| ObjectiveFrom the theory of Chinese medicine,the main etiology,pathogenesis and treatment principles of oligo-asthenospermia with VC were clarified;the clinical efficacy of Bushen Huoxue Yulin Decoction in the treatment of oligoasthenospermia with VC was observed;A rat model of oligo-asthenospermia with VC was established,and based on TRPV4-VEGFR2-ERK1/2 signaling pathway,the therapeutic effect and mechanism of Bushen Huoxue Yulin Decoction on the rat model of oligo-asthenospermia with VC with renal deficiency and blood stasis were discussed,so as to provide clinical evidence for treatment.Methods1 Theoretical research:To clarify the relationship between oligoasthenospermia with VC and renal deficiency and blood stasis,explores how renal deficiency and blood stasis result in oligo-asthenospermia with VC,and clarifies the theoretical mechanism of Chinese and Western medicine method of nourish the kidneys and activate the blood in the treatment of oligoasthenospermia with VC.2 Clinical study:There were 60 patients with oligo-asthenospermia with VC with renal deficiency blood stasis who attended the outpatient department of Hubei University of Chinese Medicine and the Phoenix Clinic of Hubei Provincial Hospital of Traditional Chinese Medicine,with a time range from October 2020 to December 2022,and were randomly divided into 30 cases in the experimental group and 30 cases in the control group.The treatment group was given Bushen Huoxue Yulin Decoction,3 times/day;The control group was given Maizhiling,and adults took two tablets twice a day,and the course of treatment was 12 weeks.After treatment,the semen quality level,the change of spermatic vein vascular diameter,and the score of TCM symptoms were compared between the two groups before treatment and 3 months after treatment,and the efficacy of TCM was evaluated.3.Experimental study:There are forty-eight male SD rats which were randomly divided into 6 groups:blank group,model group,nourishing the kidney and activating the blood group,nourishing the kidney group,activating the blood group and western medicine group,and model group,nourishing the kidneys and activating the blood group,nourishing the kidneys group,activating the blood group and western medicine group were modeled by left renal vein coarctation for 8 weeks.Normal saline intervention was given to the group after eight weeks;Nourishing the kidneys and activating the blood group,nourishing the kidneys group,activating the blood group and western medicine group were given corresponding drug intervention for 4 weeks.After 12 weeks,the general condition of rats,changes in testis body weight and testicular coefficients,serum testosterone content,testicular tissue SOD and MDA content,sperm motility detection,rat testicular tissue HE staining,testicular cell apoptosis,testicular microvascular PECAM-1/CD31 immunofluorescence staining,RT-PCR and Western Blot method were observed to detect the expression of TRPV4-related factors in testicular tissue.Result1 Renal deficiency and blood stasis are of great significance in the pathogenesis of oligo-asthenospermia with VC,and nourishing the kidneys and activating the blood is the main treatment for oligo-asthenospermia with VC.2 Clinical study:A total of 60 cases were included in this study,except 6 cases were dropped off,and 54 cases completed treatment,27 cases in the treatment group and 27 cases in the control group completed 12 weeks of treatment.The age,course of disease,pre-treatment semen analysis and testicular ultrasound between the two groups were not statistically significant(P>0.05).After completing 12 weeks of treatment,the treatment group and the control group showed that the intra-group comparison results showed that the diameter of varicocele after the treatment of the two groups decreased compared with that before treatment,and the difference was statistically significant(P<0.05).However,the diameter of varicocele in the treatment group was lower than that in the control group after treatment,and the difference was statistically significant(P<0.05).In the group,there was no significant difference in semen volume after treatment,while sperm density and PR-grade sperm ratio decreased compared with before treatment,and the difference was statistically significant(P<0.05).Compared between the two groups,the sperm density and PR grade in the treatment group were significantly lower than those in the control group(P<0.05).Compared with before treatment,there were no significant changes in the scores of four TCM symptoms in the control group(P>0.05),and there were significant changes in the scores of other TCM symptoms and all TCM symptoms in the treatment group(P<0.05).Compared with the control group,the symptom scores of waist and knee soreness,insomnia and forgetfulness,frequent urination,dizziness,tinnitus and testicular pain in the treatment group were lower than those in the control group(P<0.05),while there were no significant differences in scrotal swelling and scrotal bruises exposed to TCM symptoms(P>0.05).Comparing the clinical efficacy of TCM between the two groups,it can be seen that the total effective rate of the treatment group is higher than that of the control group,and the difference is statistically significant(P<0.05).3.Experimental study:Compared with the blank group,the wet weight and testicular coefficient of the model group were significantly reduced(P<0.05);Compared with the VC model group,the testicular wet weight and testicular coefficient of the kidney tonifying and blood activating group,the kidney tonifying group and the blank group increased(P<0.05);Compared with the western medicine group,the testicular wet weight and testicular coefficient of the kidney tonifying and blood activating group increased(P<0.05),while the testicular wet weight and testicular coefficient of the kidney tonifying group did not change significantly(P>0.05).Compared with the blank group,the sperm activity of the model group decreased(P<0.05).After drug intervention,compared with the model group,the sperm activity of the kidney invigorating and blood activating group,the kidney invigorating and blood activating group,the blood activating group,and the western medicine group increased(P<0.05);Compared with the western medicine group,the sperm activity of the kidney tonifying and blood activating group was improved(P<0.05),but the difference between the kidney tonifying group and the blood activating group was not significant(P>0.0 5).From the results of PECAM-1/CD31 immunohistochemical staining,compared with the blank group,the expression of PECAM-1/CD31 in the testicular micro vascular endothelial cells of rats in the model group was intermittent,and the IA value was(1.56±0.39)×107,the expression level was significantly lower than that of the blank group(3.3 8±0.41)×107(P<0.01).Compared with the model group,the IA value of both the kidney invigorating and blood activating groups increased(P<0.05);Compared with the blank group,the relative content of TRPV4,VEGFR2 and ERK1/2 mRNA in the testicular tissue of rats in the model group upregulated significantly(P<0.05);Compared with the model group,the expression of TRPV4,VEGFR2 and ERK1/2 mRNA in the kidney invigorating and blood activating group was upregulated(P<0.05);Compared with the blank group,the expression of TRPV4,VEGFR2 and ERK1/2 protein in the testicular tissue of rats in the model group decreased significantly(P<0.05);Compared with the model group,the expression of TRPV4,VEGFR2 and ERK1/2 protein in testicular tissue of the kidney tonifying and blood activating group was up-regulated,with a statistically significant difference(P<0.05);Compared with the western medicine group,the expression of TRPV4,VEGFR2 and ERK1/2 protein in testicular tissue of the kidney invigorating and blood activating group was significantly upregulated(P<0.05).ConclusionThe main pathogenesis of oligo-asthenospermia with VC is kidney deficiency and blood stasis,and the method of tonifying kidney and activating blood is an effective treatment for oligo-asthenospermia with VC.Bushen Huoxue Yulin Decoction can relieve the related clinical symptoms and TCM symptoms of oligo-asthenospermia with VC of kidney deficiency and blood stasis type,and the efficacy is significantly better than that of Maizhiling,and at the same time can improve the semen quantity and vitality of oligoasthenospermia with VC with kidney deficiency and blood stasis o,and there are no obvious adverse reactions,safe and effective.Bushen Huoxue Yulin Decoction can alleviate testicular microcirculation disorders by mediating the TRPV4-VEGFR2-ERK1/2 signaling pathway in the microcirculation tissue of the testis of oligo-asthenospermia with VC,and upregulating the expression levels of TRPV4,VEGFR2 and ERK1/2,of which TRPV4 is the key target. |
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