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目的:探讨中频穴位电刺激联合他莫昔芬片治疗少弱精子症的临床效果及其可行性与安全性。方法:120例少弱精子症患者随机分为他莫昔芬片口服治疗组(他莫昔芬组)、中频穴位电刺激治疗组(穴位电刺激组)与联合治疗组,每组40例。连续治疗8周,记录各组治疗前后的精液体积、精子总数及浓度、总活力、前向运动(PR)精子百分率及血清生殖激素(FSH、LH、T)水平,对比分析3组患者治疗前后的精液参数及生殖激素水平。结果:所有患者均完成本研究,治疗前后3组精液体积无明显改善(P>0.05)。与治疗前对比,3组均可改善生殖激素(FSH、LH、T)水平(P<0.05);他莫昔芬组可以显著提高精子总数[(42.65±5.78)×10~6vs(25.16±2.05)×10~6,P<0.05]及精子浓度[24.31±2.59)×10~6/ml vs(12.15±2.51)×10~6/ml,P<0.05],而精子总活力及PR精子百分率无明显改善[(22.61±5.75)%vs(21.78±8.81)%;(16.76±5.86)%vs(15.87±7.81)%,P均>0.05];穴位电刺激组可以增加精子总活力率[(32.43±4.97)%vs(24.81±8.27)%,P<0.05]及PR精子百分率[(27.17±5.09)%vs(19.71±9.15)%,P<0.05],而精子总数及精子浓度无明显改善[(25.87±4.96)×10~6vs(23.23±3.14)×10~6;(14.12±2.47)×10~6/ml vs(11.27±2.24)×10~6/ml,P均>0.05];联合治疗组不仅可以提高精子总数[(51.14±3.69)×10~6vs(26.17±5.05)×10~6,P<0.05]及精子浓度[(27.28±1.98)×10~6/ml vs(12.78±2.41)×10~6/ml,P<0.05],而且可以显著提高精子总活力[(37.12±5.33)%vs(23.89±9.05)%,P<0.05]及PR精子百分率[(31.09±7.12)%vs(17.14±8.04)%,P<0.05],并且显著优于他莫昔芬组和穴位电刺激组(P<0.05)。联合治疗组总有效率(97.5%)显著高于他莫昔芬组(72.5%)和穴位电刺激组(75.0%),P<0.05。结论:中频穴位电刺激联合他莫昔芬片口服可以明显改善特发性少弱精子症患者的精液质量和生殖激素水平,有一定的临床推广意义。
Objective: To investigate the clinical effect, feasibility and safety of intermediate frequency acupoint electrical stimulation combined with tamoxifen tablets in treating oligoasthenospermia. Methods: A total of 120 asthenospermia patients were randomly divided into tamoxifen oral treatment group (tamoxifen group), middle frequency acupoint electrical stimulation group (acupoint stimulation group) and combination therapy group (n = 40). Continuous treatment for 8 weeks, before and after treatment, the semen volume, the total number and concentration of sperm, the total activity, the percentage of preeclamptic motility (PR) sperm and the level of serum reproductive hormones (FSH, LH and T) were recorded. Sperm parameters and reproductive hormone levels. Results: All patients completed the study. Before and after treatment, there was no significant improvement in semen volume (P> 0.05). Compared with those before treatment, the levels of FSH, LH and T in all three groups were significantly improved (P <0.05), and the total number of sperm was significantly increased in tamoxifen group [(42.65 ± 5.78) × 10 ~ 6 vs (25.16 ± 2.05 ) × 10 ~ 6, P <0.05] and sperm concentration [24.31 ± 2.59] × 10 ~ 6 / ml vs (12.15 ± 2.51) × 10 ~ 6 / ml, P <0.05] There was no significant improvement in acupuncture group [(22.61 ± 5.75)% vs (21.78 ± 8.81)%; (16.76 ± 5.86)% vs (15.87 ± 7.81)%, P> 0.05] 32.43 ± 4.97% vs 24.81 ± 8.27%, P <0.05] and PR sperm percentage (27.17 ± 5.09% vs 19.71 ± 9.15%, P <0.05, respectively) (25.87 ± 4.96) × 10 ~ 6vs (23.23 ± 3.14) × 10 ~ 6; (14.12 ± 2.47) × 10 ~ 6 / ml vs (11.27 ± 2.24) × 10 ~ 6 / The combined treatment group not only increased the total number of sperm [(51.14 ± 3.69) × 10 ~ 6 vs (26.17 ± 5.05) × 10 ~ 6, P <0.05] and sperm concentration [(27.28 ± 1.98) × 10 ~ 6 / ml vs P <0.05] and PR sperm percentage [(31.09 ± 7.12)% ± (2.41) × 10 ~ 6 / ml, P <0.05] and significantly increased the total sperm motility (37.12 ± 5.33% vs 23.89 ± 9.05% )% vs (17.14 ± 8.04)%, P <0.05], and significantly better than tamoxifen group TEAS group (P <0.05). The total effective rate (97.5%) in combination therapy group was significantly higher than that in tamoxifen group (72.5%) and acupoint stimulation group (75.0%), P <0.05. Conclusion: The combination of middle frequency electroacupuncture and tamoxifen tablet oral administration can significantly improve the semen quality and reproductive hormone in patients with idiopathic oligoasthenospermia, which has some clinical significance.