The pathological mechanism could be disturbance of Qi、Xue and Jing,deducing from the research.L-carnitine was eutherapeutic and safe medicine for male infertility,but the mechanism of action needed further research.
方法:本研究将符合纳入标准的50例患者,按照随机的原则分成治疗组25例及对照组25例,分别予以观察研究,其中治疗组均采用补中益气汤结合左卡尼汀,对照组仅口服左卡尼汀,疗程3个月。主要观察临床疗效,并在治疗前后分别测定精子密度和精子活力等。对所有受检者精液采用计算机辅助精子质量分析(CASA)。所有资料应用SPSS13.0软件包进行处理,进行T检验、X~2检验及Ridit分析等统计学处理。
结果:治疗组的总有效率为90.91%,优于对照组的71.43%,经Ridit分析,治疗组疗效优于对照组治疗组,两组之间具有显著性差异(P＜0.05)。治疗后精子活率比较,经F检验,治疗组与对照组之间有显著性差异(P＜0.05),治疗组也优于对照组。治疗后精子密度、A级及A+B级精子活力比较,经F检验,治疗组与对照组之间有极显著性差异(P＜0.01),治疗组优于对照组。同时,经X~2检验,治疗后两组临床症状改善率相比较,有极显著性差异(P＜0.01),治疗组优于对照组。此外,治疗前后组内比较精子密度、精子活率及精子活力,经T检验,治疗组、对照组都有极显著的差异意义(P＜0.01),说明两组均对改善精液质量有效。
结论:补中益气汤联合左卡尼汀治疗精索静脉曲张少弱精症有良好临床疗效,不仅可以改善精索静脉曲张的临床症状,而且更能显著提高精子密度、精子活力等。由此推测精气血的生成与运行障碍是其基本病机;此外,左卡尼汀是非常有潜力的治疗男性少弱精症的药物,较为安全,值得推广。但是其作用及其转运机制等尚未完全阐明,有待进一步深入研究。
[Objective]To observe the therapeutic effect of Buzhong Yiqi Decoction combining L-carnitine for varicocele cases associated with oligozoospermia or with asthenospermia.To discuss the pathological mechanism of it and to explore the possible mechanism of improving the sperm density and motility.
[Methods]50 cases of varicocele infertility according to the accepted standard were enrolled and divided into two groups randomly:the treatment group(25cases)received Buzhong Yiqi Decoction combining L-carnitine therapy; while the control group with 25 cases received only L-carnitine.After three monthes of therapy,to evaluate the clinical effection and compare the sperm density,sperm vitality and sperm motility.The semen characteristics were carried out by the computer-aided semen analysis(CASA)technique.All the data were analysised by SPASS13.0.
[Results]The general effective rate of treatment group was 90.91%,through Ridit analysis,the treatment group was obviously superior to the control group.Compared with the control group in terms of vitality of sperm,through F test,the treatment group was superior(P<0.05).There were significant differences between the treatment group and the control group referring the sperm density and(A,A+B)grade sperm percentage(P<0.01),the treatment group was obviously superior.On the other hand,through X~2 test,the clinical symptom were markedly improved in contrast to before(P<0.01).In terms of density, vitality and movable ratio,through T test,there were differences between post-treatment and pre-therapy of the treatment group and the control group (P<0.01),both of the team were effective on improving the sperm density and motility.
[Conclusion]Therapy of Buzhong Yiqi Decoction combining L-carnitine varicocele infertility could not only release varicocele symptom,but also better the quality of semen,and improve the density,vitality and movable ratio of sperm.The pathological mechanism could be disturbance of Qi、Xue and Jing,deducing from the research.L-carnitine was eutherapeutic and safe medicine for male infertility,but the mechanism of action needed further research.
引文
[1]Noske HD,Weidner W.Varicocele—a historical perspectiver[J].World J Urol,1999,17(1):151-157.
[2]郭应禄,胡礼泉主编.男科学[M].北京:人民卫生出版社,2004.
[3]Walsh PC,Retik AB.CampbellUrologyS.W.Saun2ders,1999,43:1313.
[4]吴阶平主编.泌尿外科[M].第1版.济南:山东科学出版社,1993,934.
[5]Velez-de-la-Calle JF,Rachou E,le Martdot MT,et al.Male infertilityrisk factors in a French military population.Hum Repred,2001.16(31):481-486.
[6]王益鑫.男性不育临床研究进展[J].中国男科学杂志,1999,13(4):195-196.
[7]李其信.中医治疗精索静脉曲张不育症研究进展[J].广西中医药,2003,26(1):8.
[8]陈志强,江海身主编.男科专病中医临床诊治[M].北京:人民卫生出版社,2000.
[9]陈利生主编.中西医论治男性不育[M].上海:上海科学普及出版社,1994.
[10]戚广崇,李其信,阚钦林,等.通精冲剂对精索静脉曲张不育患者精子运动参数的影响[J].中医杂志,2000,41(11):673-675.
[11]陈新瑞.益气升清法为主治疗男科疾患的体会[J].江苏中医,1991,12(2):71.
[12]崔学教.中西结合治疗精索静脉曲张425例[J].新中医,2001,33(7):341.
[13]张长方,周方安.精索静脉曲张不育的病机探讨[J].中国中医基础医学杂志,2004,10(11):56-58.
[14]王均贵.通法为主治疗精索静脉曲张合并不育[J].北京中医,1999,18(1):46-47.
[15]梁启伟,王云翔,杜晨,等.手术配合中药治疗精索静脉曲张引起的男性不育症[J].中国男科学杂志,2000,14(3):186-187.
[16]刘建新,郑焕英.中西医结合治疗精索静脉曲张致男性不育症42例[J].山东中医杂志,2001,20(9):542-543.
[17]肖州南,应以平.精索静脉曲张合并不育症治验.中国医药学报,1994,9(4):39-401.
[18]刘时尹,马重堂,等.精索静脉曲张(合并不育症)治疗调查与分析[J].中医药研究,1995,(6):24-251.
[19]徐德伟,王兴烈,徐德厚,等.徐祖辉论治精索静脉曲张所致不育症经验[J].陕西中医1996,17(4):168-169.
[20]张耀泉.张氏精索静脉曲张方治疗精索静脉曲张不育症162例疗效观察[J].新中医,2003,35(1):22-23.
[21]崔云,冯奕,等.祛瘀通络强精法治疗精索静脉曲张不育症的疗效观察.男科医学,2006,3(10):20-23.
[22]何方敏.桃红四物汤加减治疗精索静脉曲张性不育.现代中西医结合杂志,2006,15(13):1797-1798.
[23]李波,江立军,刘东梅.补肺法治疗精子活力低下50例[J].湖北中医杂志.2002,24(11):7.
[24]刘建荣,王怀秀.伸曲助育汤治疗精索静脉曲张及其不育的临床研究[J].上海中医药杂志,2005,39(3):33-34.
[25]杨家辉,开兴亮.通补结合治疗精索静脉曲张合并不育症[J].中华男科学,2002,8(4):310-311.
[26]郭玉佳,王中伟,等.精索静脉曲张多方法联合治疗的疗效观察[J].中华男科学,2006,12(9):800-802.
[27]蒋学洲,周智恒.精索静脉曲张引起男性不育的中西医结合治疗.中国中西医结合外科杂志,2002,8(1):42-43.
[28]戚广崇,陆寄坤,阚钦林,等.通精冲剂与手术治疗精索静脉曲张不育症的临床研究[J],中国中西医结合杂志,2001,21(6):412-415.
[29]李君强,汪承领.活血补肾汤治疗精索静脉曲张合并不育症76例.中国中医药科技,2000,7(1):581.
[30]梁启伟,王云翔,杜晨,等.手术配合中药治疗精索静脉曲张引起的男性不育症[J].中国男科学杂志,2000,14(3):186-1871.
[31]周兴明,金许洪.手术加中药治疗精索静脉曲张所致不育症.镇江医学报,1999,9(4):6671.
[31]安立文,王树林,白贵林,等.生精冲剂对精索静脉曲张型不育症患者术后精子形态的影响.中医杂志,1998,39(6):349-350.
[32]张杰.精索静脉曲张致男性不育症的治疗-评估目前常用治疗方法进行比较研究[J].国外医学·泌尿系统分册,1999,19(5):238-239.
[33]吴宏飞,尤国才,睦元庚.精索盘膜肌管折叠术治疗精索静脉曲张及远期随访[J].中华泌尿外科杂志,1995,16(1):35-37.
[34]徐开宏,黄宇烽.精索静脉曲张研究进展[J].临床泌尿外科杂志,1995,10(3):187.
[35]郭应禄,李宏军.男性不育症[M].北京:人民军医出版社,2003,第一版:284,283,228-229.
[36]WHO.人类精液及精子一宫颈粘液相互作用实验室检验手册[M].4版.北京:人民卫生出版社.2001:5.
[37]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:人民卫生出版 社,1993.192-195.
[38]WHO.不孕夫妇标准检查与诊断手册[M].北京:科学技术出版社,1994:19.
[39]曹开镛,戚广崇主编.中医男科研究与临床研究进展[M].第1版.上海:上海科学技术文献出版社,1995.222-223.
[40]张均倡.中医十大名方妙用“补中益气汤”[M].北京:中国中医药出版社,1998,第一版:1-38,118-121.
[41]Costa M,Canale D,Filicori M,et al.L-carnitine in idiopathic asthenozoospermia:a multicenter study.Andrologia,1994,26(3):155-159.
[42]Lenzi A,Lombardo F,Sgro P,et al.Use of carnitine therapy in se.lected eases of male factor infertility:double blind crossover trial[J].Fertil Steril,2003,79(2):292-300.
[43]Cavallini G,Ferraretti AP,Gianaroli L,et al.Cinnoxicam and carnitine/acetyl carnitine treatment for idiopathic and varicocele-associate doligoasthenospermia.J Androl,2004,25(5):761-770.
[44]Comhaire FH,Mahmoud A.The role of food supplements in the treatment of the infertile man[J].Reprod Biomed Online,2003,7(4):385-391.
[45]商学军,黄宇烽.李克,等.L-肉碱治疗附睾结节拌弱精子症初步观察[J].中华男科学杂志,2004,10(9):671-576.
[46]李铮,谷荣华,刘勇,等.补充肉毒碱治疗少弱精了症疗效观察.上海第二医科大学学报,2005,25(3):292-294.
[47]吕海宁,腾晓明.左卡尼订治疗男性少弱精临床观察[J].中华男科学杂志.2005,11(6):470-476.
[48]王连华,左卡尼订治疗男性少弱精的临床观察.中国基层医药,2006,13(9):1524-1525.
[49]房磊臣,丘彦,幸贵邦,等.左旋肉碱和乙酰左旋肉碱联合治疗严重少弱精子症患者成功妊娠1例[J].中华男科学杂志,2006,12(11):1041-1043.
[50]戴锡珍,高淑娟,等.补中益气汤的抗缺氧研究[J].天津中医,1999,16(1):32.
[51]梁培育,李浩勇,肖劲逐,等.添加黄芪注射液对人精子线粒体功能的影响[J].中华男科学,2004,18(3):11-13.
[52]陆遥,梁玉君,陈少卿,等.丹参提取液在精液体外处理中的作用研究[J].辽宁中医杂志,2002,29(7):432.
[53]李景和.精索静脉曲张不育者睾丸流式细胞分析.中华医学会男科学分会第二届第一次全国学术会议论文摘要汇编.1999.76.
[54]安立文,隋勇,侯高峰.生精冲剂对精索静脉曲张大鼠睾丸组织抗过氧化损伤作 用的实验研究.中国中医药科技,2005,12(6):379.
[55]Agarwal A,Said TM.Oxidative stress,DNA damage and apoptosis in male infertility:a clinical approach[J].BJU Int,2005,95(4):503-507.
[56]Agarwal A,Prabakaran S,Allamaneni SS.Relationship beteen oxidative stress,varicocele and infertility:a meta-analysis[J].Reprod Biomed Online,2006,12(5):630-633.
[57]Carallini G,Caracciolo S,Vitali G,et al.Carnitine versus an.drogen administration in the treatment of sexual dysfunction,depressedmood,and fatigue associated with male aging[J].UrologY,2004,63(4):641-646.
[58]Vicari E,Calogero AE.Effects of treatment with carinitines in infertile patients with prostate-vesiculo-epididymitis[J].Hum Reprod,2001,16(11):2338-2342.
[2]郭应禄,胡礼泉主编.男科学[M].北京:人民卫生出版社,2004.
[3]Walsh PC,Retik AB.CampbellUrologyS.W.Saun2ders,1999,43:1313.
[4]吴阶平主编.泌尿外科[M].第1版.济南:山东科学出版社,1993,934.
[5]Velez-de-la-Calle JF,Rachou E,le Martdot MT,et al.Male infertilityrisk factors in a French military population.Hum Repred,2001.16(31):481-486.
[6]王益鑫.男性不育临床研究进展[J].中国男科学杂志,1999,13(4):195-196.
[7]李其信.中医治疗精索静脉曲张不育症研究进展[J].广西中医药,2003,26(1):8.
[8]陈志强,江海身主编.男科专病中医临床诊治[M].北京:人民卫生出版社,2000.
[9]陈利生主编.中西医论治男性不育[M].上海:上海科学普及出版社,1994.
[10]戚广崇,李其信,阚钦林,等.通精冲剂对精索静脉曲张不育患者精子运动参数的影响[J].中医杂志,2000,41(11):673-675.
[11]陈新瑞.益气升清法为主治疗男科疾患的体会[J].江苏中医,1991,12(2):71.
[12]崔学教.中西结合治疗精索静脉曲张425例[J].新中医,2001,33(7):341.
[13]张长方,周方安.精索静脉曲张不育的病机探讨[J].中国中医基础医学杂志,2004,10(11):56-58.
[14]王均贵.通法为主治疗精索静脉曲张合并不育[J].北京中医,1999,18(1):46-47.
[15]梁启伟,王云翔,杜晨,等.手术配合中药治疗精索静脉曲张引起的男性不育症[J].中国男科学杂志,2000,14(3):186-187.
[16]刘建新,郑焕英.中西医结合治疗精索静脉曲张致男性不育症42例[J].山东中医杂志,2001,20(9):542-543.
[17]肖州南,应以平.精索静脉曲张合并不育症治验.中国医药学报,1994,9(4):39-401.
[18]刘时尹,马重堂,等.精索静脉曲张(合并不育症)治疗调查与分析[J].中医药研究,1995,(6):24-251.
[19]徐德伟,王兴烈,徐德厚,等.徐祖辉论治精索静脉曲张所致不育症经验[J].陕西中医1996,17(4):168-169.
[20]张耀泉.张氏精索静脉曲张方治疗精索静脉曲张不育症162例疗效观察[J].新中医,2003,35(1):22-23.
[21]崔云,冯奕,等.祛瘀通络强精法治疗精索静脉曲张不育症的疗效观察.男科医学,2006,3(10):20-23.
[22]何方敏.桃红四物汤加减治疗精索静脉曲张性不育.现代中西医结合杂志,2006,15(13):1797-1798.
[23]李波,江立军,刘东梅.补肺法治疗精子活力低下50例[J].湖北中医杂志.2002,24(11):7.
[24]刘建荣,王怀秀.伸曲助育汤治疗精索静脉曲张及其不育的临床研究[J].上海中医药杂志,2005,39(3):33-34.
[25]杨家辉,开兴亮.通补结合治疗精索静脉曲张合并不育症[J].中华男科学,2002,8(4):310-311.
[26]郭玉佳,王中伟,等.精索静脉曲张多方法联合治疗的疗效观察[J].中华男科学,2006,12(9):800-802.
[27]蒋学洲,周智恒.精索静脉曲张引起男性不育的中西医结合治疗.中国中西医结合外科杂志,2002,8(1):42-43.
[28]戚广崇,陆寄坤,阚钦林,等.通精冲剂与手术治疗精索静脉曲张不育症的临床研究[J],中国中西医结合杂志,2001,21(6):412-415.
[29]李君强,汪承领.活血补肾汤治疗精索静脉曲张合并不育症76例.中国中医药科技,2000,7(1):581.
[30]梁启伟,王云翔,杜晨,等.手术配合中药治疗精索静脉曲张引起的男性不育症[J].中国男科学杂志,2000,14(3):186-1871.
[31]周兴明,金许洪.手术加中药治疗精索静脉曲张所致不育症.镇江医学报,1999,9(4):6671.
[31]安立文,王树林,白贵林,等.生精冲剂对精索静脉曲张型不育症患者术后精子形态的影响.中医杂志,1998,39(6):349-350.
[32]张杰.精索静脉曲张致男性不育症的治疗-评估目前常用治疗方法进行比较研究[J].国外医学·泌尿系统分册,1999,19(5):238-239.
[33]吴宏飞,尤国才,睦元庚.精索盘膜肌管折叠术治疗精索静脉曲张及远期随访[J].中华泌尿外科杂志,1995,16(1):35-37.
[34]徐开宏,黄宇烽.精索静脉曲张研究进展[J].临床泌尿外科杂志,1995,10(3):187.
[35]郭应禄,李宏军.男性不育症[M].北京:人民军医出版社,2003,第一版:284,283,228-229.
[36]WHO.人类精液及精子一宫颈粘液相互作用实验室检验手册[M].4版.北京:人民卫生出版社.2001:5.
[37]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:人民卫生出版 社,1993.192-195.
[38]WHO.不孕夫妇标准检查与诊断手册[M].北京:科学技术出版社,1994:19.
[39]曹开镛,戚广崇主编.中医男科研究与临床研究进展[M].第1版.上海:上海科学技术文献出版社,1995.222-223.
[40]张均倡.中医十大名方妙用“补中益气汤”[M].北京:中国中医药出版社,1998,第一版:1-38,118-121.
[41]Costa M,Canale D,Filicori M,et al.L-carnitine in idiopathic asthenozoospermia:a multicenter study.Andrologia,1994,26(3):155-159.
[42]Lenzi A,Lombardo F,Sgro P,et al.Use of carnitine therapy in se.lected eases of male factor infertility:double blind crossover trial[J].Fertil Steril,2003,79(2):292-300.
[43]Cavallini G,Ferraretti AP,Gianaroli L,et al.Cinnoxicam and carnitine/acetyl carnitine treatment for idiopathic and varicocele-associate doligoasthenospermia.J Androl,2004,25(5):761-770.
[44]Comhaire FH,Mahmoud A.The role of food supplements in the treatment of the infertile man[J].Reprod Biomed Online,2003,7(4):385-391.
[45]商学军,黄宇烽.李克,等.L-肉碱治疗附睾结节拌弱精子症初步观察[J].中华男科学杂志,2004,10(9):671-576.
[46]李铮,谷荣华,刘勇,等.补充肉毒碱治疗少弱精了症疗效观察.上海第二医科大学学报,2005,25(3):292-294.
[47]吕海宁,腾晓明.左卡尼订治疗男性少弱精临床观察[J].中华男科学杂志.2005,11(6):470-476.
[48]王连华,左卡尼订治疗男性少弱精的临床观察.中国基层医药,2006,13(9):1524-1525.
[49]房磊臣,丘彦,幸贵邦,等.左旋肉碱和乙酰左旋肉碱联合治疗严重少弱精子症患者成功妊娠1例[J].中华男科学杂志,2006,12(11):1041-1043.
[50]戴锡珍,高淑娟,等.补中益气汤的抗缺氧研究[J].天津中医,1999,16(1):32.
[51]梁培育,李浩勇,肖劲逐,等.添加黄芪注射液对人精子线粒体功能的影响[J].中华男科学,2004,18(3):11-13.
[52]陆遥,梁玉君,陈少卿,等.丹参提取液在精液体外处理中的作用研究[J].辽宁中医杂志,2002,29(7):432.
[53]李景和.精索静脉曲张不育者睾丸流式细胞分析.中华医学会男科学分会第二届第一次全国学术会议论文摘要汇编.1999.76.
[54]安立文,隋勇,侯高峰.生精冲剂对精索静脉曲张大鼠睾丸组织抗过氧化损伤作 用的实验研究.中国中医药科技,2005,12(6):379.
[55]Agarwal A,Said TM.Oxidative stress,DNA damage and apoptosis in male infertility:a clinical approach[J].BJU Int,2005,95(4):503-507.
[56]Agarwal A,Prabakaran S,Allamaneni SS.Relationship beteen oxidative stress,varicocele and infertility:a meta-analysis[J].Reprod Biomed Online,2006,12(5):630-633.
[57]Carallini G,Caracciolo S,Vitali G,et al.Carnitine versus an.drogen administration in the treatment of sexual dysfunction,depressedmood,and fatigue associated with male aging[J].UrologY,2004,63(4):641-646.
[58]Vicari E,Calogero AE.Effects of treatment with carinitines in infertile patients with prostate-vesiculo-epididymitis[J].Hum Reprod,2001,16(11):2338-2342.