选择性5-羟色胺再摄取抑制剂对精液质量影响的Meta分析  

Meta-analysis of the effect of selective 5-hydroxytryptamine reuptake inhibitors on semen parameters

作　　者：王焱 丁彩飞[1] 马健雄 苗润泽 陈望强[1] WANG Yan;DING Cai-fei;MA Jian-xiong;MIAO Run-zhe;CHEN Wang-qiang(Zhejiang Integrated Hospital of Traditional Chinese and Western Medicine,Hangzhou 310003;Zhejiang Traditional Chinese Medicine University,Hangzhou 310053)

机构地区：[1]浙江省中西医结合医院生殖医学科,杭州310003 [2]浙江中医药大学,杭州310053

出　　处：《生殖医学杂志》2023年第12期1870-1878,共9页Journal of Reproductive Medicine

基　　金：国家自然科学基金(81804092);浙江省自然科学基金(LGF20H270002)。

摘　　要：目的采用Meta分析方法系统评价选择性5-羟色胺再摄取抑制剂(SSRIs)对精液质量的影响。方法计算机检索7个中文和英文数据库(包括知网、万方、维普、中国生物医学文献数据库、Cochrane、PubMed、Embase、Web of Science)从建库至2023年9月关于服用SSRIs对精子参数影响的前瞻性研究和回顾性分析实验。制定纳入与排除标准,筛选符合标准的文献,将使用SSRIs治疗的作为实验组,未行SSRIs治疗的为对照组。采用RevMan 5.4软件对最终纳入研究的文献进行Meta分析。结果共7篇文献纳入研究,总样本量为491例。采用纽卡斯尔-渥太华量表(NOS)评估纳入研究的文献质量,2篇8分,4篇7分,1篇6分,均为高质量文献。Meta分析结果显示,服用SSRIs对精子浓度、精子活力无显著影响(P>0.05);但按照不同治疗时间进行亚组分析时,服用SSRIs≥3个月时,实验组的精子浓度[95%CI(-45.50,-39.34),P<0.00001]和精子活力[95%CI(-33.38,-1.80),P=0.03]显著下降。服用SSRIs显著降低了正常精子形态率[95%CI(-16.29,-3.77),P=0.002],显著增加了精子DNA碎片率指数(DFI)[95%CI(6.66,21.93),P=0.002];进行不同治疗时间亚组分析时,治疗≤2个月和≥3个月时服用SSRIs对正常精子形态率和DFI的影响一致。但服用SSRIs对精液体积无显著影响[95%CI(-0.75,0.65),P=0.89]。结论服用SSRIs会对男性精液质量产生一定程度的损害,且用药时间越长,对精液质量的影响越明显;但仍需进行大样本量的临床研究加以验证。Objective:To systematically evaluate the effect of selective 5-hydroxytryptamine reuptake inhibitors(SSRIs)on semen parameters.Methods:Seven Chinese and English databases(from their inception to April 2023)were searched using a computerized search strategy to collect prospective and retrospective studies on the relationship between SSRIs treatment and semen parameters.The inclusion and exclusion criteria were developed.The patients treated with SSRIs was recruited in the study group.The final included studies were analyzed using RevMan5.4 software.Results:A total of 7 literatures were finally included with a total sample size of 491 cases.The literature qulity was evaluated with Newcastle-Ottawa Scale(NOS).All literatures were high qulity ones,with 8 scores in 2 articles,7 scores in 4 articles and 6 scores in one article.The meta-analysis results showed that the treatment with SSRIs had no effects on sperm concentration and motility(P>0.05).However,when subgoups was developed by different periods of treatment,the significantly reduced sperm concentration[95%CI(-45.50,-39.34),P<0.00001]and motility[95%CI(-33.38,-1.80),P=0.03]were observed when the patients were treated with SSRIs for 3 months and more.The intake of SSRIs could significantly reduced the percentage of sperm with normal morphology[95%CI(-16.29,-3.77),P=0.002]and significantly increased the sperm DNA fragmentation index(DFI)[95%CI(6.66,21.93),P=0.002].In the subgroup analysis,there was no statistically significant diffference in the semen morphology between the treatment period of 2 months and less and that of 3 months and more,but there was no effect of SSRIs treatment on semen volume[95%CI(-0.75,0.65),P=0.89].Conclusions:SSRIs have a harmful effect on male semen parameters,and the longer the treatment period,the more significant the impact on semen quality.Large randomized clinical trials should be conducted to verify our conclusion.

关 键 词：选择性5-羟色胺再摄取抑制剂 精液质量 射精障碍 META分析 

分 类 号：R697[医药卫生—泌尿科学]