辅酵素Q10在治疗男性不孕具正面意义


  Jan. 30, 2004 - 根据一份公开、不受管制的小规模实验研究,在1月份发行的生殖力与不孕症报导,辅酵素Q10 (CoQ10)的额外的用法,在治疗有自发性乏力精虫的无生殖能力男性方面扮演正面的角色。
  
  来自于意大利Ancona大学的Giancarlo Balercia, MD,和其同事指出,额外用法的正面效益可以被解释在生物工程学腺粒体中,CoQ10的众所周知困扰,和其广泛被认知的抗氧化性能基础上。
  
  研究对象选择22位有自发性乏力精虫的病人,介于25~ 39岁,平均年龄为31岁。接受实验的人们,至少有三年主要无生殖能力的临床病史,除医疗筛检以外,研究人员使用Prader's的orchidometer(栽培兰花的测量仪器),测量接受实验者的睾丸体积。
  
  合格的判断标准包括,(1)精液总量多于20 x 106/毫升,精虫的能动性(向前能动性,根据世界健康组织 [WHO] 1999 的标准,等级分a和b。),在两个明显的精虫分析少于50%,且标准的精虫形态比50%还棒;(2)精液的白血球细胞(WBCs)少于1 x 106/毫升,阴性的精液培养和发现衣原体及类菌质体 ureoliticum;(3)正常的血清促性线激素的值为T、E2和 PRL;(4)没有传染性的生殖器疾病、生殖器道的结构异常,包括精索静脉曲张和 antispermatozoa抗体(Ab);(5)在目前研究纪录的前三个月期间,没有其它药物治疗身体组织的疾病;(6)没有抽烟、酒精、药物上瘾或职业上的化学药品暴露。
  
  研究者使用前后倒置的输卵管切除手术,用来排除在女性伙伴中反常的输卵管解剖,排卵也被认为是正常的。
  
  病人使用口服的CoQ10六个月,一天两次每次200毫克。研究者在终止治疗以后的六个月内,完成了临床的测试检查,精液的分析包括计算机辅助的精液分析(CASA)、和 CoQ10 以及 phosphatidylcho在基准线的化验。
  
  治疗以后,在精液的原生质中CoQ10 值增加,值得注意的是,在服用CoQ10六个月以后( P < 0.005)从基准线42.0 ± 5.1 ng /毫升到 127.1 ± 1.9 ng /毫升,同时研究者也在精虫细胞中里查觉CoQ10显著的增加 (从 3.1 ± 0.4 到 6.5 ± 0.3 ng/106 细胞,P < 0.05)。
  
  在精液的原生质中和精虫细胞明显增加的Phosphatidylcho值(分别地从 1.49 ± 0.50 到 5.84 ±μ 1.15 M;P < 0.05 ; 和从 6.83 ± 0.98 到 9.67 ± 1.23 个 nmol /106 细胞,P < 0.05 ,)。之前的精精动能性(等级a+b),在六个月以后,从9.13% ± 2.50%增加到16.34% ±3.43%,( P <0.05)。调查人员也发现,治疗以后,明显的曲线快速增加 ( VCL ) ,(从 26.31 ± 1.50 到 46.43 ± 2.28 μM / second; P < 0.05 )和直线的进步速度 (VSL),(从 15.20 ± 1.30 到 20.40 ±- 2.17 μM / second; P < 0.05)。
  
  调查人使用 Cramer's协会的指标,在相对变化中间找到了正面的倚赖性、基准线和在治疗以后精液的原生质中和精精虫细胞内CoQ10 的量和 VCL 及VSL 的运动参数分别是Cramer's V = 0.4637 ,0.3818 , 0.3467 , 0.5148。 在停止后的六个月,调查人员发现了精虫的向前能动性明显的减少,从 16.34% μ 3.43% 到 9.50% μ 2.28% , P < 0.001 。
  
  三对夫妇 ( 13.6% ) 在疗法非连续的三个月之内完成了自发怀孕,显示CoQ10口服剂可为病人身体良好接受。
  
  Balercia 博士和同事们表示,目前人工与计算机辅助的研究资料显示,在服用CoQ10六个月以后,精虫细胞内的运动特性会明显的增加。此外这个结果也首次证明,额外服用CoQ10可以导致精液原生质和精虫细胞值增加。

Coenzyme Q10 May Play Positive

By Mindy Hung, Medical Writer
Medscape Medical News

Jan. 30, 2004 — Exogenous administration of coenzyme Q10 (CoQ10) may play a positive role in the treatment of infertile men with idiopathic asthenozoospermia, according to results of an open, uncontrolled pilot study published in the January issue of Fertility and Sterility.

"The positive effect of exogenous administration could be explained on the basis of the well-known involvement of CoQ10 in mitochondrial bioenergetics and of its widely recognized antioxidant properties," write Giancarlo Balercia, MD, and colleagues, from the University of Ancona in Italy.

Investigators selected 22 patients (mean age, 31 years; range, 25-39 years) with idiopathic asthenozoospermia. Subjects had a clinical history of primary intertility of at least three years. In addition to medical screening, researchers measured subjects' testicular volume using Prader's orchidometer.

Eligiblity criteria included (1) sperm count greater than 20 x 106/mL, sperm motility (forward motility, class a and b, according to World Health Organization [WHO] 1999 criteria) less than 50% at two distinct sperm analyses, and normal sperm morphology greater than 50%; (2) seminal white blood cells (WBCs) less than 1 x 106/mL, negative sperm culture, and Chlamydia and Mycoplasma ureoliticum detection; (3) normal serum levels of gonadotropins, T, E2, and PRL; (4) absence of infectious genital diseases, anatomical abnormalities of the genital tract including varicocele, and antispermatozoa antibodies (Ab); (5) absence of systemic diseases or treatment with other drugs during the three months before enrollment in the present study; and (6) absence of smoking, alcohol, drug addiction, or occupational chemical exposure.

Researchers employed hysterosalpingography to rule out abnormal fallopian tube anatomy in female partners. Ovulation was also deemed normal.

Patients underwent oral administration of CoQ10, 200 mg/day twice daily for six months. Researchers performed clinical examination, semen analysis including computer-assisted sperm analysis (CASA), and CoQ10 and phosphatidylcholine assays at baseline, after six months of therapy, and six months after termination (washout).

After treatment, CoQ10 levels increased in seminal plasma; the mean value rising significantly from 42.0 ± 5.1 ng/mL at baseline to 127.1 ± 1.9 ng/mL after six months of CoQ10 administration (P < .005). Researchers also detected a significant increase of CoQ10 content in sperm cells (from 3.1 ± 0.4 to 6.5 ± 0.3 ng/106 cells; P < .05).

Phosphatidylcholine levels increased significantly both in seminal plasma and sperm cells after treatment (from 1.49 ± 0.50 to 5.84 ± 1.15 µm; P < .05; and from 6.83 ± 0.98 to 9.67 ± 1.23 nmol/106 cells; P < .05, respectively)

Forward (class a+b) motility of sperm cells went from 9.13% ± 2.50% to 16.34% ± 3.43% after six months (P < .05). Investigators also found a significant increase of curvilinear velocity (VCL) (from 26.31 ± 1.50 to 46.43 ± 2.28 µm/second; P < .05) and straight progressive velocity (VSL) (from 15.20 ± 1.30 to 20.40 ± -2.17 µm/second; P < .05) after treatment.

Using the Cramer's index of association, the investigators found a positive dependence among the relative variations, baseline and after treatment, of seminal plasma or intracellular CoQ10 content and of VCL and VSL kinetic parameters (Cramer's V = 0.4637, 0.3818, 0.3467, and 0.5148, respectively). After six months of washout, the investigators found a significant reduction in sperm forward motility (from 16.34% µ 3.43% to 9.50% µ 2.28%; P < .001).

CoQ10 oral administration was well tolerated. Three couples (13.6%) achieved spontaneous pregnancy within three months of discontinuation of therapy.

"The data of the present study show a significant improvement of sperm cell kinetic features after 6 months of administration of CoQ10, on the basis of both manual and computer- assisted evaluation," write Dr. Balercia and colleagues.

"Furthermore, our results are the first to demonstrate that exogenous administration of CoQ10 leads to increased levels in seminal plasma and in sperm cells."

Fertil Steril. 2004;81:93-98

Reviewed by Gary D. Vogin, MD

    
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