摘要
目的比较维生素D、右归胶囊单独或联合治疗对少弱精子症患者临床症状及精子质量的影响,探讨二者联合治疗效果。方法2023年1月—2024年2月郑州大学附属洛阳中心医院诊治少弱精子症患者153例,随机分为对照组、观察组、联合组各51例。对照组给予右归胶囊治疗(4粒/次,3次/d,口服),观察组给予维生素D3软胶囊治疗(4粒/次,3次/d,口服,2周后逐步增加至5~6粒/次),联合组给予维生素D3联合右归胶囊口服治疗;3组均连续治疗3个月。比较3组治疗前、后中医证候积分(性欲减退、腰膝酸软、精神疲惫、夜尿频多),精子质量(精子密度、精子总活力、精子前向运动百分率),精浆白细胞介素(IL)-18、IL-1β、caspase-1水平,血清睾酮、卵泡刺激素(FSH)、黄体生成素(LH)水平;比较3组治疗总有效率,记录随访1年期间患者配偶受孕情况。结果治疗后联合组、观察组、对照组性欲减退[(1.08±0.17)、(1.85±0.28)、(2.07±0.34)分]、腰膝酸软[(0.95±0.21)、(1.81±0.34)、(2.11±0.35)分]、精神疲惫[(1.12±0.18)、(1.92±0.27)、(2.33±0.35)分]、夜尿频多[(1.28±0.25)、(1.96±0.26)、(2.27±0.22)分]证候积分均依次升高(F=13.375~17.519,P均<0.05);3组治疗后各项证候积分均低于治疗前(t=11.773~24.192,P均<0.05)。治疗后联合组、观察组、对照组精子密度[(26.73±3.77)×10^(9)/L、(19.62±4.63)×10^(9)/L、(16.15±4.96)×10^(9)/L]、精子总活力[(51.12±2.69)%、(42.18±2.24)%、(39.12±2.13)%]、精子前向运动百分率[(41.12±4.05)%、(33.19±3.62)%、(31.19±3.39)%]及血清睾酮水平[(17.72±2.96)、(15.13±2.72)、(14.58±2.53)nmol/L]均依次降低(F=6.152~19.311,P均<0.05),精浆IL-18[(153.65±4.26)、(164.18±5.18)、(170.05±5.59)μg/L]、IL-1β[(36.24±2.19)、(40.13±2.76)、(42.15±2.95)ng/L]、caspase-1[(147.16±6.72)、(157.11±6.94)、(162.35±7.16)pmol/L]及血清FSH[(6.93±1.09)、(7.79±1.08)、(8.24±1.15)u/L]、LH[(6.27±0.89)、(6.94±1.05)、(7.52±1.02)u/L]水平均依次升高(F=5.134~12.718,P均<0.05);3组治疗后精子密度、精子总活力、精子前向运动百分率及血清睾酮水平均高于治疗前(t=4.357~31.152,P均<0.05),精浆IL-18、IL-1β、caspase-1及血清FSH、LH水平均低于治疗前(t=2.012~14.162,P均<0.05)。治疗前3组上述指标比较差异均无统计学意义(F=0.092~0.878,P均>0.05)。联合组治疗总有效率(94.12%)及配偶受孕率(80.39%)均高于观察组(76.47%、60.78%)、对照组(72.55%、56.86%)(χ^(2)=4.722~8.541,P均<0.05);观察组治疗总有效率及配偶受孕率与对照组比较差异均无统计学意义(χ^(2)=0.206,P=0.650;χ^(2)=0.162,P=0.687)。结论少弱精子症患者采用维生素D联合右归胶囊治疗可改善临床症状,提高精子质量,减轻精浆炎症,疗效良好。
Objective To compare the influences of vitamin D and Yougui Capsules alone and in combination on clinical symptoms and sperm quality of patients with oligoasthenospermia,and to investigate the efficacy of the combination of them two.Methods From January 2023 to February 2024,153 patients with oligoasthenospermia treated in Luoyang Central Hospital Affiliated to Zhengzhou University were randomly divided into a control group,an observation group,and a combination group,with 51 patients in each group.The control group was given Yougui Capsules orally(4 capsules/time,3 times/day),the observation group was given vitamin D3 soft capsules orally(4 capsules/time,3 times/day,gradually increased to 5-6 capsules/time after 2 weeks of administration),and the combination group was given Yougui Capsules plus vitamin D3,soft capsules continuously for 3 months.The traditional Chinese medical syndrome scores(diminished libido,lumbago and knee debility,spiritual lassitude and nocturnal polyuria),sperm quality(sperm density,sperm motility,percentage of progressively motile sperm),seminal plasma interleukin(IL)-18,IL-1β,caspase-1,serum testosterone(T),follicle-stimulating hormone(FSH),and luteinizing hormone(LH)were detected and compared among three groups before and after treatment.The overall effective rate was compared among three groups,and the pregnancy status of patients'spouses during 1-year follow-up was recorded.Results After treatment,the syndrome scores of diminished libido(1.08±0.17,1.85±0.28,2.07±0.34),lumbago and knee debility(0.95±0.21,1.81±0.34,2.11±0.35),spiritual lassitude(1.12±0.18,1.92±0.27,2.33±0.35),and nocturnal polyuria(1.28±0.25,1.96±0.26,2.27±0.22)increased sequentially in the combination,observation and control groups(F=13.375-17.519,all P values<0.05),which were significantly lower than those before treatment(t=11.773-24.192,all P values<0.05).The sperm densities[(26.73±3.77)×10^(9)/L(19.62±4.63)×10^(9)/L,(16.15±4.96)×10^(9)/L],sperm motilities[(51.12±2.69)%,(42.18±2.24)%,(39.12±2.13)%],percentages of progressively motile sperm[(41.12±4.05)%,(33.19±3.62)%,(31.19±3.39)%],and serum testosterone levels[(17.72±2.96),(15.13±2.72),(14.58±2.53)nmol/L]decreased sequentially in the combination,observation and control groups after treatment(F=6.152-19.311,all P values<0.05).The seminal plasma levels of IL-18[(153.65±4.26),(164.18±5.18),(170.05±5.59)μg/L],IL-1β[(36.24±2.19),(40.13±2.76),(42.15±2.95)ng/L]and caspase-1[(147.16±6.72),(157.11±6.94),(162.35±7.16)pmol/L],as well as the serum levels of FSH[(6.93±1.09),(7.79±1.08),(8.24±1.15)u/L]and LH[(6.27±0.89),(6.94±1.05),(7.52±1.02)u/L]increased sequentially in the combination,observation and control groups after treatment(F=5.134-12.718,all P values<0.05).The sperm density,sperm motility,percentage of progressively motile sperm,and serum testosterone levels in all three groups were significantly higher after treatment than those before treatment(t=4.357-31.152,all P values<0.05),while the levels of IL-18,IL-1β,caspase-1,FSH and LH were significantly lower after treatment than those before treatment(t=2.012-14.162,all P values<0.05).All above indicators showed no significant differences among three groups before treatment(F=0.092-0.878,all P values>0.05).The overall effective rate and pregnancy rate of patients'spouses were significantly higher in the combination group(94.12%,80.39%)than those in the observation group(76.47%,60.78%)and the control group(72.55%,56.86%)(χ^(2)=4.722-8.541,all P values<0.05),and showed no significant differences between the observation and control groups(χ^(2)=0.206,P=0.650;χ^(2)=0.162,P=0.687).Conclusion The combination of vitamin D and Yougui Capsules can relieve clinical symptoms,improve sperm quality,reduce seminal plasma inflammatory cytokines,and has a good therapeutic effect on oligoasthenospermia.
作者
高国政
常轲祎
雷晓航
郭紫轩
王芳
GAO Guozheng;CHANG Keyi;LEI Xiaohang;GUO Zixuan;WANG Fang(Reproductive Medicine Center,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang,Henan 471000,China)
出处
《中华实用诊断与治疗杂志》
2025年第8期750-755,共6页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划联合共建项目(LHGJ20200847)。
关键词
少弱精子症
右归胶囊
维生素D
精子质量
炎性因子
oligoasthenospermia
Yougui Capsules
vitamin D
sperm quality
inflammatory cytokines
作者简介
通信作者:王芳,E-mail:wangfang_1967@sina.com。
