中华男科学杂志最新文献

Objective: To evaluate the efficacy and safety of traditional Chinese medicine (TCM) in the treatment of male immune infertility (MII) by meta-analysis.

Methods: We retrieved randomized controlled trial (RCT) on the treatment of male immune infertility with traditional Chinese medicine from the databases of WanFang, Chinese Biomedical Literature, Cochrane Library, Weipu, PubMed and CNKI, and performed methodological quality assessment of the RCTs identified and statistical analysis and evaluation of the publication bias using the RevMan5.4 software.

Results: Totally, 25 RCTs (2 563 cases) were included in this study. Compared with Western medicine alone in the treatment of MII, TCM achieved a significantly higher total effectiveness rate (OR = 6.35, 95% CI: 4.96－8.13, P<0.000 01), negative conversion rate of seminal plasma anti-sperm antibodies (OR = 4.52, 95% CI: 2.72 － 7.51, P<0.000 01), negative rate of serum anti-sperm antibodies (OR = 2.98, 95% CI: 2.23－3.96, P<0.000 01), sperm concentration (MD = 15.56, 95% CI: 11.32－19.79, P<0.000 01), grade a sperm motility (MD = 3.85, 95% CI: 1.91－5.79, P=0.000 01), grade a+b sperm motility (MD = 13.77, 95% CI: 7.06－20.48, P<0.000 1), sperm viability (MD = 10.32, 95% CI: 6.78－13.86, P<0.000 01) and pregnancy rate (OR = 3.53, 95% CI: 2.68－4.63, P<0.000 01), but a lower rate of adverse reactions (OR = 0.06, 95% CI: 0.01－0.23, P<0.000 01). There was no statistically significant difference in the percentage of morphologically abnormal sperm between TCM and Western medicine alone in the treatment of MII (MD = －7.53, 95% CI: －15.50－0.44, P = 0.06).

Conclusion: TCM has a definite effectiveness and high safe in the treatment of male immune infertility.

Objective: To explore the mechanisms of Qianlie Jindan Tablets (QLJD) acting on chronic nonbacterial prostatitis (CNP) in rats based on non-targeted urine metabolomics.

Methods: According to the body mass index, we equally randomized 30 eight-week-old male SD rats into a blank control, a CNP model control and a QLJD medication group. We established the CNP model in the latter groups and, from the 4th day of modeling, treated the rats in the blank and model control groups intragastrically with normal saline and those in the QLJD medication group with QLJD suspension, qd, for 30 successive days. Then we detected the changes in the metabolites of the rats by ultra-high-performance liquid chromatography-tandem mass spectrometry, and identified the differential metabolites in different groups by multivariate statistical analysis, followed by functional annotation of the differential metabolites.

Results: Eight common metabolites were identified by metabolomics analysis, of which 5 were decreased in the CNP model controls and increased in the QLJD medication group, while the other 3 increased in the former and decreased in the latter group. Creatinine and genistein were important differential metabolites, and the arginine and proline metabolic pathways and isoflavone biosynthesis pathways were the main ones for QLJD acting on CNP. Compared with the blank controls, the model controls showed up-regulated arginine and proline metabolic pathways, increased production of creatinine, down-regulated isoflavone biosynthetic pathway and decreased production of genistein. The above changes in the model controls were all reversed in the QLJD medication group.

Conclusion: QLJD acts effectively on CNP in male rats by regulating L-arginine and proline metabolic pathways, as well as the isoflavone biosynthesis pathway and naringenin metabolism.

Objective: To investigate the application value of single-sperm sequencing in resolving the carrier status of preimplantation genetic testing (PGT) for chromosomal structural rearrangements in Robertsonian translocations.

Methods: Haplotypes were constructed by single-sperm isolation combined with single-sperm sequencing for a patient with 45, XY, der(13; 14)(q10; q10). Twenty single-sperm samples were isolated by mechanical braking and subjected to whole-genome amplification (WGA), and then the Asian Screening Array (ASA) gene chip was used to detect the 183 708 single nucleotide polymorphisms (SNP) of the WGA products. The single sperm associated with the translocation that could be used as haplotype inference was detected by copy number variation (CNV) sequencing, and the chromosomal haplotypes with normal and Robertsonian translocations were inferred. Three biopsy samples of embryonic trophoblast cells were used as the objects. After whole-genome amplification, high-throughput sequencing was employed to determine the status of the translocation chromosome carried by the embryos. The available blastocysts were selected for transfer, and the amniotic fluid samples were taken at 18 weeks of gestation to confirm whether the fetus carried the pathogenic mutation.

Results: A total of 6 037 SNP sites were screened by single-sperm sequencing, and 30 sites selected to distinguish normal and translocation haplotypes. Preimplantation haplotype analysis showed that all the three embryos were euploids without Robertsonian translocation chromosome. Genetic testing of amniotic fluid in the second trimester confirmed that the karyotype of the fetus was 46, XN, carrying no Robertsonian translocation chromosome.

Conclusion: For male carriers of Robertsonian translocation, single sperm sequencing can be used to screen SNP sites to construct haplotypes for distinguishing normal and Robertsonian translocation embryos, and to provide a basis for embryo selection by preimplantation chromosomal structural genetic testing.

Objective: To comprehensively analyze the numbers of involved chromosomes and breakpoints and the clinical phenotypes of the patients with complex chromosome rearrangement (CCR).

Methods: We selected 23 745 patients with abnormal fertility seeking medical care in the Center of Reproductive Medicine of Peking University Third Hospital from 2011 to 2015, and analyzed their peripheral blood chromosomal karyotypes using G-banding, C-banding and fluorescence in situ hybridization (FISH).

Results: A total of 28 CCR carriers (0.118%) were detected among the 23 745 patients with abnormal fertility, including 18 males mainly with azoospermia or oligoasthenospermia and 10 females mainly with infertility, recurrent abortion, embryo termination and abnormal birth. Of the 28 cases of CCR, tripartite rearrangement was found in 9 (32.14%), double translocation in 7 (25%) and special translocation in 12 (42.86%). CCR carrier-related chromosomes were all involved but chromosomes 12 and 19, while 2 and 5 were involved most frequently.

Conclusion: At present, the incidence of CCR is low. CCR carriers with normal phenotypes are often found because of reproductive problems, and their low chance of having a normal baby necessitates the use of preimplantation genetic test to improve the rate of live birth. Due to the diversity of the chromosomes and breakpoints involved in CCR, it is crucial to give each CCR carrier precise genetic counseling.

Objective: To evaluate the clinical efficacy of Xiaozheng Granules (XZG) combined with Jingqiankang Bacteriostatic Gelatin (JBG) on chronic prostatitis of the damp-heat and blood-stasis type based on infrared thermography (IRT).

Methods: This study included 120 cases of chronic prostatitis with damp-heat and blood stasis treated in the First Affiliated Hospital of Henan University of Chinese Medicine with oral XZG (the control group, n = 60) or oral XZG combined with anal administration of JBG (the trial group, n = 60), both for 4 weeks. We obtained the NIH-CPSI and traditional Chinese medicine (TCM) syndrome scores of the patients, measured the temperatures in the belt-vessel, lower focal and inguinal regions by IRT before and after treatment, recorded the adverse reactions during the treatment, and compared them between the two groups of patients.

Results: Compared with the baseline, the NIH-CPSI and TCM syndrome scores were significantly decreased in the two groups of patients after treatment (P < 0.05), even more significantly in the trial than in the control group (P < 0.05), and after 1 hour of treatment, the temperatures in the Xiajiao (［34.09 ± 0.34］ vs ［33.60 ± 0.40］ ℃, P < 0.05) and the groin region (［34.49 ± 0.28］ vs ［33.78 ± 0.30］ ℃, P < 0.05) were remarkably reduced in the trial group, but showed no significant change in the control group (Xiajiao region: ［34.02 ± 0.29］ vs ［34.05 ± 0.26］ ℃, P > 0.05; groin region: ［34.54 ± 0.25］ vs ［34.51±0.22］ ℃, P > 0.05). After 4 weeks of treatment, the temperatures in the Xiajiao and groin regions were even lower in the trial (［33.13 ± 0.41］ ℃ and ［33.21 ± 0.29］ ℃) and the control group (［33.42±0.25］ ℃ and ［33.86±0.29］ ℃) than the baseline and those after 1 hour of treatment (P < 0.05), and still more significantly in the former than in the latter group (P < 0.05). The total effectiveness rate was markedly higher in the trial group than in the control (88.14% vs 77.19%, P < 0.05), and no obvious adverse reactions were observed in neither group.

Conclusion: XZG combined with JBG is a safe and effective treatment of chronic prostatitis with damp-heat and blood-stasis, which can significantly reduce the NIH-CPSI and TCM syndrome scores and IRT temperatures in the lower focal and inguinal regions of the patients.

Chronic nonbacterial prostatitis (CNP) is one of the most common diseases in urology and andrology, with a complex etiology and a high incidence rate. Traditional Chinese medicine plays an important role in the treatment of CNP and can produce therapeutic effects through various action mechanisms. This article presents an overview of recent studies on the specific mechanisms of traditional Chinese medicine acting on CNP, including the mechanisms underlying its effects of anti-infection, anti-inflammation, immune regulation, improvement of urodynamics, endocrine regulation, improvement of microcirculation, and regulation of gut microbiota, aiming to provide some reference for the clinical application and basic studies of traditional Chinese medicine in the treatment of CNP.

The incidence of male infertility has been increasing year by year, and one of the major causes is testicular spermatogenic epithelial injury, which affects the spermatogenic function of the testis. Ferroptosis is a novel mode of cell death and plays an important role in testicular cell injury. Some traditional Chinese medicines can intervene in the progression of testicular injury by regulating the ferroptosis pathway in testicular spermatogenic epithelia. This paper focuses on the effect of traditional Chinese drugs in regulating the ferroptosis pathway in testicular cells, and summarizes the advances in the studies of traditional Chinese medicines in the treatment of testicular spermatogenic epithelial injury, aiming to provide a theoretical basis for the selection of relevant medicines and their clinical application.

Objective: To investigate the efficiency and safety of the pulsatile GnRH therapy in the treatment of male congenital hypogonadotropic hypogonadism (CHH).

Methods: We retrospectively analyzed the clinical data on 45 CHH males treated by pulsatile GnRH therapy in our hospital from January 2013 to March 2023. We treated the patients with gonadorelin at 7－15 μg, one pulse/90 min, and followed them up every month in the first 3 months and then every 3 to 6 months after treatment, for an average of 19.1±4.3 months, during which we recorded the height, body weight, penile length, testis volume, Tanner stages, levels of FSH, LH and T, semen parameters and adverse reactions of the patients, followed by comparison of the data obtained with the baseline.

Results: The levels of FSH, LH and T of the patients were dramatically elevated after treatment (P < 0.01). The T level of the 6 cases of cryptorchidism, however, failed to reach the normal value within 18.2 ± 8.6 months of follow-up. Significant improvement was seen in the external genitalia and secondary sexual characteristics of all the patients, and spermatogenesis was observed in the semen in 33 cases (73.3%), with a mean sperm concentration of (18.2 ± 6.2) 10⁶/ml, sperm progressive motility of (19.7 ± 6.5) %, and semen volume of (1.8 ± 0.6) ml. Eight of the cases achieved natural fertility, and another 3 achieved childbirth by assisted reproductive technology. As for adverse events, gynecomastia was observed in 8, subcutaneous induration in 6, and allergic reaction to therapeutic agent in 3 cases.

Conclusion: Pulsatile GnRH therapy is an effective and safe strategy for male CHH. However, clinicians should choose appropriate approaches to different individual cases.

Chronic prostatitis is a process of kidney deficiency and blood stasis mixed with various pathological factors involving the essence chamber, which is manifested as kidney deficiency and blood stasis. Based on the concept of the "brain-heart-kidney-essence chamber" axis of medication, Xiongji Formula is applied to the treatment of chronic prostatitis, due to its "simultaneous holistic and local action" and effects of tonifying the kidney yang and assisting the systemic yang, acting on the brain, heart and kidney as a whole, and meanwhile activating blood circulation, eliminating blood stasis and restoring the function of the essence chamber. This paper discusses the etiology and pathogenesis of chronic prostatitis with kidney deficiency and blood stasis in Chinese medicine, expounds the significance of "brain-heart-kidney-essence chamber" axis of medication, and explores the specific value and clinical application of Xiongji Formula.

Objective: To explore the potential causal relationship between gut microbiota and teratozoospermia.

Methods: We searched the database of Genome-Wide Association Study (GWAS) for gut microbiota- and teratozoospermia-related data. We used gut microbiota as an exposure factor, determined the instrumental variables according to the GWAS data on 18 340 participants released by the MiBioGen Alliance, and derived the outcome variables from the European data on teratozoospermia, with a sample size of 85 716, including 915 cases and 209 006 controls. Using inverse-variance weighting (IVW), MR-Egger regression and the weighted median estimator (WME), we performed two-sample Mendelian randomization (MR) analysis on the retrieved data, and estimated the causal relationship between gut microbiota and teratozoospermia based on the β value.

Results: Two-sample MR analysis indicated that the class Erysipelotrichia, family Erysipelotrichaceae, family Streptococcaceae, genus Coprococcusl, genus Ruminococcaceae UCG009, genus Streptococcus, order Clostridialesm and order Erysipelotrichales were causally related with the increased risk, while the family Porphyromonadaceae with the decreased risk of teratozoospermia.

Conclusion: The class Erysipelotrichia, family Erysipelotrichaceae, family Streptococcaceae, genus Coprococcusl, genus Ruminococcaceae UCG009, genus Streptococcus, order Clostridialesm and order Erysipelotrichales are one of the causes of teratozoospermia, related to the increased risk of the condition, while the family Porphyromonadaceae has a protective effect on sperm morphology, reducing the risk of teratozoospermia.