从“阴成形”探讨聚精汤治疗畸形精子症的临床疗效  

Clinical efficacy of Jujing Decoction on teratospermia:An investigation based on the theory of"yin forming"

作　　者：樊千 薛建国[2] 张星 王庆 孙志兴 黄健 陈赟 FAN Qian;XUE Jian-guo;ZHANG Xing;WANG Qing;SUN Zhi-xing;HUANG Jian;CHEN Yun(Department of Andrology,The Affliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing,Jiangsu 210029,China;The First School of Clinical Medicine,Nanjing University of Traditional Chinese Medicine,Nanjing,Jiangsu 210046,China)

机构地区：[1]南京中医药大学附属医院男科,江苏南京210029 [2]南京中医药大学第一临床医学院,江苏南京210046

出　　处：《中华男科学杂志》2022年第9期817-821,共5页National Journal of Andrology

基　　金：江苏省中医药科技发展计划项目(MS2021021);国家中医药管理局全国名老中医药专家传承工作室建设项目[国中医药人教函(2014)143号]。

摘　　要：目的:从中医“阴成形”理论探讨聚精汤治疗畸形精子症的临床疗效及其对精子浓度、形态、DNA碎片指数(DFI)和线粒体超微结构的影响。方法:将40例畸形精子症患者随机分为空白对照组(16例)和治疗组(24例),分别采用生育健康指导和聚精汤口服治疗,疗程均为12周。观察两组患者治疗前后的临床疗效、精子浓度、精液量、前向运动精子百分率、畸形精子百分率、精子DFI和精子线粒体超微结构的变化。结果:治疗组总有效率为87.50%,显著优于空白对照组的6.66%;与治疗前相比较,治疗组患者精液量[(3.27±1.14)ml vs(4.16±1.84)ml]、精子浓度[(38.85±15.88)×10^(6)/ml vs(39.35±14.58)×10^(6)/ml]虽有提高但差异不具有统计学意义(P>0.05),前向运动精子百分率[(37.47±2.74)%vs(42.55±7.07)%]、畸形精子百分率[(97.43±1.01)%vs(95.52±0.85)%]、顶体完整率[(45.27±5.14)%vs(51.88±4.48)%]、DFI[(25.53±6.89)%vs(17.68±2.38)%]均明显改善(P<0.05);空白对照组患者精液量[(3.67±1.77)mlvs(4.40±1.78)ml]、精子浓度[(37.24±9.31)×10^(6)/ml vs(38.32±10.54)×10^(6)/ml]、前向运动精子百分率[(35.42±2.64)%vs(36.30±6.04)%]、畸形精子百分率[(98.15±0.84)%vs(97.86±1.01)%]、顶体完整率[(43.06±4.47)%vs(44.47±4.83)%]、DFI[(26.42±6.54)%vs(27.34±6.17)%]均无明显改善(P>0.05);治疗后治疗组前向运动精子百分率、畸形精子百分率、顶体完整率、DFI的改善均优于空白对照组(P<0.05)。两组患者治疗前精子线粒体透射电镜观察均表现为精子顶体膜折叠、不连续,颈部线粒体堆叠、大小不一;尾部微管外周线粒体排列杂乱、部分线粒体肿胀明显;治疗后治疗组患者精子线粒体超微结构明显改善,精子顶体膜相对连续、完整,颈部及尾部线粒体排列相对整体、大小均一。结论:聚精汤不仅能提高畸形精子症患者精液量、精子浓度、前向运动精子百分率,而且能降低畸形精子百分率和DFI、�Objective:To study the clinical efficacy of Jujing Decoction(JJD)based on the theory of"yin forming"in the treatment of teratospermia and its effects on semen parameters,sperm morphology,sperm DNA fragmentation index(DFI)and the ultrastructure of sperm mitochondria.Methods:We randomly divided 40 patients with teratospermia into a blank control group(n=16)and a JJD group(n=24),the former treated by reproductive health guidance and the latter with JJD,respectively.After 12 weeks of intervention,we observed the clinical effects and changes in the semen volume,sperm concentration,percentages of progressively motile sperm(PMS)and morphologically abnormal sperm(MAS),sperm DFI and the ultrastructure of sperm mitochondria,and analyzed the data obtained based on the"yin forming"theory.Results:The total effectiveness rate was significantly higher in the JJD than in the blank control group(87.50%vs 6.66%,P<0.05).Compared with the baseline,the patients after treated with JJD showed significant improvement in semen volume([3.27±1.14]vs[4.16±1.84]ml,P<0.05),sperm concentration([38.85±15.88]vs[39.35±14.58]×10^(6)/ml,P<0.05),PMS([37.47±2.74]%vs[42.55±7.07]%,P<0.05),MAS([97.43±1.01]%vs[95.52±0.85]%,P<0.05),acrosomal integrity([45.27±5.14]%vs[51.88±4.48]%,P<0.05),and DFI([25.53±6.89]%vs[17.68±2.38]%,P<0.05),while the blank controls exhibited only slightly increased semen volume([3.67±1.77]vs[4.40±1.78]ml)and sperm concentration([37.24±9.31]vs[38.32±10.54]×10^(6)/ml),but no significant improvement in the other parameters(P>0.05).Before treatment,folded and discontinuous sperm acrosomal membrane was observed under the transmission electron microscope in the sperm mitochondria of the two groups of patients,the mitochondria stacked and differently sized in the neck and disorderly arranged and some obviously swollen around the tail microtubule.After treated with JJD,the ultrastructure of sperm mitochondria was significantly improved,with relative continuity and integrity of the acrosomal membrane and well-arranged and

关 键 词：阴成形 畸形精子症 聚精汤 精子形态 DNA碎片指数 精子线粒体超微结构 

分 类 号：R321.1[医药卫生—人体解剖和组织胚胎学] R698.2[医药卫生—基础医学]