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针药结合治疗少弱精子症有效性的Meta分析
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Abstract:
目的：评价针药结合治疗少弱精子症有效性及安全性。方法：计算机检索中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普期刊数据库、万方资源数据库、Pubmed、Cochrane图书馆中关于针刺结合药物治疗少弱精子症的随机对照试验，并手工检索相关杂志，由两位研究者独立进行筛选和资料提取后，依据Cochrane Handbook 5.1.0偏倚风险评估工具评价纳入研究质量，应用Revman 5.4软件进行Meta分析。结果：纳入5篇文献，共485例患者，其中试验组233例，对照组252例。Meta分析结果显示，与对照组相比，针药结合对少弱精子治疗率显著提升(RR = 1.22, 95% CI [1.12, 1.33])；提高精子活动水平(A + B)级(MD = 9.03, 95% CI [7.79, 10.26])；提高精子密度(MD = 10.51, 95% CI [8.71, 12.31])和提高睾酮水平(MD = 0.6, 95% CI [0.45, 0.75])。结论：与单一治疗相比，针刺与药物联用能明显提高精子的活动率，精子密度和睾酮，由于纳入的文献其研究方法学质量不高，有待进一步进行高质量的研究对其疗效及安全性进行研究。
Objective: To evaluate the efficacy and safety of acupuncture combined with medication in the treatment of oligoasthenozoospermia. Methods: Computerized searches were conducted in the Chinese Biomedical Literature Database (CBM), Chinese Journal Full-text Database (CNKI), VIP Journal Database, Wanfang Resources Database, PubMed, and Cochrane Library for randomized controlled trials on acupuncture combined with medication for oligoasthenozoospermia. Hand searches were also conducted in relevant journals. Two researchers independently screened and extracted data. The quality of the included studies was evaluated using the Cochrane Handbook 5.1.0 Risk of Bias Assessment Tool. Meta-analysis was performed using Revman 5.4 software. Results: Five articles were included, involving 485 patients. Among them, 233 patients were in the acupuncture group and 252 patients were in the control group. The meta-analysis results showed that compared with the control group, acupuncture combined with medication significantly increased the treatment rate of oligoasthenozoospermia (RR = 1.22, 95% CI [1.12, 1.33]); increased the grade of sperm motility (A + B) (MD = 9.03, 95% CI [7.79, 10.26]); increased sperm density (MD = 10.51, 95% CI [8.71, 12.31]) and increased testosterone levels (MD = 0.6, 95% CI [0.45, 0.75]). Conclusion: Compared with single treatment, the combination of acupuncture and medication can significantly improve sperm motility, sperm density and testosterone levels. Due to the low methodological quality of the included studies, further high-quality research is needed to investigate its efficacy and safety.
| [1] | 世界卫生组织. 人类精液及精子-宫颈粘液相互作用实验室检验手册[M]. 北京: 人民卫生出版社, 2001: 51-52. |
| [2] | Jungwirth, A., Giwercman, A., Tournaye, H., Diemer, T., Kopa, Z., Dohle, G., et al. (2012) European Association of Urology Guidelines on Male Infertility: The 2012 Update. European Urology, 62, 324-332. https://doi.org/10.1016/j.eururo.2012.04.048 |
| [3] | 覃湛, 陈慰填, 马庆辉. 中西医结合治疗少弱精子症32例[J]. 中外健康文摘, 2007, 4(1): 2-3． |
| [4] | 叶玲玲, 索永善, 曹文丽, 等. 雷达辐射对精液质量的影响[J]. 中华男科学杂志, 2007, 13(9): 801-803． |
| [5] | Lanfranco, F., Kamischke, A., Zitzmann, M. and Nieschlag, E. (2004) Klinefelter’s Syndrome. The Lancet, 364, 273-283. https://doi.org/10.1016/s0140-6736(04)16678-6 |
| [6] | 江凡, 邹建华, 张修发. 生殖激素测定在男性不育病因学诊断中的临床价值[J]. 临床和实验医学杂志, 2014, 13(16): 1361-1363. |
| [7] | Maegawa, M., Kamada, M., Irahara, M., et al. (2001) Concentration of Granu-Locyte Elastase in Seminal Plasma Is not Associated with Sperm Motility. Archives of Andrology, 47, 31-36. |
| [8] | 闵立贵, 贾宏亮, 南玉奎. 精索静脉曲张合并附睾精液囊肿163报告[J]. 现代泌尿外科杂志, 2011, 15(2): 149-150. |
| [9] | Ramlau-Hansen, C.H., Thulstrup, A.M., Aggerholm, A.S., Jensen, M.S., Toft, G. and Bonde, J.P. (2006) Is Smoking a Risk Factor for Decreased Semen Quality? A Cross-Sectional Analysis. Human Reproduction, 22, 188-196. https://doi.org/10.1093/humrep/del364 |
| [10] | 陆金春, 黄宇烽, 吕年青. 《世界卫生组织人类精液分析实验室技术手册》与我国男科实验室现状[J]. 中华男科学杂志, 2010, 16(10): 867-871. |
| [11] | 党伟龙, 林鸿金, 袁翔辉, 等. 基于网络药理学和分子对接探讨龟龄集胶囊治疗少弱精子症的作用机制[J]. 中医临床研究, 2024, 16(23): 124-132. |
| [12] | WHO (2001) Laboratory Manual of the WHO for the Examination of Human Semen and Sperm-Cervical Mucus Interaction. Annali Dellistituto Superiore Di Sanità, 37, 3. |
| [13] | Cooper, T.G., Noonan, E., von Eckardstein, S., Auger, J., Baker, H.W.G., Behre, H.M., et al. (2009) World Health Organization Reference Values for Human Semen Characteristics. Human Reproduction Update, 16, 231-245. https://doi.org/10.1093/humupd/dmp048 |
| [14] | 刘茂松, 王琦. 中西医结合治疗少弱精子症疗效评估的方法和标准[J]. 中国男科学杂志, 2010, 24(2): 61-62. |
| [15] | 丁劲, 唐楚英, 曹义国, 等. 基于“脾肾亏虚、精失所养”理论应用针刺疗法治疗弱精子症临床疗效的随机对照研究[J]. 针灸临床杂志, 2019, 35(10): 10-14. |
| [16] | 张国锋, 李朋, 沈洋, 等. 补肾生精汤配合针刺治疗少弱精子症45例[J]. 中国药业, 2014, 23(24): 106-108. |
| [17] | 徐愿, 王俊. 粗针命门穴平刺联合中药治疗特发性少弱精子症疗效观察[J]. 上海针灸杂志, 2020, 39(6): 720-723. |
| [18] | 梁卓, 门波. 补肾强精方联合针刺治疗男性少弱精子症疗效观察[J]. 实用中医药杂志, 2024, 40(6): 1045-1047. |
| [19] | 肖少芳. 针刺联合补虚泻实法治疗男性不育少弱精症疗效观察[J]. 内蒙古中医药, 2017, 36(17): 69-70. |
| [20] | Sakamoto, H., Saito, K., Shichizyo, T., Ishikawa, K., Igarashi, A. and Yoshida, H. (2006) Color Doppler Ultrasonography as a Routine Clinical Examination in Male Infertility. International Journal of Urology, 13, 1073-1078. https://doi.org/10.1111/j.1442-2042.2006.01499.x |
| [21] | 周瑞, 刘春丽, 孙璐. 温针灸配合中药治疗无排卵性不孕症临床观察[J]. 上海针灸杂志, 2015, 34(10): 951-954. |
| [22] | 盛拥辉. 针药联合治疗耐克罗米芬型多囊卵巢综合征不孕症临床研究[J]. 亚太传统医药, 2015, 11(16): 106-107. |
| [23] | 刘鹂言, 邓燕琴, 杜艳, 等. 针灸治疗不孕症的临床研究进展[J]. 光明中医, 2015, 30(7): 1596-1598. |
| [24] | 宋阳, 肖春艳, 何燕萍, 等. 加减归肾丸结合针刺对女性免疫性不孕患者IL-6、β-EP及ENK的影响[J]. 吉林中医药, 2014, 34(12): 1292-1294. |
| [25] | 孙一鸣, 李世大, 李岳. 针刺治疗男性特发性少弱精子症临床观察[J]. 上海针灸杂志, 2016, 35(6): 691-693. |
| [26] | 吴忠刚, 高君, 刘学义, 等. 左卡尼汀治疗弱精子症临床分析[J]. 齐齐哈尔医学院学报, 2010, 31(13): 2105-2106. |
| [27] | 余柯达, 师帅, 毛佳婷, 等. 他莫昔芬联合左卡尼汀对特发性少弱精子症患者体外受精结局的疗效观察[J]. 中国男科学杂志, 2025, 39(1): 105-110. |
| [28] | 谭天阳, 唐田, 刘柘君, 等. 五子衍宗丸治疗少弱精子症的研究进展[J]. 中国药物警戒, 2024, 21(11): 1232-1237. |
| [29] | 白雪, 陈亚飞, 唐田, 等. 补肾生精方对少弱精子症潜在防治作用的研究进展[J]. 中国药物警戒, 2024, 21(11): 1243-1249. |
| [30] | 陈天帷, 李海松, 毕焕洲, 等. 针刺“三阴交”对微波辐射诱导的少弱精子症小鼠生精细胞作用研究[J]. 针刺研究, 2022, 47(10): 891-895. |
| [31] | Sinisi, A.A., Esposito, D., Maione, L., Quinto, M.C., Visconti, D., De Bellis, A., et al. (2008) Seminal Anti-Mullerian Hormone Level Is a Marker of Spermatogenic Response during Long-Term Gonadotropin Therapy in Male Hypogonadotropic Hypogonadism. Human Reproduction, 23, 1029-1034. https://doi.org/10.1093/humrep/den046 |
| [32] | Dhanoa, J.K., Mukhopadhyay, C.S., Arora, J.S. and Kaur, S. (2015) Expression Profile of Leptin and Aromatase-P450 Genes and Association with Sperm Motility in Fresh Bovine Ejaculates. Proceedings of the National Academy of Sciences, India Section B: Biological Sciences, 86, 611-616. https://doi.org/10.1007/s40011-015-0494-0 |
