Clinical Study of Warm Needle with Long Segment Moxa on the Asthenozoospermia with Kidney Deficiency and Liver Depression
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摘要: 目的 观察大艾段温针灸法治疗肾虚肝郁型弱精子症的临床疗效及对精液常规、精浆生化、性激素水平的影响。方法 将纳入病例随机分为观察组、药物组、常规温针组、普通针刺组，每组各35例，观察组使用大艾段温针灸法，采用4 cm艾段，药物组应用硫酸锌片、维生素E软胶囊、五子衍宗丸，常规温针组采用2.5 cm艾段，普通针刺组常规针刺，不用灸法。各组均4周为1个疗程，共治疗2个疗程。观察4组治疗前后中医证候积分、精液常规、精浆生化以及性激素水平变化情况。结果 观察组、药物组疗效均优于普通针刺组(P＜0.05)。中医证候积分(情绪低落、记忆力下降、精液清冷)改善方面，观察组优于其他3组(P＜0.05~0.01)。4组精子活率、a级精子、a+b级精子均较治疗前升高(P＜0.05~0.01)，4组的精子畸形率均较治疗前下降(P＜0.01)；畸形率、a级精子、a+b级精子方面，观察组均优于其他3组(P＜0.05~0.01)，精子活率方面，观察组优于常规温针组、普通针刺组(P＜0.01)。4组的精浆果糖、中性α-葡萄糖糖苷酶及药物组精浆锌含量均较治疗前升高(P＜0.01)，在精浆果糖、中性α-葡萄糖糖苷酶方面，观察组均优于其他3组(P＜0.01)。4组的睾酮、促黄体生成素、促卵泡生成激素均较治疗前升高(P＜0.05~0.01)；睾酮方面观察组优于药物组(P＜0.01)，促黄体生成素、促卵泡生成激素方面，观察组均优于其他3组(P＜0.05~0.01)。结论 大艾段温针灸法治疗肾虚肝郁型弱精子症疗效较好，可显著改善中医临床症状、精液常规、精浆生化以及性激素水平相关指标。其作用机制可能与调节性激素水平相关。Abstract: OBJECTIVE To observe the clinical efficacy of warm needle with long segment moxa on semen routine examination, seminal plasma biochemistry, and sex hormone levels in the treatment of asthenozoospermia with kidney deficiency and liver depression.METHODS The included cases were randomly divided into the observation group, the drug group, the conventional warm needle group and the ordinary needle group, 35 cases in each group. The observation group used the warm needle with 4 cm moxa segments, the drug group applied zinc sulfate tablets, vitamin E soft capsules, and Wuzi Yanzong pill, the conventional warm needle group used 2.5 cm moxa segments, and the ordinary needle group used conventional acupuncture without moxibustion. All groups were treated for 4 weeks as a course of treatment, and 2 courses for each group. The changes of traditional Chinese medicine (TCM) syndrome score, semen routine examination, seminal plasma biochemistry, and sex hormone levels were observed before and after treatment in the four groups.RESULTS The efficacies of the observation group and the drug group were better than those of the general acupuncture group (P < 0.05). In terms of the improvement of TCM symptom scores (depressed mood, memory loss, clear and cold semen), the observation group was better than the other 3 groups (P < 0.05, P < 0.01). Sperm viability, grade a sperm, and grade a+b sperm in all 4 groups were higher than those before treatment (P < 0.05, P < 0.01). Sperm malformation rate in each group decreased than that before treatment (P < 0.01). Malformation rate, grade a sperm, and grade a+b sperm in the observation group was better than those of the other 3 groups (P < 0.05, P < 0.01). In terms of sperm viability, the observation group was better than the conventional warm needle group and the ordinary acupuncture group (P < 0.01). The seminal plasma fructose, neutral α-glucocerebrosidase of the four groups and zinc content in seminal plasma of the drug control group were all higher than those before treatment (P < 0.01). The observation group were better than the other three groups in the levels of seminal plasma fructose and neutral α-glucocerebrosidase(P < 0.01). The testosterone, luteinizing hormone and follicle-stimulating hormone in all groups were higher than those before treatment (P < 0.05, P < 0.01). The observation group was better than the drug group in terms of testosterone level (P < 0.01), and the observation group were better than the other three groups in terms of the levels of luteinizing hormone and follicle-stimulating hormone (P < 0.05, P < 0.01).CONCLUSION The treatment of asthenozoospermia with kidney deficiency and liver depression by the warm needle with long segment moxa was more effective and could significantly improve the clinical TCM symptoms, semen routine examination, seminal plasma biochemistry and indexes related to sex hormone levels. The mechanism may be related to the regulation of sex hormone level.
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表 1 4组患者临床疗效比较
组别 例数 痊愈 显效 有效 无效 总有效率/% 观察组 34 10 14 7 3 91.18# 药物组 33 9 13 7 4 87.88# 温针组 33 6 12 10 5 84.85 针刺组 34 4 11 12 7 79.41 注：χ观察、针刺2=5.84，χ药物、针刺2=4.94，#P＜0.05。 
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表 2 4组治疗前后中医证候积分比较(x±s)
组别 时间 例数 情绪低落 腰膝酸软 性功能低下 神疲乏力 头昏耳鸣 记忆力下降 胸胁胀满 精液清冷 观察组 治疗前 34 5.24±1.17 3.45±0.88 4.08±1.27 1.69±0.25 1.91±0.28 2.32±0.69 1.06±0.29 1.45±0.33 治疗后 34 1.44±0.35** 1.98±0.25* 1.09±0.23** 1.58±0.11 1.79±0.33 0.59±0.16** 0.99±0.32 0.40±0.11** 药物组 治疗前 33 5.22±1.20* 3.43±0.92 4.10±1.24 1.70±0.23 1.91±0.29 2.30±0.71 1.05±0.30 1.46±0.32 治疗后 33 3.19±0.71# 1.57±0.22* 1.12±0.25** 1.55±0.33 1.80±0.31 2.20±0.63## 0.98±0.25 0.93±0.10# 温针组 治疗前 33 5.24±1.15 3.44±0.94 4.09±1.19 1.69±0.26 1.93±0.24 2.31±0.70 1.06±0.28 1.45±0.34 治疗后 33 3.11±0.89*# 1.89±0.33* 2.30±0.28*# 1.60±0.37 1.90±0.35 2.29±0.63## 0.88±0.21 1.02±0.24# 针刺组 治疗前 34 5.23±1.18 3.45±0.77 4.09±1.21 1.70±0.22 1.92±0.22 2.32±0.68 1.05±0.29 1.45±0.35 治疗后 34 4.99±1.13## 3.01±0.35# 2.45±0.32# 1.71±0.24 1.88±0.25 2.21±0.59## 1.24±0.33 1.19±0.28# 注：组内比较，*P＜0.05，**P＜0.01；与观察组比较，#P＜0.05，##P＜0.01。
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表 3 4组治疗前后精液常规指标比较(x±s)
组别 时间 例数 精液量/mL 精子浓度/ (×106·mL-1) 畸形率/% 精子活率/% a级精子/% a+b级精子/% 观察组 治疗前 34 2.65±0.52 27.76±4.54 73.32±4.22 53.35±6.30 10.97±2.41 23.74±6.88 治疗后 34 2.64±0.38 30.71±4.85* 53.35±8.20** 67.59±10.20** 23.09±4.64** 44.32±8.11** 药物组 治疗前 33 2.68±0.38 27.76±4.30 73.21±3.94 53.18±4.67 11.0±2.21 23.0±5.71 治疗后 33 3.08±0.49**##△ 29.52±4.50 65.55±4.42**## 64.67±8.58** 19.70±4.86**## 38.33±8.94**# 温针组 治疗前 33 2.65±0.38 27.36±3.05 72.64±3.0 53.45±4.36 10.67±2.35 24.21±5.02 治疗后 33 2.65±0.31 28.79±3.65 64.91±4.03**## 61.39±7.97**## 17.97±4.88**## 36.12±8.03**## 针刺组 治疗前 34 2.67±0.44 27.71±3.54 72.82±3.58 54.12±4.92 9.94±2.79 23.29±6.46 治疗后 34 2.66±0.27 29.03±3.45 66.53±5.30**## 61.35±7.08**## 16.09±4.18**## 33.35±8.99**## 注：组内比较，*P＜0.05，**P＜0.01；组间比较，与观察组比较，#P＜0.05，##P＜0.01；与常规温针组比较，△P＜0.05。
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表 4 4组治疗前后一次射精精浆生化比较(x±s)
组别 时间 例数 锌定量/μmol 果糖定量/μmol 中性α-葡萄糖苷酶/mU 观察组 治疗前 34 2.19±0.35 10.49±1.22 17.94±1.74 治疗后 34 2.33±0.27 15.27±2.04** 24.56±2.76** 药物组 治疗前 33 2.14±0.35 10.51±1.22 19.49±1.19 治疗后 33 2.40±0.30** 12.97±1.87**## 23.01±2.49**## 温针组 治疗前 33 2.18±0.45 10.52±1.28 18.48±1.28 治疗后 33 2.25±0.37 12.83±1.95**## 22.70±2.70**## 针刺组 治疗前 34 2.11±0.36 10.49±1.21 18.51±1.18 治疗后 34 2.18±0.33 12.01±1.57**## 22.61±2.41**## 注：组内比较，**P＜0.01；组间比较，与观察组比较，##P＜0.01。
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表 5 4组治疗前后性激素水平比较(x±s)
组别 时间 例数 T/(ng·mL-1) LH/(mU·mL-1) FSH/(mU·mL-1) 观察组 治疗前 34 4.65±1.23 4.51±1.67 5.67±1.36 治疗后 34 7.71±1.57** 8.55±1.78** 9.74±2.34** 药物组 治疗前 33 4.64±1.25 4.49±1.69 5.64±1.40 治疗后 33 6.14±1.24**##△ 6.89±1.55**## 6.25±1.11*##△ 温针组 治疗前 33 4.66±1.19 4.48±1.59 5.69±1.29 治疗后 33 7.03±2.12** 7.65±1.91**# 7.36±1.83**## 针刺组 治疗前 34 4.63±1.28 4.50±1.63 5.66±1.27 治疗后 34 6.65±1.47**# 6.73±1.40**##△ 6.18±1.58**##△ 注：组内比较，*P＜0.05，**P＜0.01；组间比较，与观察组比较，#P＜0.05，##P＜0.01；与常规温针组比较，△P＜0.05。
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