摘要
目的:探讨不同程度的精索静脉曲张(VC)对精子质量的影响及丹红通精方对双侧VC患者术后精子质量的影响。方法:将68例双侧VC患者随机分为对照组和治疗组各34例。对照组采用显微镜下精索静脉结扎术,治疗组在显微镜下行精索静脉结扎术后予"丹红通精方"中药颗粒口服,治疗前和治疗后检查精液多参数分析、正常形态精子率、精子顶体酶定量、抑制素B(INHB)、精子DNA碎片指数(DFI)。结果:不同程度的VC治疗前精子浓度、前向运动精子百分率、顶体酶、DFI比较无统计学意义。治疗3个月后,两组患者的精子浓度、精子总数、精子总活力、前向运动精子百分率、精子顶体酶均较治疗前提高,DFI较治疗前下降,治疗组的INHB较治疗前提高,且在提高精子总数、前向运动精子百分率、顶体酶,降低DFI方面,治疗组疗效优于对照组。结论:双侧的VC的严重程度与精液质量的下降无明确相关性。丹红通精方通过提高精子总数、前向运动精子百分率及顶体酶,降低DFI来改善VC患者术后精子质量,表明手术联合中药治疗双侧VC具有较好的疗效,值得进一步临床推广应用。其作用机制可能与抗氧化应激、改善生殖系统缺氧状态、进而改善生精环境及一定程度上改善睾丸支持细胞功能相关,但具体的信号通道尚未明确,需要进一步研究。
Objective: To investigate the effect of Danhong Tongjing Prescription(DTP) on sperm quality in patients with bilateral varicocele(VC) after microsurgical varicocelectomy. Methods: We randomly assigned 68 patients with bilateral VC to receive microsurgical varicocelectomy(the control group, n = 34) or microsurgical varicocelectomy followed by oral administration of DTP for a course of 90 days(the DTP group, n = 34). Before and after treatment, we obtained the sperm concentration, total sperm count, total sperm motility, the percentage of progressively motile sperm(PMS), sperm acrosomal enzyme activity, inhibin B(Inh-B) level, and sperm DNA fragmentation index(DFI) from the patients and compared the parameters between the two groups. Results: There were no statistically significant differences in sperm concentration, PMS, acrosomal enzyme activity or sperm DFI among the patients with different degrees of VC preoperatively. After 3 months of medication, sperm concentration, total sperm count, total sperm motility, PMS and acrosomal enzyme activity were all increased while DFI decreased in both the control and DTP groups, even more significantly in the DTP group than in the control, and the Inh-B level was also markedly elevated in the DTP group in comparison with the baseline. Conclusion: The severity of bilateral VC is not correlated with the reduction of semen quality. DTP can improve sperm quality by improving total sperm count, PMS and acrosomal enzyme activity and reducing DFI in VC patients after varicocelectomy. The underlying mechanisms of the prescription may be related to its anti-oxidative stress action and abilities of improving reproductive hypoxia, spermatogenic environment and the function of Sertoli cells, but the specific signaling pathway involved is not yet clear.
作者
耿立果
袁少英
秦国政
GENG Li-guo;YUAN Shao-ying;QIN Guo-zheng(Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210033,China;Department of Andrology,Zhuhai Hospital,Guangdong Provincial Hospital of Traditional Chinese Medicine,Zhuhai,Guangdong 519015;Yunnan Provincial Hospital of Traditional Chinese Medicine/The First Affiliated Hospital of Yunnan University of Chinese Medicine,Kunming,Yunnan 650021,China)
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2021年第7期635-640,共6页
National Journal of Andrology
基金
珠海市医学科研基金项目(20191207A010057)。
关键词
丹红通精方
双侧精索静脉曲张
精子质量
Danhong Tongjing Prescription
bilateral varicocele
sperm quality
