中药复方治疗抗精子抗体阳性免疫性不孕症的系统评价
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摘要
目的:系统分析中药复方治疗抗精子抗体阳性免疫性不孕症的有效性、安全性,以期做出客观、可信的评价,指导临床用药,并提出临床研究中存在的问题和拟采取的对策,为选择中药复方治疗的医患提供当前可得知的最好证据,为今后的临床研究提供了依据和基础,并通过循证医学的研究方法,促进中药复方治疗抗精子抗体阳性免疫性不孕症的推广应用。
方法:采用循证医学的方法,全面检索国内外已发表的关于中药复方治疗抗精子抗体阳性免疫性不孕症的临床研究随机对照实验,并按照改良的Jadad质量评分方法对研究文献进行质量评价。采用RevMan4.2(ReviewManager)免费软件,根据异质性检验选用固定或者随机效应模型(fixedorrandomeffectsmodels)计算比值比(OR)及其95%可信区间(CI),临床总有效率、临床总治愈率和临床总复发率的比较,采用卡方检验进行统计分析。
结果:共有12篇文献符合纳入标准,中药复方治疗组共计660例患者,治疗有效人数为589例,治愈人数为331例;西医对照组共计426例患者,其中单纯西药组为237例,单纯工具(避孕套)组为154例,单纯西药+工具(避孕套)组为35例,有效人数为237例,治愈人数为71例。研究表明,抗精子抗体阳性免疫性不孕症的临床总有效率以及患者疗程结束后的临床总治愈率,中药复方治疗组均高于西医对照组,而对于临床总复发率而言,中药复方治疗组却低于西医对照组,其比值比分别为:OR=8.34(I2=14%,固定效应模型,95%CI:5.86-11.87P<0.01)、OR=5.33(I2=0%,固定效应模型,95%CI:3.87-7.35P<0.01)、OR=0.09(I2=0%,固定效应模型,95%CI:0.04-0.21P<0.01)。
结论:中药复方治疗抗精子抗体阳性免疫性不孕症的临床总有效率是西医对照组的8.34倍,临床总治愈率是西医对照组的5.33倍,而临床复发率则是西医对照组为中药复方治疗组的0.09倍。由于所纳入的随机对照实验的质量较低,存在潜在的发表偏倚,其临床疗效及安全性有待今后通过大样本随机对照实验进一步证实。
Objective: Analyse systematically the effectiveness and security of the compound traditional Chinese medicine on immune infertilitas feminis with positive anti-sperm antibodies, in order to make objective and credible eva- luation,instruct clinical treatment.And we can propose the problems in clini- cal studies and measures to be taken.The result provided the best evidence currently available for the patients who choose to use compound Chinese herbal to treat disease and the basis and foundation for the future clinical studies.Through such methods, the expand and applications of the treatment of the compound traditional Chinese medicine on immune infertilitas feminis with positive anti-sperm antibodies can be promoted.
Methods: By using the evidence-based medicine approach, compre- hensively search the randomized controlled trials of the clinical experiments published in domestic and foreign of treatment of compound Chinese herbal on the anti-sperm antibodies of immune infertility , and evaluate the quality of the research literature in accordance with the modified Jadad quality score method . By RevMan4.2 (Review Manager) free software and choosing a fixed or random effects models according to the heterogeneity test , calculate odds ratio (OR) and 95% confidence interval (CI).For the comparison of theclinical total effective ,cure rate and relapse rate, we can use Chi-square test for the statistical analysis.
Results: A total of 12 studies met the inclusion criteria.a group ofChinese herbal formula treatment totally includes 660 patients,589 cases of which have effective treatment and 331 cases cured; Western control group patients have a total of 426 cases, of which only western group of 237 cases,simple tools (condoms) group of 154,and only western + tool (condoms) group of 35, and the effective number is 237, the cured 71. Studies have shown that in the aspect of the clinical total efficiency and overall cure rate after the end of the treatment on the compound traditional Chinese medicine on immune infer- tilitas feminis with positive anti-sperm antibodies, Chinese herbal formula treatment group is higher than Western medicine control group, while for the clinical total recurrence rate, traditional Chinese medicine compound is lower than Western medicine control group.The odds ratio are: OR = 8.34 (I2 = 14%, fixed effects model, 95% CI :5.86-11 .87 P <0.01), OR = 5.33 (I2 = 0%, fixed effect model, 95% CI :3.87-7 .35 P <0.01), OR = 0.09 (I2 = 0%, fixed effects model, 95% CI :0.04-0 .21 P <0.01).
Conclusion: The clinical total effective rate of Chinese herbal formula treatment of immune infertility with positive antisperm antibody is 8.34 times of the Western control group, and clinical total cure rate 5.33 times , while the clinical relapse rate of Western medicine control group is 0.09 times of Chinese herbal formula treatment group. Because of the low quality of the inclusion of randomized controlled trials , there are potential publication bias, and the clinical efficacy and safety need to be further confirmed in the future by a large randomized controlled trials .
方法:采用循证医学的方法,全面检索国内外已发表的关于中药复方治疗抗精子抗体阳性免疫性不孕症的临床研究随机对照实验,并按照改良的Jadad质量评分方法对研究文献进行质量评价。采用RevMan4.2(ReviewManager)免费软件,根据异质性检验选用固定或者随机效应模型(fixedorrandomeffectsmodels)计算比值比(OR)及其95%可信区间(CI),临床总有效率、临床总治愈率和临床总复发率的比较,采用卡方检验进行统计分析。
结果:共有12篇文献符合纳入标准,中药复方治疗组共计660例患者,治疗有效人数为589例,治愈人数为331例;西医对照组共计426例患者,其中单纯西药组为237例,单纯工具(避孕套)组为154例,单纯西药+工具(避孕套)组为35例,有效人数为237例,治愈人数为71例。研究表明,抗精子抗体阳性免疫性不孕症的临床总有效率以及患者疗程结束后的临床总治愈率,中药复方治疗组均高于西医对照组,而对于临床总复发率而言,中药复方治疗组却低于西医对照组,其比值比分别为:OR=8.34(I2=14%,固定效应模型,95%CI:5.86-11.87P<0.01)、OR=5.33(I2=0%,固定效应模型,95%CI:3.87-7.35P<0.01)、OR=0.09(I2=0%,固定效应模型,95%CI:0.04-0.21P<0.01)。
结论:中药复方治疗抗精子抗体阳性免疫性不孕症的临床总有效率是西医对照组的8.34倍,临床总治愈率是西医对照组的5.33倍,而临床复发率则是西医对照组为中药复方治疗组的0.09倍。由于所纳入的随机对照实验的质量较低,存在潜在的发表偏倚,其临床疗效及安全性有待今后通过大样本随机对照实验进一步证实。
Objective: Analyse systematically the effectiveness and security of the compound traditional Chinese medicine on immune infertilitas feminis with positive anti-sperm antibodies, in order to make objective and credible eva- luation,instruct clinical treatment.And we can propose the problems in clini- cal studies and measures to be taken.The result provided the best evidence currently available for the patients who choose to use compound Chinese herbal to treat disease and the basis and foundation for the future clinical studies.Through such methods, the expand and applications of the treatment of the compound traditional Chinese medicine on immune infertilitas feminis with positive anti-sperm antibodies can be promoted.
Methods: By using the evidence-based medicine approach, compre- hensively search the randomized controlled trials of the clinical experiments published in domestic and foreign of treatment of compound Chinese herbal on the anti-sperm antibodies of immune infertility , and evaluate the quality of the research literature in accordance with the modified Jadad quality score method . By RevMan4.2 (Review Manager) free software and choosing a fixed or random effects models according to the heterogeneity test , calculate odds ratio (OR) and 95% confidence interval (CI).For the comparison of theclinical total effective ,cure rate and relapse rate, we can use Chi-square test for the statistical analysis.
Results: A total of 12 studies met the inclusion criteria.a group ofChinese herbal formula treatment totally includes 660 patients,589 cases of which have effective treatment and 331 cases cured; Western control group patients have a total of 426 cases, of which only western group of 237 cases,simple tools (condoms) group of 154,and only western + tool (condoms) group of 35, and the effective number is 237, the cured 71. Studies have shown that in the aspect of the clinical total efficiency and overall cure rate after the end of the treatment on the compound traditional Chinese medicine on immune infer- tilitas feminis with positive anti-sperm antibodies, Chinese herbal formula treatment group is higher than Western medicine control group, while for the clinical total recurrence rate, traditional Chinese medicine compound is lower than Western medicine control group.The odds ratio are: OR = 8.34 (I2 = 14%, fixed effects model, 95% CI :5.86-11 .87 P <0.01), OR = 5.33 (I2 = 0%, fixed effect model, 95% CI :3.87-7 .35 P <0.01), OR = 0.09 (I2 = 0%, fixed effects model, 95% CI :0.04-0 .21 P <0.01).
Conclusion: The clinical total effective rate of Chinese herbal formula treatment of immune infertility with positive antisperm antibody is 8.34 times of the Western control group, and clinical total cure rate 5.33 times , while the clinical relapse rate of Western medicine control group is 0.09 times of Chinese herbal formula treatment group. Because of the low quality of the inclusion of randomized controlled trials , there are potential publication bias, and the clinical efficacy and safety need to be further confirmed in the future by a large randomized controlled trials .
引文
[1]朱伟杰梁蔚波抗精子抗体阳性不孕妇女采用避孕套疗法后的抗体水平改变[J]中国优生与遗传杂志2002,10(3):109-113
[2]马宝璋中医妇科学[M]六版上海科学技术出版社1997,16-18
[3]罗元恺不孕症的临床辨治.当代名医临证精华·不孕专辑[J],北京:中医古籍出版社,1992:l-7.
[4]张玉珍罗颂平罗元恺教授论治不孕不育症学术经验介绍[J].新中医,2002,34(4):7-9.
[5]陈伟仁不孕症从肾论治概说[J]中药新药与临床药理2002年7月第13卷第3期264-267
[6]赵州凤不孕症从肝论治60例[J]河南中医2006年11月第26卷第11期74
[7]黄九辨证辨病及月经周期用药法治疗不孕症46例[J].上海中医药杂志,2002,36(5):27-28.
[8]李顺实不孕症从心脾辨治验案三则[J]山东中医杂志2007年2月第26卷第2期135-136
[9]曲淑艳侯丽辉吴效科从痰证治不孕症的探析[J]世界中西医结合杂志2009年第4卷第2期140-142
[10]李丽芸湿浊与不孕症证治[J].新中医,2002,34(11):3-.5
[11]上海第一医院对祖国医学“肾”本质的探讨[J].中华内科杂志,1976,1(2):80
[12]姚美玉王素霞抗精子抗体与滑胎[J]中医药学报2003年第31卷第2期7
[13]陈伟仁不孕症从肾论治概说[J].中药新药与临床药理,2002,13(4):264-267.
[14]莫蕙略论免疫性不孕和不育的中医证治[J].江苏中医药,2002,3(6):30-31.
[15]郭东晓免疫性不孕的中医药治疗[J].北京中医药大学学报(中医临床版),2003,10(2):58-60.
[16]陈惠铮王素霞王秀霞中药治疗49例抗精子免疫性不孕症[J].中医药信息,2000(2):66.
[17]黄丽云抗精子抗体阳性不孕不育的中医药治疗进展[J]江西中医药2002年6月第33卷第3期50-51
[18]刘显磊沈坚华辨证治疗抗精子抗体阳性不孕40例(J).湖南中医杂志,2003;19(3):40-40.
[19]杨灵君赵兴无史巧英.辨证分型治疗抗精子抗体阳性56例(J).河南中医,2005;25(10):50-51.
[20]单立峰辨证治疗抗精子抗体引起不孕20例[J]浙江中医学院学报2000年10月第24卷第5期37
[21]朱惠云辨证分型治疗女性抗精子抗体异常所致不孕与流产88例[J]广西中医药1997年2月第20卷第1期15-16
[22]李凤仪抗精子抗体阳性的中医分型[J]新中医1995年第9期37-38
[23]郝树涛保阴煎治疗抗精子抗体所致免疫性不孕症94例[J]新中医2004年3月第36卷第3期55
[24]白志军刘静君补肾活血法治疗抗精子抗体阳性102例[J]湖南中医杂志2007年9月第23卷第5期46-47
[25]姚伊王华补肾活血汤治疗女性血清抗精子抗体阳性不孕56例疗效观察[J]河南中医2008年3月第28卷第3期51-52
[26]井梅桂枝茯苓胶囊治疗抗精子抗体40例临床观察[J]中医临床选萃2006年第4期第22卷总第298期39
[27]赵凯抗免Ⅰ号片治疗女性血清抗精子抗体阳性不孕疗效观察[J]四川中医2001年第19卷第4期57-58
[28]马春亮郭瑞宝刘青抗免促孕胶囊治疗抗精子抗体所致免疫性不孕症临床观察[J]中国中医药信息杂志2009年7月第l6卷第7期56-57
[29]吴晓莉口服中药治疗抗精子抗体阳性182例分析中医药学刊2003年5月第21卷第5期775
[30]吴爱明郭霞清化消抗汤治疗抗精子免疫性不孕症60例[J]河南中医2007年3月第27卷第3期50
[31]马春亮程令梅张华忍冬藤汤治疗抗精子抗体所致免疫性不孕47例[J]山东中医杂志2003年7月第22卷第7期407-408
[32]张迎春徐淑琴消抗汤治疗免疫性不孕症120例[J].新中医,2003;35(10)49-50
[33]孙红李艳青宋红湘补肾化瘀消抗方治疗抗精子抗体阳性不孕症32例[J]陕西中医2006年第27卷第8期931-932
[34]黄惠娟王忠轩丘业健扶正促孕汤治疗抗精子抗体不孕症28例[J]中医中药2008年35期75
[35]陆遥消抗汤治疗抗精子抗体阳性80例观察[J]实用医杂志1999年第15春第7期(总78期) 3-4
[36]叶铤抑抗汤治疗免疫性不孕抗精子抗体阳性的临床观察[J]湖北中医学院学报2003年6月第5卷第2期41
[37]唐哗贾淑华张庆蔚针药并用治疗抗精子抗体阳性不孕症40例[J]中国民间疗法2001年9月第9卷第9期9-10
[38]张继红张慧岭赵藏朵等补肾化浊法药针并用治疗免疫性不孕23例[J].陕西中医,2005,26(10):1024-1025.
[39]陈栋郑仰泉方黎明针挑治疗免疫性不育(孕)(附1200例临床分析) [J].暨南大学学报(医学版),1996;17(2):89-92.
[40]汤莉黄芪地黄合剂治疗女性抗精子抗体阳性不孕症25例[J]四川中医2004年第22卷第5期64
[41]苏小军六味地黄汤加鱼腥草薰洗治疗抗精子抗体阳性不孕症[J]深圳中西医结合杂志2006年2月第16卷第1期42-44
[42]李爱青林海波周士源滋阴活血中药配合宫腔内人工授精治疗肝肾阴虚型AsAb阳性不孕[J]中国中医药信息杂志2005年4月第12卷第4期76-77
[43]王晨媛蒋贵林黄炜补肾育阴方合醋酸泼尼松治疗肾阴虚型AsAb阳性免疫不孕[J]江西中医药2009年6月第6期第40卷第318期51-52
[44]马文丽强的松配合消抗汤治疗女性抗精子抗体阳性88例[J]河南科技大学学报(医学版)2009年3月第27卷第1期54-55
[45]郑瑞君孙自学门波抑抗汤结合西药治疗抗精子抗体阳性不孕81例[J]河南中医2006年11月第26卷第11期59
[46]任国秀吴永庆萸芪四物胶囊配合西药治疗抗精子抗体阳性不孕43例[J]陕西中医2009年第30卷第3期266-267
[47]KoyajnaK.Innnunologietests:Antispermantibody.NipponRinsho , 2005Jul 63SuPP 17:58 1-4.
[48]郭应禄胡礼泉主编.男科学[M].第一版,北京:人民卫生出版社,2004:202-213
[49]张永峰王俊玲马德芬等.助孕灵对抗精子抗体阳性大鼠模型的影响[J].中药药理与临床,2001,17(5):38-39.
[50]范海涛郭航不同睾丸活检术前后血清抗精子抗体的检测[J].中华男科学杂志,2005,(11):862-863
[51]Chavez Badiola A,Drakeley AJ,Finney V.Necrospermia,antispermantibodies,and vasectomy.Fertility and Sterility,2008,89(4):723.e5-732.e7
[52]薛宁崔明玉精索静脉曲张不育症的病理观察及免疫组化研究[J].中国计划生育学杂志,2006,(8),482-484
[53]Donatella Paoli,Barbara Gilio,Emanuela Piroli et al.Testicular tumors as a possible cause of antispermautoimmune response.Fertil Steril,2009,91(2):414-419
[54]Arap MA ; Vicentini FC ; Cocuzza M et al.Late Hormonallevels,Semen Parameters,and Presence of AntispermAtibodies in Patients for Testicular Torsion.Journal of Andrology 2007,28(4):528-532
[55]刘子明郑新民杨志伟等单侧睾丸扭转引发对侧睾丸生精损伤免疫机制的实验研究[J].中华泌尿外科杂志,2006,27(1):59-62
[56]Yasuoka H; Kuwana M.Autoantibody response against a novel testicular antigen protein highly expressed in testis(PHET)in SSc patients.Autoimmunity Reviews,2007 6(4):228-231
[57]赖安妮宋济范刘仙菊等中药胎宝抑制抗精子抗体的试验研究[J].中国中西医结合杂志,1997,17(6):360-362.
[58]温海霞张玮张大勇IL-2对抗精子抗体阳性大鼠附皋精子凋亡的探讨[J].哈尔滨医科大学学报,2003,37(2):107-109.
[59]张海旭侯丽辉102例继发性不孕妇女病因分析[J].中国现代药物应用, 2009,3(4):69.
[60]曹泽毅郎景和张以文等.中华妇产科学[M].第二版.北京:人民卫生出版社2004, 2602-2603
[61]Hatasaka H. Immunologic factors in infertility(J).ClinObstetGynecol,2000,43(4): 830-843
[62]Samuel AS,Naz RK.Isolation of human single chain variablefragment antibodies against specific sperm antigens for immunocontraceptive development.Human Reproduction, 2008,23(6): 1324-1337
[63]KremerJJagerS:Thesignificaneeofanti-spermantibodiesforsperm-eervieal mueusin-teraetion.HumReprod7(6):781, 1992
[64]Shibahara H,Shigeta M,Inoue M.Diversity of the blockingeffects of antisper antibodies on fertilization in human andmouse.Hum Reprod,1996,11: 2595-2599
[65]Bronson RA,Cooper GW,Rosenfeld DL.Sperm-specificisoantibodies and auto- antibodies inhibit the binding of human sperm to the human zona pellucida.Fertil Steril 1982, 38:724–729
[66]芦志华胡敬海张宝钢等精浆抗精子抗体对男性不育者精液参数和精子顶体酶活性的影响[J].吉林医学,2006,27(1):14-15
[67]邢荣威赵大伟马圣君IgA抗精子抗体对精子顶体反应的影响[J].中国男科学杂志,2005,19(6):37-39
[68]张利王东文王璟琦等抗精子抗体检测的临床意义[J].临床医药实践杂志,2008, 17( 2): 98-99
[69]Lahteenmaki A,Reima I,Hovatta O.Treatment of severe male immunological infertility by intracytoplasmic sperm injection.Hum Reprod,1995,10(11):2824–2828
[70]郑武飞主编医学免疫学[M],第一版,第36页,人民卫生出版社, 1989
[71]赵武述主编现代临床免疫学[M],第一版,人民军医出版社, 1991 ( 16)
[72]Haas GG Jr , DCruzOJ: The predominace of IgG1 and IgG3 subelass antisperm Antibodies in infertile Patients with serum antisPerm antibodies.AmJReProd Immunol 26(3):104, 1991
[73]DCruz-OJ Hass GG Jr: Laek of complement activation in the seminal Plasma of men with antisPerm antibodies assoeiated in vivo on theirsPerm.AmJReprod Immunol 24(2):511990
[74]刘继红男性免疫性不育[J]男性学杂志3(2):123, 1989
[75]HaasGGJr, ManganielloP.Adouble一blind, plaeebo eontrolled study of These of methyl Prednisolone in infertile men with sPerm assoeiated immunoglobulins. Fertisteril, 1997;47:295-301.
[76]王丽黄萍1020例免疫性不孕患者的治疗结果分析[J].中华妇产科杂志,1999;34(4).
[77]孙晖姚利小剂量免疫抑制剂与知柏地黄丸联合治疗女性免疫性不孕的临床研究[J].河南中医,2003;23(6)
[78]王吉耀循证医学与临床实践[M].科技出版社.2002.第2版.68
[79]中华人民共和国卫生部.中药(新药)临床研究指导原则[S].1993.
[80]吕黄霞补肾祛琅法治疗肾虚血盛型不孕女性抗精子抗体阳性的临床观察[J]2008年5月硕士毕业论文
[81]梁洁莎益真2号对不孕症妇女清抗精子抗体影响的临床研究[J] 2007年4月硕士毕业论文
[82]姜向坤种子转阴汤治疗不孕女性血清抗精子抗体阳性的临床研究[J]山东中医药大学学报2002年7月第26卷第4期294-298
[83]赵凯消抗Ⅰ号片治疗女性血清抗精子抗体阳性不孕112例[J]陕西中医2008年第29卷第11期1444-1445
[84]詹思延系统综述和Meta分析[M]//李立明.流行病学.北京:人民卫生出版社,2007: 180.
[85]周旭毓等Meta分析的常见偏倚[J].循证医学, 2002;2(4):216-220
[2]马宝璋中医妇科学[M]六版上海科学技术出版社1997,16-18
[3]罗元恺不孕症的临床辨治.当代名医临证精华·不孕专辑[J],北京:中医古籍出版社,1992:l-7.
[4]张玉珍罗颂平罗元恺教授论治不孕不育症学术经验介绍[J].新中医,2002,34(4):7-9.
[5]陈伟仁不孕症从肾论治概说[J]中药新药与临床药理2002年7月第13卷第3期264-267
[6]赵州凤不孕症从肝论治60例[J]河南中医2006年11月第26卷第11期74
[7]黄九辨证辨病及月经周期用药法治疗不孕症46例[J].上海中医药杂志,2002,36(5):27-28.
[8]李顺实不孕症从心脾辨治验案三则[J]山东中医杂志2007年2月第26卷第2期135-136
[9]曲淑艳侯丽辉吴效科从痰证治不孕症的探析[J]世界中西医结合杂志2009年第4卷第2期140-142
[10]李丽芸湿浊与不孕症证治[J].新中医,2002,34(11):3-.5
[11]上海第一医院对祖国医学“肾”本质的探讨[J].中华内科杂志,1976,1(2):80
[12]姚美玉王素霞抗精子抗体与滑胎[J]中医药学报2003年第31卷第2期7
[13]陈伟仁不孕症从肾论治概说[J].中药新药与临床药理,2002,13(4):264-267.
[14]莫蕙略论免疫性不孕和不育的中医证治[J].江苏中医药,2002,3(6):30-31.
[15]郭东晓免疫性不孕的中医药治疗[J].北京中医药大学学报(中医临床版),2003,10(2):58-60.
[16]陈惠铮王素霞王秀霞中药治疗49例抗精子免疫性不孕症[J].中医药信息,2000(2):66.
[17]黄丽云抗精子抗体阳性不孕不育的中医药治疗进展[J]江西中医药2002年6月第33卷第3期50-51
[18]刘显磊沈坚华辨证治疗抗精子抗体阳性不孕40例(J).湖南中医杂志,2003;19(3):40-40.
[19]杨灵君赵兴无史巧英.辨证分型治疗抗精子抗体阳性56例(J).河南中医,2005;25(10):50-51.
[20]单立峰辨证治疗抗精子抗体引起不孕20例[J]浙江中医学院学报2000年10月第24卷第5期37
[21]朱惠云辨证分型治疗女性抗精子抗体异常所致不孕与流产88例[J]广西中医药1997年2月第20卷第1期15-16
[22]李凤仪抗精子抗体阳性的中医分型[J]新中医1995年第9期37-38
[23]郝树涛保阴煎治疗抗精子抗体所致免疫性不孕症94例[J]新中医2004年3月第36卷第3期55
[24]白志军刘静君补肾活血法治疗抗精子抗体阳性102例[J]湖南中医杂志2007年9月第23卷第5期46-47
[25]姚伊王华补肾活血汤治疗女性血清抗精子抗体阳性不孕56例疗效观察[J]河南中医2008年3月第28卷第3期51-52
[26]井梅桂枝茯苓胶囊治疗抗精子抗体40例临床观察[J]中医临床选萃2006年第4期第22卷总第298期39
[27]赵凯抗免Ⅰ号片治疗女性血清抗精子抗体阳性不孕疗效观察[J]四川中医2001年第19卷第4期57-58
[28]马春亮郭瑞宝刘青抗免促孕胶囊治疗抗精子抗体所致免疫性不孕症临床观察[J]中国中医药信息杂志2009年7月第l6卷第7期56-57
[29]吴晓莉口服中药治疗抗精子抗体阳性182例分析中医药学刊2003年5月第21卷第5期775
[30]吴爱明郭霞清化消抗汤治疗抗精子免疫性不孕症60例[J]河南中医2007年3月第27卷第3期50
[31]马春亮程令梅张华忍冬藤汤治疗抗精子抗体所致免疫性不孕47例[J]山东中医杂志2003年7月第22卷第7期407-408
[32]张迎春徐淑琴消抗汤治疗免疫性不孕症120例[J].新中医,2003;35(10)49-50
[33]孙红李艳青宋红湘补肾化瘀消抗方治疗抗精子抗体阳性不孕症32例[J]陕西中医2006年第27卷第8期931-932
[34]黄惠娟王忠轩丘业健扶正促孕汤治疗抗精子抗体不孕症28例[J]中医中药2008年35期75
[35]陆遥消抗汤治疗抗精子抗体阳性80例观察[J]实用医杂志1999年第15春第7期(总78期) 3-4
[36]叶铤抑抗汤治疗免疫性不孕抗精子抗体阳性的临床观察[J]湖北中医学院学报2003年6月第5卷第2期41
[37]唐哗贾淑华张庆蔚针药并用治疗抗精子抗体阳性不孕症40例[J]中国民间疗法2001年9月第9卷第9期9-10
[38]张继红张慧岭赵藏朵等补肾化浊法药针并用治疗免疫性不孕23例[J].陕西中医,2005,26(10):1024-1025.
[39]陈栋郑仰泉方黎明针挑治疗免疫性不育(孕)(附1200例临床分析) [J].暨南大学学报(医学版),1996;17(2):89-92.
[40]汤莉黄芪地黄合剂治疗女性抗精子抗体阳性不孕症25例[J]四川中医2004年第22卷第5期64
[41]苏小军六味地黄汤加鱼腥草薰洗治疗抗精子抗体阳性不孕症[J]深圳中西医结合杂志2006年2月第16卷第1期42-44
[42]李爱青林海波周士源滋阴活血中药配合宫腔内人工授精治疗肝肾阴虚型AsAb阳性不孕[J]中国中医药信息杂志2005年4月第12卷第4期76-77
[43]王晨媛蒋贵林黄炜补肾育阴方合醋酸泼尼松治疗肾阴虚型AsAb阳性免疫不孕[J]江西中医药2009年6月第6期第40卷第318期51-52
[44]马文丽强的松配合消抗汤治疗女性抗精子抗体阳性88例[J]河南科技大学学报(医学版)2009年3月第27卷第1期54-55
[45]郑瑞君孙自学门波抑抗汤结合西药治疗抗精子抗体阳性不孕81例[J]河南中医2006年11月第26卷第11期59
[46]任国秀吴永庆萸芪四物胶囊配合西药治疗抗精子抗体阳性不孕43例[J]陕西中医2009年第30卷第3期266-267
[47]KoyajnaK.Innnunologietests:Antispermantibody.NipponRinsho , 2005Jul 63SuPP 17:58 1-4.
[48]郭应禄胡礼泉主编.男科学[M].第一版,北京:人民卫生出版社,2004:202-213
[49]张永峰王俊玲马德芬等.助孕灵对抗精子抗体阳性大鼠模型的影响[J].中药药理与临床,2001,17(5):38-39.
[50]范海涛郭航不同睾丸活检术前后血清抗精子抗体的检测[J].中华男科学杂志,2005,(11):862-863
[51]Chavez Badiola A,Drakeley AJ,Finney V.Necrospermia,antispermantibodies,and vasectomy.Fertility and Sterility,2008,89(4):723.e5-732.e7
[52]薛宁崔明玉精索静脉曲张不育症的病理观察及免疫组化研究[J].中国计划生育学杂志,2006,(8),482-484
[53]Donatella Paoli,Barbara Gilio,Emanuela Piroli et al.Testicular tumors as a possible cause of antispermautoimmune response.Fertil Steril,2009,91(2):414-419
[54]Arap MA ; Vicentini FC ; Cocuzza M et al.Late Hormonallevels,Semen Parameters,and Presence of AntispermAtibodies in Patients for Testicular Torsion.Journal of Andrology 2007,28(4):528-532
[55]刘子明郑新民杨志伟等单侧睾丸扭转引发对侧睾丸生精损伤免疫机制的实验研究[J].中华泌尿外科杂志,2006,27(1):59-62
[56]Yasuoka H; Kuwana M.Autoantibody response against a novel testicular antigen protein highly expressed in testis(PHET)in SSc patients.Autoimmunity Reviews,2007 6(4):228-231
[57]赖安妮宋济范刘仙菊等中药胎宝抑制抗精子抗体的试验研究[J].中国中西医结合杂志,1997,17(6):360-362.
[58]温海霞张玮张大勇IL-2对抗精子抗体阳性大鼠附皋精子凋亡的探讨[J].哈尔滨医科大学学报,2003,37(2):107-109.
[59]张海旭侯丽辉102例继发性不孕妇女病因分析[J].中国现代药物应用, 2009,3(4):69.
[60]曹泽毅郎景和张以文等.中华妇产科学[M].第二版.北京:人民卫生出版社2004, 2602-2603
[61]Hatasaka H. Immunologic factors in infertility(J).ClinObstetGynecol,2000,43(4): 830-843
[62]Samuel AS,Naz RK.Isolation of human single chain variablefragment antibodies against specific sperm antigens for immunocontraceptive development.Human Reproduction, 2008,23(6): 1324-1337
[63]KremerJJagerS:Thesignificaneeofanti-spermantibodiesforsperm-eervieal mueusin-teraetion.HumReprod7(6):781, 1992
[64]Shibahara H,Shigeta M,Inoue M.Diversity of the blockingeffects of antisper antibodies on fertilization in human andmouse.Hum Reprod,1996,11: 2595-2599
[65]Bronson RA,Cooper GW,Rosenfeld DL.Sperm-specificisoantibodies and auto- antibodies inhibit the binding of human sperm to the human zona pellucida.Fertil Steril 1982, 38:724–729
[66]芦志华胡敬海张宝钢等精浆抗精子抗体对男性不育者精液参数和精子顶体酶活性的影响[J].吉林医学,2006,27(1):14-15
[67]邢荣威赵大伟马圣君IgA抗精子抗体对精子顶体反应的影响[J].中国男科学杂志,2005,19(6):37-39
[68]张利王东文王璟琦等抗精子抗体检测的临床意义[J].临床医药实践杂志,2008, 17( 2): 98-99
[69]Lahteenmaki A,Reima I,Hovatta O.Treatment of severe male immunological infertility by intracytoplasmic sperm injection.Hum Reprod,1995,10(11):2824–2828
[70]郑武飞主编医学免疫学[M],第一版,第36页,人民卫生出版社, 1989
[71]赵武述主编现代临床免疫学[M],第一版,人民军医出版社, 1991 ( 16)
[72]Haas GG Jr , DCruzOJ: The predominace of IgG1 and IgG3 subelass antisperm Antibodies in infertile Patients with serum antisPerm antibodies.AmJReProd Immunol 26(3):104, 1991
[73]DCruz-OJ Hass GG Jr: Laek of complement activation in the seminal Plasma of men with antisPerm antibodies assoeiated in vivo on theirsPerm.AmJReprod Immunol 24(2):511990
[74]刘继红男性免疫性不育[J]男性学杂志3(2):123, 1989
[75]HaasGGJr, ManganielloP.Adouble一blind, plaeebo eontrolled study of These of methyl Prednisolone in infertile men with sPerm assoeiated immunoglobulins. Fertisteril, 1997;47:295-301.
[76]王丽黄萍1020例免疫性不孕患者的治疗结果分析[J].中华妇产科杂志,1999;34(4).
[77]孙晖姚利小剂量免疫抑制剂与知柏地黄丸联合治疗女性免疫性不孕的临床研究[J].河南中医,2003;23(6)
[78]王吉耀循证医学与临床实践[M].科技出版社.2002.第2版.68
[79]中华人民共和国卫生部.中药(新药)临床研究指导原则[S].1993.
[80]吕黄霞补肾祛琅法治疗肾虚血盛型不孕女性抗精子抗体阳性的临床观察[J]2008年5月硕士毕业论文
[81]梁洁莎益真2号对不孕症妇女清抗精子抗体影响的临床研究[J] 2007年4月硕士毕业论文
[82]姜向坤种子转阴汤治疗不孕女性血清抗精子抗体阳性的临床研究[J]山东中医药大学学报2002年7月第26卷第4期294-298
[83]赵凯消抗Ⅰ号片治疗女性血清抗精子抗体阳性不孕112例[J]陕西中医2008年第29卷第11期1444-1445
[84]詹思延系统综述和Meta分析[M]//李立明.流行病学.北京:人民卫生出版社,2007: 180.
[85]周旭毓等Meta分析的常见偏倚[J].循证医学, 2002;2(4):216-220