【作者】 张华俊；

【导师】 金保方；

【作者基本信息】 南京中医药大学 ， 中医外科学， 2010， 硕士

【摘要】 [目的]探讨DAZ基因缺失所致无精子症药物治疗的可能性,研究养精胶囊对DAZ基因缺失所致无精子症的疗效,并进一步分析其作用机理。[方法]将48例患者随机分为治疗组28例,对照组20例。治疗组给予养精胶囊,每次5粒,每日3次；对照组给予十一酸睾酮胶丸(安特尔),每次40mg,每日2次。观察指标：治疗6个月后疗效,随访ICSI/PGD结果,治疗前和治疗3个月后精液量、精浆α-糖苷酶(α-Glu)、精浆前列腺酸性磷酸酶(ACP)、精浆果糖(Fru),血清性激素指标(FSH、LH、T、E2、PRL)。[结果]1.治疗组有效10例,无效18例,有效率35.7%；对照组有效2例,无效18例,有效率10.0%(P<0.05); ICSI/PGD后,治疗组正常受精数34,受精率44.7%,生化妊娠5例,生化妊娠率41.7%,临床妊娠3例,临床妊娠率33.3%,活产2例。对照组正常受精数5,受精率35.7%,生化妊娠1例,生化妊娠率50.0%,无临床妊娠。2.治疗组中有效患者和无效患者的平均年龄,双侧睾丸容积和血清FSH之间均存在显著性差异(P<0.05)。3.养精胶囊能升高血清FSH、LH及T水平,对E2及PRL无显著影响；十一酸睾酮能通过升高T水平,进而负反馈抑制LH的分泌。4.养精胶囊能增加精液量,促进附属性腺的分泌,升高精浆α-Glu、Fru及ACP水平。[结论]1.临床上对于DAZ基因缺失患者中,年龄较轻、睾丸体积较大及血清FSH不是很高的无精子症患者,可以尝试给予药物治疗。反之,则不主张治疗。2.养精胶囊可以作为治疗DAZ基因缺失所致无精子症的候选药物之一。探讨养精胶囊有效的原因,可能是养精胶囊通过调节下丘脑-垂体-性腺轴功能,从而促进精子的生成。’3.养精胶囊还能促进附睾、精囊及前列腺的分泌功能。更多还原

【Abstract】 Objective:To observe the effects of Yangjing Capsule treatment on azoospermia due to DAZ gene deletion, and discuss the mechanisms.Methods:Forty-eight patients of azoospermia with DAZ gene deletion, were randomly divided into a treatment group(n=28) and a control(n=20). The former treated by Yangjing Capsule (5 pills, tid) and the latter with testosterone undecanoate (40mg, bid). The efficacy was observed after treatment for six months and the inedxes such as semen volume, seminal a-glucosidase enzyme(a-Glu), prostatic acid phosphatase(ACP), fructose in seminal plasma(Fru), gonadal hormone(FSH, LH, T, E2, PRL) were analyzed at 3 months before and after treatment.Results:1. The totaleffective rate was 35.7%(10/28) in the treated group, which was significantly higher than that in the controlgroup,10.0%(2/20, P<0.05). After ICSI/PGD, in treatment group, fertilization number was 34, fertilization rate was 44.7%,5 cases got biochemical pregnancy, biochemical pregnancy rate was 41.7%,3 cases got clinical pregnancy, clinical pregnancy rate was 33.3% and two of live births. While in the control group, fertilization number was 5, the fertilization rate of 35.7%,1 case of biochemical pregnancy, biochemical pregnancy rate was 50.0%, no clinical pregnancy.2. There are significant differences on the average age, bilateral testicular volume and serum FSH values between the effectives and non-effectives in the treatment group(P<0.05).3. Yangjing capsule elevated serum FSH, LH and T levels, had no significant impact on the E2 and PRL, while testosterone undecanoate increased T levels, and suppressed LH levels by the way of the negative feedback.4. Yangjing capsule increased semen volume and the a-Glu, Fru and ACP level in seminal plasma.Conclusion:1. It is treatable for the patients of lower age, larger testicular volume and not too high serum FSH.2. Yangjing capsule is an effective drug on azoospermia duo to DAZ gene deletion. The mechanisms which may act on the hypothalamus-pituitary-gonadal axis, thus promoting the generation of sperm.3.Yang Jing Capsule can also promote the secretory function of epididymis, seminal vesicle and prostate.更多还原