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磷酸二酯酶-5抑制剂对男性不育治疗的影响：一项系统评价和荟萃分析。

Effect of Phosphodiesterase-5 Inhibitors on the Treatment of Male Infertility: A Systematic Review and Meta-Analysis.

作者信息

Dong Liang, Zhang Xiaojin, Yan Xuhong, Shen Yifeng, Li Yulin, Yu Xujun

机构信息

TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P. R. China.

Department of Andrology, School of Medical and Life Sciences/Reproductive & Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P. R. China.

出版信息

World J Mens Health. 2021 Oct;39(4):776-796. doi: 10.5534/wjmh.200155. Epub 2021 Feb 24.

DOI:10.5534/wjmh.200155
PMID:33663030
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8443990/
Abstract

PURPOSE

Male infertility is a worldwide problem with limitations in the treatment. Phosphodiesterase-5 inhibitors (PDE5is) is the first choice for the treatment of erectile dysfunction, more and more studies show that it has a certain effect on male infertility in recent years. But there was currently no high quality of systematic review to evaluate the effects of PDE5is on semen quality.

MATERIALS AND METHODS

We retrieved the electronic databases of MEDLINE, PubMed, Web of Science, EMBASE, Related randomized controlled trials (RCTs) were collected and selected up to May 20, 2020. We have searched literature with terms "male infertility", "phosphodiesterase-5 inhibitors", "PDE5i", "Tadalafil", "Sildenafil", "Vardenafil", "Udenafil", "Avanafil", "semen", and "sperm". Mean value and its standard deviation were used to perform quantitative analysis. All statistical analyses were conducted by RevMan 5.3 and Stata software.

RESULTS

There were a total of 1,121 participants in the nine included studies. There was a statistically significant improvement treated with PDE5is compared with sham therapy, which including sperm concentration (mean difference [MD]=1.96, 95% confidence interval [CI]=1.70-2.21, p<0.001; MD=3.22, 95% CI=1.96-4.48, p<0.001), straight progressive motility (%) Grade A (MD=3.71, 95% CI=2.21-5.20, p<0.001), sperm motility (MD=8.09, 95% CI=7.83-8.36, p<0.001), morphologically normal spermatozoa (%) (MD=0.67, 95% CI=0.20-1.15, p=0.005; MD=1.27, 95% CI=0.02-2.52, p=0.05), sperm abnormalities (%) (MD=-0.64, 95% CI=-0.81--0.47, p<0.001), and progressive motile sperm (MD=5.34, 95% CI=3.87-6.81, p<0.001).

CONCLUSIONS

In this meta-analysis of nine RCTs, treatment with PDE5is could improve some indicators of male sperm.

摘要

目的

男性不育是一个全球性问题，治疗存在局限性。磷酸二酯酶5抑制剂（PDE5is）是治疗勃起功能障碍的首选药物，近年来越来越多的研究表明其对男性不育有一定疗效。但目前尚无高质量的系统评价来评估PDE5is对精液质量的影响。

材料与方法

检索MEDLINE、PubMed、Web of Science、EMBASE等电子数据库，收集并筛选截至2020年5月20日的相关随机对照试验（RCTs）。我们使用了“男性不育”“磷酸二酯酶5抑制剂”“PDE5i”“他达拉非”“西地那非”“伐地那非”“乌地那非”“阿伐那非”“精液”和“精子”等检索词。采用均值及其标准差进行定量分析。所有统计分析均通过RevMan 5.3和Stata软件进行。

结果

9项纳入研究共有1121名参与者。与假治疗相比，PDE5is治疗有统计学显著改善，包括精子浓度（平均差[MD]=1.96，95%置信区间[CI]=1.70 - 2.21，p<0.001；MD=3.22，95% CI=1.96 - 4.48，p<0.001）、直线前向运动率（A级）（MD=3.71，95% CI=2.21 - 5.20，p<0.001）、精子活力（MD=8.09，95% CI=7.83 - 8.36，p<0.001）、形态正常精子百分比（MD=0.67，95% CI=0.20 - 1.15，p=0.005；MD=1.27，95% CI=0.02 - 2.52，p=0.05）、精子异常百分比（MD=-0.64，95% CI=-0.81 - -0.47，p<0.001）和前向运动精子（MD=5.34，95% CI=3.87 - 6.81，p<0.001）。

结论

在这项对9项RCTs的荟萃分析中，PDE5is治疗可改善男性精子的一些指标。

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