Objective: To investigate the effect of alpha-lipoic acid (α-LA) combined with tamoxifen citrate (TC) in the treatment of oligoasthenospermia.
Methods: From June to November 2016, we treated 60 patients with oligoasthenospermia in our Department of Andrology, 30 (the trial group) with oral α-LA (0.6 g, qd) + TC (20 mg, qd) and the other 30 (the control group) with oral L-carnitine (1g, bid) + TC (20 mg, qd). Before and after 3 months of medication, we examined the semen parameters of the patients and the levels of their seminal oxidative stress biomarkers, including methylenedioxyamphetamine (MDA) and total antioxidant capacity (TAC) in the seminal plasma. We also compared the pregnancy rate and adverse reactions between the two groups.
Results: Totally, 57 of the patients completed the treatment, 28 in the trial group and 29 in the control. Compared with the baseline, the patients of the trial group showed significant improvement after 3 months of medication in the semen volume (［2.50 ± 0.71］ vs ［3.37 ± 0.70］ ml, P <0.05), sperm concentration (［12.00 ± 1.65］ vs ［19.34 ± 2.04］ ×10⁶/ml, P <0.05), percentage of progressively motile sperm (PMS) (［18.01 ± 3.01］% vs ［35.41 ± 6.49］%, P<0.05), MDA level (［14.96 ± 2.76］ vs ［10.04 ± 1.04］ nmol/ml, P <0.05), and TAC in the seminal plasma (［9.83 ± 1.02］ vs ［12.25 ± 1.11］ U/ml, P <0.05), and so did the controls in the semen volume (［2.76 ± 0.67］ vs ［3.36 ± 0.93］ ml, P <0.05), sperm concentration (［11.47 ± 1.10］ vs ［17.77 ± 3.56］ ×10⁶/ml, P <0.05), percentage of PMS (［19.22 ± 1.41］ vs ［36.01 ± 5.22］ %, P <0.05), MDA level (［14.66 ± 2.75］ vs ［10.14 ± 1.01］ nmol/ml, P <0.05), and TAC in the seminal plasma (［9.84 ± 0.90］ vs ［11.14 ± 0.84］ U/ml, P <0.05). There were no statistically significant differences in the above post-medication parameters between the trial and control groups (P >0.05) except in TAC, which was markedly more improved in the former than in the latter (P <0.05), nor in the percentage of morphologically normal sperm before and after treatment in either of the two groups (P >0.05). After 3 months of treatment, 3 pregnancies were achieved in the trial group and 1 in the control (10.7% vs 3.45%, P >0.05). No obvious adverse events occurred during the treatment.
Conclusions: Alpha-lipoic acid combined with tamoxifen citrate can evidently improve semen parameters in oligoasthenospermia patients by relieving oxidative stress injury.
目的： 观察α-硫辛酸胶囊联合枸橼酸他莫昔芬片对少弱精子症患者的疗效。方法： 选择2016年6~11月就诊的60例少弱精子症患者，将其随机分为2组，每组30例。治疗组给予α-硫辛酸胶囊（0.6 g， 1次/d）联合枸橼酸他莫昔芬片（20 mg，1次/d）口服治疗，对照组给予左卡尼汀口服液(1 g， 2次/d)联合枸橼酸他莫昔芬片（20 mg， 1次/d）口服治疗，治疗前及治疗后3个月检测所有病例精液参数及精液氧化应激生物标志物，包括丙二醛（MDA），总抗氧能力（TAC）水平，同时了解配偶妊娠率及不良反应发生情况。结果： 57例患者完成了全部治疗，包括治疗组28例，对照组29例。治疗组治疗前、后精液量分别为(2.50±0.71) ml、 (3.37±0.70) ml，精子浓度 (12.00±1.65) ×10⁶/ml、 (19.34±2.04) ×10⁶/ml，前向运动精子百分率 (18.01±3.01) %、 (35.41±6.49)%，精浆TAC (9.83±1.02) U/ml、 (12.25±1.11)U/ml，MDA (14.96±2.76) nmol/ml、 (10.04±1.04) nmol/ml；对照组治疗前、后精液量分别为(2.76±0.67) ml、(3.36±0.93) ml，精子浓度(11.47±1.10) ×10⁶/ml、(17.77±3.56)×10⁶/ml，前向运动精子百分率(19.22±1.41)%、 (36.01±5.22)%、精浆TAC (9.84±0.90) U/ml、 (11.14±0.84)U/ml，MDA (14.66±2.75) nmol/ml、(10.14±1.01) nmol/ml，上述各指标两组治疗后均较治疗前有显著改善(P< 0.05)，精浆TAC改善方面治疗组优于对照组（P< 0. 05），其余指标两组之间差异无统计学意义（P> 0.05），两组正常形态精子百分率治疗前后无统计学差异（P> 0.05）。治疗3个月后配偶妊娠，治疗组3例(10.7%)，对照组1例(3.45%)，两组比较差异无统计学意义（P> 0.05），治疗期间所有患者均未见明显不良反应。结论： α-硫辛酸胶囊联合枸橼酸他莫昔芬片可明显改善精浆氧化应激损伤，进而改善少弱精子症患者的精液质量。.
Keywords: L-carnitine; oligoasthenospermia; oxidative stress; tamoxifen citrate; lipoic acid.