补肾填精法对肾精亏虚型弱精子症患者的临床疗效及AMPK/mTORC1信号通路相关蛋白表达水平的影响  

Clinical Efficacy of Tonifying Kidney and Replenishing Essence on Asthenospermia Patients with Syndrome of Kidney Essence Deficiency and Effect of This Method on Expression Levels of AMPK/mTORC1 Signaling Pathway-associated Proteins

作　　者：付远杰 李富豪 彭成华 徐栋 尹国安 黄晓朋[3] 常德贵[3] 董良 FU Yuanjie;LI Fuhao;PENG Chenghua;XU Dong;YIN Guoan;HUANG Xiaopeng;CHANG Degui;DONG Liang(Chengdu University of Traditional Chinese Medicine(TCM),Chengdu 610075,China;The TCM Hospital of Longquanyi,Chengdu 610100,China;Affiliated Hospital of Chengdu University of TCM,Chengdu 610072,China;School of Medicine and Life Science,Chengdu University of TCM,Chengdu 611137,China)

机构地区：[1]成都中医药大学,成都610075 [2]成都市龙泉驿区中医医院,成都610100 [3]成都中医药大学附属医院,成都610072 [4]成都中医药大学医学与生命科学学院,成都611137

出　　处：《中国实验方剂学杂志》2025年第7期141-147,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金青年科学基金项目(82205131);成都市医学科研课题项目(2023062);四川省妇幼医学科技创新课题重点项目(FXZD08)。

摘　　要：目的:观察补肾填精法对肾精亏虚型弱精子症患者的临床疗效及腺苷酸活化蛋白激酶(AMPK)/哺乳动物雷帕霉素靶蛋白复合物1(mTORC1)信号通路的影响。方法:选取成都中医药大学附属医院2023年2月至2024年1月符合标准的肾精亏虚型弱精子症患者72例,随机分为观察组和对照组,每组各36例。观察组口服龟鹿填精胶囊,对照组口服左卡尼汀口服溶液,两组疗程均为4周。观察治疗前后两组患者精子前向运动(PR)、精子总活力(PR+NP)、精子线粒体膜电位(MMP)正常比例、中医证候评分变化情况,并随访3个月,记录配偶受孕情况。并从符合纳入标准的观察组病例中随机抽取8例,并且纳入4例精液常规检查正常的健康男性作为对照组,采用蛋白免疫印迹法(Western blot)检测观察组治疗前后、正常精液组精子AMPK及磷酸化(p)-AMPK、mTOR调节相关蛋白(RAPTOR)及p-RAPTOR、PTEN诱导激酶1(PINK1)蛋白的表达情况。结果:观察组配偶受孕率为9.09%(3/33)高于对照组的3.33%(1/30),但差异无统计学意义。观察组总有效率为84.8%(28/33),对照组总有效率66.7%(20/30),观察组高于对照组,但差异无统计学意义。与本组治疗前比较,两组患者PR、PR+NP、MMP、中医证候评分均显著改善(P<0.01)。与对照组治疗后比较,观察组患者中医证候评分降低更为明显(P<0.05),而两组PR、PR+NP、MMP改善差异均无统计学意义。与正常组比较,观察组患者AMPK、RAPTOR的磷酸化水平及PINK1蛋白水平显著上调(P<0.01)。使用龟鹿填精胶囊治疗后AMPK、RAPTOR蛋白的磷酸化水平和PINK1蛋白量水平较治疗前显著下调(P<0.01),而AMPK、RAPTOR蛋白的表达水平与治疗前差异无统计学意义。研究期间,两组患者均未出现明显的不良反应。结论:龟鹿填精胶囊能有效提高肾精亏虚型弱精子症患者的精子活力、MMP正常比例,其机制可能与下调AMPK/mTORC1信号通路,降低PINK1蛋白水平,抑制过Objective:To observe the clinical efficacy of tonifying kidney and replenishing essence on asthenozoospermia patients with the syndrome of kidney essence deficiency and the effects of this method on the adenosine 5′-monophosphateactivated protein kinase(AMPK)/mammalian target of rapamycin complex 1(mTORC1)signaling pathway.Methods:Seventytwo eligible asthenozoospermia patients with the syndrome of kidney essence deficiency treated in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from February 2023 to January 2024 were selected and randomly assigned into an observation group and a control group,with 36 patients in each group.The observation group received oral administration of Guilu Tianjing capsules,while the control group received oral administration of L-carnitine oral solution.The treatment course lasted for 4 weeks in both groups.The observed indicators included sperm progressive motility rate(PR),total sperm motility(PR+NP),percentage of normal mitochondrial membrane potential(MMP),and traditional Chinese medicine(TCM)symptom scores before and after treatment in both groups.A three-month follow-up was instituted to record the conception status of the patients’spouses.Additionally,eight patients were randomly selected from the eligible patients in the observation group,and four healthy males with normal semen routine examination results were included as the control group for the determination of protein expression.Western blotting was conducted to assess the expression of AMPK,phosphorylated(p)-AMPK,regulatory-associated protein of mTOR(RAPTOR)and p-RAPTOR,and PTEN-induced putative kinase 1(PINK1)in sperms from the observation group before and after treatment,as well as in the sperms of the control group.Results:The pregnancy rate of spouses in the observation group was 9.09%(3/33),which was higher than that(3.33%,1/30)in the control group.The total response rate was 84.8%(28/33)in the observation group and 66.7%(20/30)in the control group,with no statistically significant

关 键 词：龟鹿填精胶囊 肾精亏虚 弱精子症 腺苷酸活化蛋白激酶(AMPK)/哺乳动物雷帕霉素靶蛋白复合物1(mTORC1)信号通路 线粒体膜电位 

分 类 号：R259[医药卫生—中西医结合] R256.56[医药卫生—中医内科学] R698.2[医药卫生—中医学]