来曲唑联合复方玄驹胶囊治疗肥胖性少弱精子症的临床疗效观察

目的观察来曲唑、枸橼酸氯米芬分别联合复方玄驹胶囊及维生素E治疗肥胖性少弱精子症的临床疗效。方法选取2018年8月至2020年8月在洛阳市妇幼保健院生殖医学研究所就诊的188例肾阳不足型肥胖性少弱精子症患者,随机分为来曲唑联合组(A组)和枸橼酸氯米芬联合组(B组)各94例,疗程为3个月,以精子浓度、精子前向运动百分率和生殖激素(FSH、LH、E 2、T)水平为观察指标进行治疗前、后疗效评估。结果精液质量上,治疗前,两组患者的精子浓度和前向运动百分率均无显著性差异;治疗3个月后,两组患者均有显著提升,且A组患者的精子浓度(26.32±2.59)×10⁶/ml vs.(21.48±3.37)×10⁶/ml]显著高于B组,即A组精子浓度增加更加显著(P<0.05)。生殖激素水平的比较:与治疗前相比,治疗后A组患者的LH(5.31±2.24)U/L vs.(3.84±1.47)U/L]及T(1.73±0.06)nmol/L vs.(1.12±0.05)nmol/L]水平显著升高(P<0.05),E 2水平(152.16±55.89)pmol/L vs.(206.69±60.44)pmol/L]显著下降(P<0.05),T/E 2比值显著升高(P<0.05);B组中仅有T水平(1.53±0.07)nmol/L vs.(1.17±0.06)nmol/L]显著改善,且A组E 2水平与T/E 2比值显著高于B组(P<0.05)。结论对于肾阳不足型肥胖性少、弱精子症,尤其是高E 2而T/E 2值相对较低的患者,以来曲唑为主效药物的联合用药在提高精子数量、改善精子活力方面具有显著效果,值得临床推广。

Clinical efficacy of letrozole combined with Compound Xuanju Capsule in treatment of obesity patients with oligoasthenospermia

Objective:To investigate the clinical efficacy of letrozole or clomiphene citrate combined with Compound Xuanju Capsule and vitamin E in treatment of the obesity patients with oligoasthenospermia.Methods:A total of 188 male patients with Kidney-Yang deficiency type obesity and oligoasthenospermia were admitted in Institute of Reproductive Medicine of Luoyang Maternal and Child Health Hospital from Aug.2018 to Aug.2020.They were randomly divided into letrozole combined group(group A)and clomiphene citrate combined group(group B),94 patients for each group.After three months treatment,the clinical efficacy was assessed according to sperm concentration,the sperm forward movement rate of and sex hormone levels(FSH,LH,E 2,T).Results:In terms of semen quality,there was no significant difference in sperm concentration and sperm forward movement rate before treatment between the two groups(P>0.05).After three months treatment,the sperm concentration and the sperm forward movement rate were significantly improved in both groups,and the sperm concentration in group A was significantly higher than that in group B(26.32±2.59)×10⁶/ml vs.(21.48±3.37)×10⁶/ml](P<0.05).For sex hormone levels,the LH(5.31±2.24)U/L vs.(3.84±1.47)U/L]and T(1.73±0.06)nmol/L vs.(1.12±0.05)nmol/L]levels were significantly increased,the E 2 levels(152.16±55.89)pmol/L vs.(206.69±60.44)pmol/L]were significantly decreased,and the T/E 2 ratio was significantly increased after treatment in group A(all P<0.05).Only T level(1.53±0.07)nmol/L vs.(1.17±0.06)nmol/L]was significantly improved in group B(P<0.05).Moreover,the E 2 level and the T/E 2 ratio in group A were significantly higher than that in group B(P<0.05).Conclusions:For male patients with Kidney-Yang deficiency type obesity and oligoasthenospermia,especially the patients with high E 2 level and relatively low T/E 2 radio,the combination therapeutic regimen of letrozole as the main drug has a significant effect in improving sperm counts and sperm motility,which is worthy of clinical promotion.