【作者】 许峰嘉；

【导师】 崔学教；

【作者基本信息】 广州中医药大学 ， 中医外科学， 2005， 博士

【摘要】 目的:慢性前列腺炎不育症是男科常见的疾病。由于不育症是由男女双方多方面因素所造成的,治疗该病应当从前列腺炎着手。慢性前列腺炎是男性生殖系统疾病中最常见的一种,好发生在20-40岁的青壮年,通常慢性前列腺炎并没有什么症状,只偶而会感到会阴部或尿道深部有一些隐隐的酸痛,小便频数或有灼热感,余沥不尽,排尿后有少许分泌物,尤其喝酒或吃刺激食物或过劳后,症状尤为明显。许多学者都认为前列腺局部免疫功能的异常导致慢性前列腺炎长期不愈或反复发作,以致该病仍然缺乏确切有效的治疗手段。中医认为慢性前列腺炎属于中医文献中“精淋”,“白浊”,“劳淋”等病的范畴。起病多由气血瘀滞,瘀久化热或湿热入络,久病成肾虚湿热瘀阻之症。在治疗上宜清热解毒,清热利湿或补肾壮阳等法为主。在实验室指标上,超氧化歧化酶（SOD）能清除超氧阴离子自由基O₂^-保护细胞免疫损伤,因此在机体的氧化与抗氧化平衡上起着至关重要的作用。研究中发现,不育患者与正常人比较,SOD及顶体酶活力均明显降低,精液中SOD及顶体酶活力的变化可能是导致其不育的因素之一。WHO认为在免疫性不育指标上MAR方法检测AsAb比单纯测定血清中的AsAb更有临床价值。在生殖道感染指标方面,精浆中性粒细胞弹性蛋白酶（NE）可以作为筛选和诊断男性生殖道感染的客观而有效的指标。本实验旨在通过观察临床患者和大鼠前列腺炎模型使用清热益肾法治疗前后前列腺症状指数,精液质量,抗精子抗体以及中性粒细胞弹性硬蛋白酶的变化,探索改善慢性前列腺炎患者生活质量与精液质量的治疗方法,并为慢性前列腺炎合并弱精症患者提供一种有效,经济的方案。 方法:本实验由临床观察及动物实验组成,临床方面采用实验前后实验组和对照组自身对照及实验组与对照组问对照的研究方法,统计方法采用两样本均数比较的student-t检验或x²检验。病例来源于广州中医药大学第一附属医院泌尿男科门诊2004年9月-2005年1月就诊的慢性前列腺炎合并弱精症的患者,中医属于瘀热内阻证型,选择符合诊断标准患者共60例,随机分为治疗组和对照组各30例,两组患者临床一般资料和实验室指标在统计学检查均无显著性差异（P<0.05）,有可比性。实验组患者给予清热益肾法中药方,早晚各一次。对照组给予活血化瘀法中药方,早晚各一次。记录症状评分,前列腺液检查,精更多还原

【Abstract】 Objective: Male infertility caused by Chronic Prostatitis (CP) is common seen in andrology. because infertility is caused by various reasons in both gender, therefore to treat the disease should engage in CP. CP is the most common seen disease in male reproductive system, it is likely to occur in the prime age between 20-40 years of age. There is likely not much symptom when CP happens, only feel a little occult pain in perineal region or deep part of urethra, frequent micturition or burning sensation, a few secretion after urinate, especially after drink or eating hot food or overwork, the symptom will manifest. Many scientists consider that abnormal of immune function in regional prostate gland is a radical reason result in bad recovery or recur, that causes in short of effective methods on therapy. TCM consider that CP is in the category of "Jinglin" , "baizhou" and "laolin" . It’ s start with moist heat afferent collaterals, stagnation of blood and qi, invalidism form sign of renal deficiency and moist heat hinder. In laboratory indexes, SOD can clean out Superoxide radical anion O_x~- to protect cell immunity damage, therefore it’ s very important for the oxidation and antioxidation to balance in our body. The research shows that male infertility patient compare with health adult, the activity of SOD and the acrosomal enzyme is much lower, changes of semen SOD and acrosomal enzyme may be one of the reason for mail infertility. WHO consider that infertility caused by immunity is more valuable in clinic to test by MAR rather than simply tested by AsAb in the serum. In the infection of genital tract index,neutrophil elastase (NE) in seminal plasma can be an objective and effective index in screening and diagnose male genital tract infection. This experiment aimed to observe Cleaning Heat and Nourishing Kidney methods in clinical and rat’ s effectiveness using NIH-CPSI, CASA, AsAb and neutrophil elastase index. It also observes a better way of improving CP patient’ s sperm and living quality, providing an effective and economical scheme in treating CP with asthenospermia. Methods: This experiment composes in clinical and animal experiment. In the clinical observation we’ re using methods of own control on experimental group and control group before and after the experiment, also own control on experiment group with control group. We used student-t test or x2 test for statistics methods. Asthenospermia caused by CP patients are collected between Sep, 2004-Jan, 2005 from The First Affiliated Hospital of Guangzhou TCM University during the visit, belonging to stagnated heat and internal resistant syndrome in TCM. There’ re 60 patients with these diagnostic criteria, divide into experimental group and control group randomly with 30 patients each. General information and laboratory index shows no significant difference, which are comparable. We give experiment group Clearing-Heat and Nourishing-Kidney method Herb twice a day. And give control group Blood-Activating and Stasis-Eliminating Methods herbs twice a day. We Record down the NIH-CPSI, EPS-WBC, CASA, MAR and NE readings. In the animal experiment we observe changes in rat’ s EPS-WBC, CASA, and SOD in seminal plasma’ s level after the experiment. We also taking prostate gland in microscopic examination, analysis changes in histotype to exam the effectiveness of Clearing-Heat and Nourishing-Kidney method, Blood-Activating and Stasis-Eliminating Methods and Floxacin to CP. All the data are examined by using SPSS 10.0 software pack.Results: NIH-CPSI, EPS-WBC, CASA and NE shows great improvement in the experimental group (P<0. 05). AsAb with improvement but no significant difference (P>0.05). Compare experiment group with control group we find更多还原