本文選題：生精通絡方　切入點：左卡尼汀　出處：《山東中醫(yī)藥大學》2014年碩士論文

【摘要】：目的：本研究從梗阻性無精子癥附睪液中精子活力及腫瘤壞死因子-α（TNF-α）、活性氧（ROS）水平等方面出發(fā)，觀察自擬生精通絡方對妊娠結局的影響和探討可能的機制。 方法：將2012年4月至2012年10月于山東中醫(yī)藥大學第二附屬醫(yī)院生殖中心行卵泡漿內單精子顯微注射（ICSI）的100例梗阻性無精子癥患者隨機分成4組：分別為生精通絡方組25例；左卡尼汀（陽性對照）組26例；安慰劑加生活干預組24例；生活干預組25例。生精通絡方組服用生精通絡方（日一劑，早晚分服）；左卡尼汀組服用左卡尼汀口服液（1.0g/次，3次/天）；安慰劑加生活干預組服用與生精通絡方外觀相似的安慰劑加生活干預治療，生活干預組僅進行生活干預治療；連續(xù)治療30天為一個療程，療程結束后采集精液標本，，分別測定四組用藥前后附睪液中腫瘤壞死因子-α（TNF-α）、活性氧（ROS）水平，以及附睪精子活力、形態(tài)，并采集精液當日行卵泡漿內單精子顯微注射（ICSI），比較四組間PESA-ICSI的獲卵數、受精數、受精率、優(yōu)質胚胎數、優(yōu)質胚胎率和妊娠率。 結果： 1.治療前后精子活力指標的組內對比：生精通絡方組的a級精子活動率（P=0.00040.01），b級精子活動率(P=0.04560.05）和精子活動率（P=0.00530.01.）同治療前相比均有提高，左卡尼汀組的a級精子活動率(P=0.00010.01）,b級精子活動率（P=0.00970.01）與精子活動率（P=0.00510.01）同治療前相比均有顯著提高，其余兩組各項指標的變化均無統計學意義。 2.治療前后生精通絡方組和左卡尼汀組附睪液中腫瘤壞死因子-α（TNF-α）（P=0.00000.01）、活性氧（ROS）水平（P=0.00000.01）同治療前相比均有顯著降低，其余兩組附睪液中各項指標變化均無統計學意義。 3.治療前后四組間獲卵數、受精數和受精率無顯著性差異（P＞0.05）。生精通絡方組和左卡尼丁組獲得優(yōu)質胚胎數及優(yōu)質胚胎率明顯高于其余兩組(P0.01),有統計學意義。四組間妊娠率無顯著性差異（P＞0.05）。 結論：證實梗阻性無精子癥患者附睪液中TNF-α和ROS，與精子活力尤為相關。生精通絡方可以通過下調附睪液中TNF-α和ROS水平，從而改善附睪環(huán)境，并能增強精子活力和受精能力，從而改善ICSI妊娠結局。
[Abstract]:Objective: to observe the effect of Shenjingtongluo recipe on pregnancy outcome in the epididymal fluid of obstructive azoospermia from the aspects of sperm motility and tumor necrosis factor- 偽 TNF- 偽, reactive oxygen species (Ros). Methods: from April 2012 to October 2012, 100 patients with obstructive azoospermia received intracytoplasmic intracytoplasmic sperm microinjection (ICSII) in the Reproductive Center of the second affiliated Hospital of Shandong University of traditional Chinese Medicine were randomly divided into 4 groups: 25 patients in the group of living and mastering the collateral; Leucarnitine (positive control) group (n = 26); placebo plus life intervention group (n = 24); life intervention group (n = 25). In the morning and evening, the patients in the leucarnitine group were treated with 1. 0 g of levacarnitine oral liquid three times a day, the placebo plus life intervention group were treated with placebo and life intervention which were similar in appearance to Shengjing Tongluo recipe, and the life intervention group was only treated with life intervention. Semen samples were collected after 30 days of continuous treatment. The levels of tumor necrosis factor- 偽 -TNF- 偽, reactive oxygen species (Ros), sperm motility and morphology of epididymal sperm were measured before and after treatment in the four groups. Semen was collected and intracytoplasmic intracytoplasmic sperm microinjection (ICSI) was performed to compare the number of PESA-ICSI eggs, fertilization, fertilization rate, number of high-quality embryos, high quality embryo rate and pregnancy rate among the four groups. Results:. 1. Intra-group comparison of sperm motility indexes before and after treatment: the sperm motility rate of the Shenjingtongluo prescription group was higher than that of the pre-treatment group. The motility rate of spermatozoa was 0.04560.05) and the sperm motility rate was 0.00530.01.Compared with that before treatment, the sperm motility rate of the Shenjingtongluo prescription group was higher than that of the control group before and after treatment. The sperm motility rate of levocarnitine group was significantly higher than that of control group (P < 0. 00010.01). The other two groups had no statistical significance in the change of the other two groups' sperm motility rate (P < 0. 00010. 01) and the sperm motility rate (P < 0. 00510. 01). 2. Before and after treatment, the levels of TNF- 偽 TNF- 偽 TNF- 偽 TNF- 偽 TNF- 偽 TNF- 偽 and Ros in the epididymal fluid of Shengjingtongluo recipe group and leucarnitine group were significantly lower than those before and after treatment, but there were no significant changes in the other two groups in the epididymal fluid. 3.The number of eggs obtained between the four groups before and after treatment, There was no significant difference in fertilization number and fertilization rate (P > 0.05). The number of high-quality embryos and the rate of high-quality embryos in Shengjing Tongluo recipe group and levacarnitine group were significantly higher than those in the other two groups (P > 0.05), and there was no significant difference in pregnancy rate among the four groups (P > 0.05). Conclusion: TNF- 偽 and ROSin the epididymal fluid of patients with obstructive azoospermia are particularly related to sperm motility. Shengjingtongluo prescription can improve the environment of epididymis by down-regulating the levels of TNF- 偽 and ROS in epididymal fluid, and can enhance sperm motility and fertilization ability. In order to improve the pregnancy outcome of ICSI.
【學位授予單位】：山東中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R698.2

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