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Эффективность сперматопротективной терапии на основе Селцинка плюс у больных туберкулезом предстательной железы
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Kulchavenya E.V., Osadchiy A.V. The effectiveness of therapy based on sperm-protective Selzink plus in patients with tuberculosis of the prostate. Consilium Medicum. 2016; 18 (7): 22–26. DOI: 10.26442/2075-1753_2016.7.22-26
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Цель исследования – разработать и апробировать способ восстановления/сохранения фертильности больных туберкулезом ПЖ и оценить его эффективность.
Материал и методы. Проведено открытое проспективное сравнительное рандомизированное исследование, в которое были включены 72 больных туберкулезом ПЖ. Пациенты основной группы (n=49) получали стандартное противотуберкулезное лечение в комплексе с патогенетической сперматопротективной терапией, включавшей Селцинк плюс и хорионический гонадотропин. В группе сравнения (n=23) мужчины получали только этиотропное противотуберкулезное лечение.
Результаты. Противотуберкулезная химиотерапия оказала негативное влияние на эякулят: 2-месячный прием препаратов в группе сравнения обусловил уменьшение числа сперматозоидов на 23,9%, числа активно подвижных форм сперматозоидов – на 10,6%, числа нормальных спермиев – на 32,3%. Проведение патогенетической сперматопротективной терапии способствовало увеличению числа сперматозоидов на 47,8%, числа активно подвижных форм сперматозоидов (суммарно группы А и В) – на 40,5%, количества нормальных форм спермиев – на 41,9%.
Выводы. Сперматопротективная терапия, включающая Селцинк плюс и хорионический гонадотропин, позволяет достоверно повысить фертильность эякулята. Необходим длительный прием препаратов для предотвращения негативных последствий туберкулезного воспаления и противотуберкулезной терапии в отношении сперматогенеза.
Ключевые слова: туберкулез предстательной железы, химиотерапия, селен, цинк, Селцинк, бесплодие, спермограмма, эякулят, урогенитальный туберкулез, противотуберкулезная терапия, простатит, патогенетическая терапия.
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Material and methods. An open, prospective, comparative, randomized study in which 72 patients with pancreatic tuberculosis were included. Patients of the main group (n=49) received standard tuberculosis (TB) treatment in combination with pathogenetic spermatoprotektivnoy therapy include Selzink plus and chorionic gonadotropin. The comparison group (n=23) received only men etiotropic TB treatment.
Results. Treatment for TB had a negative effect on the ejaculate 2-month administration of drugs in the comparison group led to a decrease in sperm count of 23.9%, the number of actively motile sperm forms – by 10.6%, the number of normal spermatozoa – by 32.3%. Carrying sperm-protective pathogenetic therapy helped to increase the number of sperm by 47.8%, the number of active mobile forms of spermatozoa (total of A and B) – by 40.5%, the number of normal sperm forms – by 41.9%.
Conclusions. Sperm-protective therapy including Selzink plus and human chorionic gonadotropin, allows to significantly increase the fertility of an ejaculate. We need long-term use of drugs to prevent the negative effects of tuberculous inflammation and TB treatment in respect of spermatogenesis.
Key words: tuberculosis of the prostate, chemotherapy, selenium, zinc, Selzink, infertility, semen, ejaculate, urogenital tuberculosis, anti-tuberculosis therapy, prostatitis, pathogenetic therapy.
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4. Goodarzi D, Cyrus A, Baghinia MR et al. The efficacy of zinc for treatment of chronic prostatitis. Acta Med Indones 2013; 45 (4): 259–64.
5. Ludwig M, Dimitrakov J, Diemer T et al. Prostatitis syndrome. Changes in the ejaculate and effects on fertility. Urologe A 2001; 40 (1): 18–23.
6. Cai T, Wagenlehner FM, Mondaini N et al. Effect of human papillomavirus and Chlamydia trachomatis co-infection on sperm quality in young heterosexual men with chronic prostatitis-related symptoms. BJU Int 2014; 113 (2): 281–7. doi: 10.1111/bju.12244
7. Ivanov IB, Gritsenko VA, Kuzmin MD. Phenotypic differences between coagulase-negative staphylococci isolated from seminal fluid of healthy men and men suffering from chronic prostatitis syndrome. Int J Androl 2010; 33 (3): 563–7. doi: 10.1111/j.1365-2605.2009.00969.x
8. Dohle GR. Inflammatory-associated obstructions of the male reproductive tract. Andrologia 2003; 35 (5): 321–4.
9. Zhao H, Shen JH, Chen YP et al. Changes of seminal parameters, zinc concentration and antibacterial activity in patients with non-inflammatory chronic prostatitis/chronic pelvic pain syndrome. Zhonghua Nan Ke Xue 2008; 14 (6): 530–2.
10. Flibotte JJ, Lee GE, Buser GL et al. Infertility, in vitro fertilization and congenital tuberculosis. J Perinatol 2013; 33 (7): 565–8. doi: 10.1038/jp.2012.146
11. Perletti G, Marras E, Wagenlehner FM, Magri V. Antimicrobial therapy for chronic bacterial prostatitis. Cochrane Database Syst Rev 2013; 8: CD009071. doi: 10.1002/14651858.CD009071.pub2
12. Yanushpolsky EH, Politch JA, Hill JA, Anderson DJ. Is leukocytospermia clinically relevant? Fertil Steril 1996; 66 (5): 822–5.
13. Domes T, Lo KC, Grober ED et al. The incidence and effect of bacteriospermia and elevated seminal leukocytes on semen parameters. Fertil Steril 2012; 97 (5): 1050–5. doi: 10.1016/j.fertnstert.2012.01.124
14. Кульчавеня Е.В., Неймарк А.И. Простатит. Диагностика и лечение: руководство. М.: ГЭОТАР-Медиа, 2010. / Kulchavenya E.V., Neimark A.I. Prostatit. Diagnostika i lechenie: rukovodstvo. M.: GEOTAR-Media, 2010. [in Russian]
15. Kulchavenya E. Best practice in the diagnosis and management of Urogenital Tuberculosis. Ther Adv Urol 2013; 5 (3): 143–51. doi: 10.1177/1756287213476128
16. Кульчавеня Е.В., Бреусов А.А. Эффективность уро-ваксома при рецидивирующих инфекционно-воспалительных заболеваниях мочеполовой системы. Урология. 2011; 4: 7–11. / Kulchavenya E.V., Breusov A.A. Effektivnost' uro-vaksoma pri retsidiviruiushchikh infektsionno-vospalitel'nykh zabolevaniiakh mochepolovoi sistemy. Urologiia. 2011; 4: 7–11. [in Russian]
17. Mirone M, Giannetta E, Isidori AM. Selenium and reproductive function. A systematic review. J Endocrinol Invest 2013; 36 (10 Suppl): 28–36.
18. Walczak-Jedrzejowska R, Wolski JK, Slowikowska-Hilczer J. The role of oxidative stress and antioxidants in male fertility. Cent European J Urol 2013; 66 (1): 60–7. doi: 10.5173/ceju.2013.01.art19
19. Мохирева Л.В., Богадельникова И.В. Биологическая роль цинка в организме человека. Туберкулез и болезни легких. 2011; 7: 3–10. / Mokhireva L.V., Bogadel'nikova I.V. Biologicheskaia rol' tsinka v organizme cheloveka. Tuberkulez i bolezni legkikh. 2011; 7: 3–10. [in Russian]
20. Lombardo F, Fiducia M, Lunghi R et al. Effects of a dietary supplement on chronic pelvic pain syndrome (Category IIIA), leucocytospermia and semen parameters. Andrologia 2012; 44 (Suppl. 1): 672–8. doi: 10.1111/j.1439-0272.2011.01248.x
21. Witkowska-Zimny M, Gunerka A, Wietrak E et al. Verification of the effectiveness of the dietary supplementation in infertility treatment. Pol Merkur Lekarski 2013; 35 (210): 347–51.
22. Eslamian G, Amirjannati N, Rashidkhani B et al. Nutrient patterns and asthenozoospermia: a case-control study. Andrologia 2016. doi: 10.1111/and.12624. [Epub ahead of print]
23. Ansar S, Abudawood M, Hamed SS, Aleem MM. Sodium Selenite Protects Against Silver Nanoparticle-Induced Testicular Toxicity and Inflammation. Biol Trace Elem Res 2016. [Epub ahead of print]
24. Russo A, Capogrosso P, La Croce G et al. Serenoa repens, selenium and lycopene to manage lower urinary tract symptoms suggestive for benign prostatic hyperplasia. Expert Opin Drug Saf 2016 Jun 1: 1–10. [Epub ahead of print]
25. Zhu C, Ling Q, Cai Z et al. Selenium (Se) containing phycocyanin from Se-enriched Spirulina platensis reduces inflammation in DSS-induced colitis by inhibiting NF-κB activation. J Agric Food Chem 2016. [Epub ahead of print]
26. Amin KA, Hashem KS, Alshehri FS et al. Antioxidant and Hepatoprotective Efficiency of Selenium Nanoparticles Against Acetaminophen-Induced Hepatic Damage. Biol Trace Elem Res 2016. [Epub ahead of print]
27. Bierla K, Flis-Borsuk A, Suchocki P et al. Speciation of selenium in selenium-enriched sunflower oil by HPLC-ICP MS/electrospray – Orbitrap MS/MS. J Agric Food Chem 2016. [Epub ahead of print]
28. Sun JW, Shu XO, Li HL et al. Dietary selenium intake and mortality in two population-based cohort studies of 133 957 Chinese men and women. Public Health Nutr. 2016 May 20: 1–8. [Epub ahead of print]
29. Chan JM, Darke AK, Penney KL et al. Selenium- or vitamin E-related gene variants, interaction with supplementation, and risk of high-grade prostate cancer in SELECT. Cancer Epidemiol Biomarkers Pre 2016. pii: cebp.0104.2016. [Epub ahead of print]
30. Magri V, Marras E, Restelli A et al. Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients. Exp Ther Med 2015; 9 (3): 658–66. Epub 2014 Dec 19.
31. Kim HW, Ha US, Woo JC et al. Preventive effect of selenium on chronic bacterial prostatitis. J Infect Chemother 2012; 18 (1): 30–4. doi: 10.1007/s10156-011-0276-4
32. Попова В.В., Кожин А.И., Афонин А.А. и др. Комплексная терапия функциональной задержки полового развития у мальчиков-подростков. Врач. 2015; 3: 50–3. / Popova V.V., Kozhin A.I., Afonin A.A. i dr. Kompleksnaia terapiia funktsional'noi zaderzhki polovogo razvitiia u mal'chikov-podrostkov. Vrach. 2015; 3: 50–3. [in Russian]
33. Неймарк А.И., Клепикова И.И. Применение препарата Cелцинк плюс у мужчин с нарушением фертильности. Андрология и генитальная хирургия. 2013; 4: 77–80. / Neimark A.I., Klepikova I.I. Primenenie preparata Celtsink plius u muzhchin s narusheniem fertil'nosti. Andrologiia i genital'naia khirurgiia. 2013; 4: 77–80. [in Russian]
34. Сивков А.В., Ощепков В.Н., Евдокимов В.В. и др. Применение препарата Селцинк Плюс у больных хроническим неинфекционным простатитом и нарушениями фертильности. Урология. 2011; 5: 27–33. / Sivkov A.V., Oshchepkov V.N., Evdokimov V.V. i dr. Primenenie preparata Seltsink Plius u bol'nykh khronicheskim neinfektsionnym prostatitom i narusheniiami fertil'nosti. Urologiia. 2011; 5: 27–33. [in Russian]
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1. Kulchavenya E.V., Brizhatiuk E.V., Khomiakov V.T. Tuberkulez ekstratorakal'nykh lokalizatsii v Sibiri i na Dal'nem Vostoke. Tuberkulez i bolezni legkikh. 2005; 6: 23–5. [in Russian]
2. Kulchavenya E.V., Brizhatiuk E.V., Koveshnikova E.Iu., Sveshnikova N.N. Novye tendentsii v epidemicheskoi situatsii po tuberkulezu ekstratorakal'nykh lokalizatsii v Sibiri i na Dal'nem Vostoke. Tuberkulez i bolezni legkikh. 2009; 10: 27–31. [in Russian]
3. Zhukova I.I., Kulchavenya E.V., Kholtobin D.P. Tuberkulez mochepolovoi sistemy segodnia. Urologiia. 2013; 1: 13–6. [in Russian]
4. Goodarzi D, Cyrus A, Baghinia MR et al. The efficacy of zinc for treatment of chronic prostatitis. Acta Med Indones 2013; 45 (4): 259–64.
5. Ludwig M, Dimitrakov J, Diemer T et al. Prostatitis syndrome. Changes in the ejaculate and effects on fertility. Urologe A 2001; 40 (1): 18–23.
6. Cai T, Wagenlehner FM, Mondaini N et al. Effect of human papillomavirus and Chlamydia trachomatis co-infection on sperm quality in young heterosexual men with chronic prostatitis-related symptoms. BJU Int 2014; 113 (2): 281–7. doi: 10.1111/bju.12244
7. Ivanov IB, Gritsenko VA, Kuzmin MD. Phenotypic differences between coagulase-negative staphylococci isolated from seminal fluid of healthy men and men suffering from chronic prostatitis syndrome. Int J Androl 2010; 33 (3): 563–7. doi: 10.1111/j.1365-2605.2009.00969.x
8. Dohle GR. Inflammatory-associated obstructions of the male reproductive tract. Andrologia 2003; 35 (5): 321–4.
9. Zhao H, Shen JH, Chen YP et al. Changes of seminal parameters, zinc concentration and antibacterial activity in patients with non-inflammatory chronic prostatitis/chronic pelvic pain syndrome. Zhonghua Nan Ke Xue 2008; 14 (6): 530–2.
10. Flibotte JJ, Lee GE, Buser GL et al. Infertility, in vitro fertilization and congenital tuberculosis. J Perinatol 2013; 33 (7): 565–8. doi: 10.1038/jp.2012.146
11. Perletti G, Marras E, Wagenlehner FM, Magri V. Antimicrobial therapy for chronic bacterial prostatitis. Cochrane Database Syst Rev 2013; 8: CD009071. doi: 10.1002/14651858.CD009071.pub2
12. Yanushpolsky EH, Politch JA, Hill JA, Anderson DJ. Is leukocytospermia clinically relevant? Fertil Steril 1996; 66 (5): 822–5.
13. Domes T, Lo KC, Grober ED et al. The incidence and effect of bacteriospermia and elevated seminal leukocytes on semen parameters. Fertil Steril 2012; 97 (5): 1050–5. doi: 10.1016/j.fertnstert.2012.01.124
14. Kulchavenya E.V., Neimark A.I. Prostatit. Diagnostika i lechenie: rukovodstvo. M.: GEOTAR-Media, 2010. [in Russian]
15. Kulchavenya E. Best practice in the diagnosis and management of Urogenital Tuberculosis. Ther Adv Urol 2013; 5 (3): 143–51. doi: 10.1177/1756287213476128
16. Kulchavenya E.V., Breusov A.A. Effektivnost' uro-vaksoma pri retsidiviruiushchikh infektsionno-vospalitel'nykh zabolevaniiakh mochepolovoi sistemy. Urologiia. 2011; 4: 7–11. [in Russian]
17. Mirone M, Giannetta E, Isidori AM. Selenium and reproductive function. A systematic review. J Endocrinol Invest 2013; 36 (10 Suppl): 28–36.
18. Walczak-Jedrzejowska R, Wolski JK, Slowikowska-Hilczer J. The role of oxidative stress and antioxidants in male fertility. Cent European J Urol 2013; 66 (1): 60–7. doi: 10.5173/ceju.2013.01.art19
19. Mokhireva L.V., Bogadel'nikova I.V. Biologicheskaia rol' tsinka v organizme cheloveka. Tuberkulez i bolezni legkikh. 2011; 7: 3–10. [in Russian]
20. Lombardo F, Fiducia M, Lunghi R et al. Effects of a dietary supplement on chronic pelvic pain syndrome (Category IIIA), leucocytospermia and semen parameters. Andrologia 2012; 44 (Suppl. 1): 672–8. doi: 10.1111/j.1439-0272.2011.01248.x
21. Witkowska-Zimny M, Gunerka A, Wietrak E et al. Verification of the effectiveness of the dietary supplementation in infertility treatment. Pol Merkur Lekarski 2013; 35 (210): 347–51.
22. Eslamian G, Amirjannati N, Rashidkhani B et al. Nutrient patterns and asthenozoospermia: a case-control study. Andrologia 2016. doi: 10.1111/and.12624. [Epub ahead of print]
23. Ansar S, Abudawood M, Hamed SS, Aleem MM. Sodium Selenite Protects Against Silver Nanoparticle-Induced Testicular Toxicity and Inflammation. Biol Trace Elem Res 2016. [Epub ahead of print]
24. Russo A, Capogrosso P, La Croce G et al. Serenoa repens, selenium and lycopene to manage lower urinary tract symptoms suggestive for benign prostatic hyperplasia. Expert Opin Drug Saf 2016 Jun 1: 1–10. [Epub ahead of print]
25. Zhu C, Ling Q, Cai Z et al. Selenium (Se) containing phycocyanin from Se-enriched Spirulina platensis reduces inflammation in DSS-induced colitis by inhibiting NF-κB activation. J Agric Food Chem 2016. [Epub ahead of print]
26. Amin KA, Hashem KS, Alshehri FS et al. Antioxidant and Hepatoprotective Efficiency of Selenium Nanoparticles Against Acetaminophen-Induced Hepatic Damage. Biol Trace Elem Res 2016. [Epub ahead of print]
27. Bierla K, Flis-Borsuk A, Suchocki P et al. Speciation of selenium in selenium-enriched sunflower oil by HPLC-ICP MS/electrospray – Orbitrap MS/MS. J Agric Food Chem 2016. [Epub ahead of print]
28. Sun JW, Shu XO, Li HL et al. Dietary selenium intake and mortality in two population-based cohort studies of 133 957 Chinese men and women. Public Health Nutr. 2016 May 20: 1–8. [Epub ahead of print]
29. Chan JM, Darke AK, Penney KL et al. Selenium- or vitamin E-related gene variants, interaction with supplementation, and risk of high-grade prostate cancer in SELECT. Cancer Epidemiol Biomarkers Pre 2016. pii: cebp.0104.2016. [Epub ahead of print]
30. Magri V, Marras E, Restelli A et al. Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients. Exp Ther Med 2015; 9 (3): 658–66. Epub 2014 Dec 19.
31. Kim HW, Ha US, Woo JC et al. Preventive effect of selenium on chronic bacterial prostatitis. J Infect Chemother 2012; 18 (1): 30–4. doi: 10.1007/s10156-011-0276-4
32. Popova V.V., Kozhin A.I., Afonin A.A. i dr. Kompleksnaia terapiia funktsional'noi zaderzhki polovogo razvitiia u mal'chikov-podrostkov. Vrach. 2015; 3: 50–3. [in Russian]
33. Neimark A.I., Klepikova I.I. Primenenie preparata Celtsink plius u muzhchin s narusheniem fertil'nosti. Andrologiia i genital'naia khirurgiia. 2013; 4: 77–80. [in Russian]
34. Sivkov A.V., Oshchepkov V.N., Evdokimov V.V. i dr. Primenenie preparata Seltsink Plius u bol'nykh khronicheskim neinfektsionnym prostatitom i narusheniiami fertil'nosti. Urologiia. 2011; 5: 27–33. [in Russian]
1 ФГБУ Новосибирский НИИ туберкулеза Минздрава России. 630040, Россия, Новосибирск, ул. Охотская, д. 81а;
2 ГБОУ ВПО Новосибирский государственный медицинский университет Минздрава России. 630091, Россия, Новосибирск, Красный пр-т, д. 52
*urotub@yandex.ru
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1 Novosibirsk Research Institute of Tuberculosis of the Ministry of Health of the Russian Federation. 630040, Russian Federation, Novosibirsk, ul. Okhotskaia, d. 81a;
2 Novosibirsk State Medical University of the Ministry of Health of the Russian Federation. 630091, Russian Federation, Novosibirsk, Krasnyi pr-t, d. 52
*urotub@yandex.ru