低强度激光疗法治疗男性生殖与性功能障碍

doi:10.19723/j.issn.1671-167X.2025.04.001

摘要/Abstract

摘要：

低强度激光疗法(low-level laser therapy, LLLT)常用波长600~1 000 nm, 功率5~500 mW, 为红光或近红外光(near-infrared, NIR)。LLLT作为一种非侵入性治疗方式, 作用于细胞色素C氧化酶(cytochrome C oxidase, CCO)等靶点, 激活PI3K/Akt、MAPK/ERK等信号通路, 增强线粒体三磷酸腺苷(adenosine triphosphate, ATP)合成并调节氧化应激与炎症反应, 具有抗氧化、抗炎及促细胞修复功能, 在皮肤相关疾病、癌症和骨关节疾病等临床领域被广泛应用。近年来研究表明, LLLT可改善勃起功能障碍(erectile dysfunction, ED)模型动物阴茎海绵体病理变化, 康复治疗ED的潜在效果与激活PI3K/Akt、MAPK/ERK等信号通路相关。LLLT处理新鲜及冻融精子的研究发现, LLLT显著提升精子运动能力和顶体完整性效果与调节线粒体能量代谢重编程(如CCO介导的电子传递链激活)、氧化应激动态平衡(ROS/GSH-Px/SOD轴)及表观遗传修饰(DNA甲基化、组蛋白乙酰化)等有关; 在LLLT治疗阴囊热应激诱导的少精子症模型中, LLLT可显著促进生精上皮细胞分化, 其提升血清睾酮水平与抑制脂质过氧化、降低活性氧(reactive oxygen species, ROS)水平有关。这些研究结果提示, LLLT的光生物调节作用在男性生殖与性功能障碍的康复治疗中具有潜在效果。未来有待于开展融合生命科学、工程学与物理学的多学科研究, 以优化LLLT设备的物理参数; 同时, 通过高质量的基础与临床研究, 促进其在相关疾病治疗中的转化应用。

关键词: 低强度激光疗法, 光生物调节, 男性不育, 勃起功能障碍

Abstract:

Low-level laser therapy (LLLT), a noninvasive photobiomodulation technique, employs red or near-infrared (NIR) light (600-1 000 nm) with power outputs ranging from 5 to 500 mW. It exerts therapeutic effects through molecular mechanisms, specifically the activation of cytochrome C oxidase (CCO) and the modulation of intracellular signaling pathways. By enhancing mitochondrial adenosine triphosphate (ATP) synthesis, LLLT mitigates oxidative stress, regulates the reactive oxygen species (ROS)/glutathione peroxidase (GSH-Px)/superoxide dismutase (SOD) axis, and activates key pathways, including phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) and mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK). These mechanisms confer antioxidant, anti-inflammatory, and pro-regenerative properties to LLLT, making it a viable intervention for dermatological conditions, oncological therapies, and musculoskeletal disorders. Recent preclinical studies underscore LLLT' s potential in male reproductive health. Specifically, it ameliorates cavernosal fibrosis and endothelial dysfunction in erectile dysfunction (ED) models by upregulating the PI3K/Akt and MAPK/ERK pathways. In the context of sperm biology, LLLT enhances motility and acrosomal integrity in both fresh and cryopreserved spermatozoa. This is achieved through mitochondrial metabolic reprogramming, such as CCO-mediated electron transport chain activation, redox homeostasis restoration, and epigenetic modulation involving DNA methylation and histone acetylation. Additionally, LLLT alleviates scrotal heat-induced oligospermia by promoting seminiferous epithelial differentiation, elevating serum testosterone levels, and suppressing lipid peroxidation. These findings highlight the translational potential of LLLT in regenerative medicine, particularly for male sexual and reproductive disorders. Future research efforts should focus on interdisciplinary collaborations spanning life sciences, engineering, and physics. The goal is to optimize laser parameters, including wavelength, irradiance, and treatment duration, and establish standardized protocols. Rigorous preclinical and clinical investigations are paramount to validate the safety, efficacy, and long-term outcomes of LLLT, ultimately paving the way for its integration into precision medicine frameworks for urological and reproductive therapies.

Key words: Low-level laser therapy, Photobiomodulation, Male infertility, Erectile dysfunction

中图分类号:

R698

牛远杰, 辛钟成, 林桂亭, 丁攀, 潘建成, 封玉宏, 郭应禄. 低强度激光疗法治疗男性生殖与性功能障碍[J]. 北京大学学报（医学版）, 2025, 57(4): 627-632.

Yuanjie NIU, Zhongcheng XIN, Guiting LIN, Pan DING, Jiancheng PAN, Yuhong FENG, Yinglu GUO. Low-level laser therapy for the treatment of male infertility and erectile dysfunction[J]. Journal of Peking University (Health Sciences), 2025, 57(4): 627-632.

图/表 1

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Wavelength/nm	Signaling pathway	Biological effects	Reference
904	Catalase	Reduces ROS, promotes wound healing in diabetic mice	^[29]
635	NF-κB	Reduces ROS, inhibits NF-κB, decreases PGE2, COX-1, and COX-2 expression, anti-inflammatory	^[30]
980	PI3K/Akt/Bcl-2	Regulates S-phase progression in osteoblasts	^[31]
910	MAPK/ERK	Enhances cell migration and cytoskeletal remodeling	^[32]
808	Hedgehog (Ptch, Ihh, Smo, Gli)	Promotes osteoblast proliferation	^[33]
650	NO/Ca²⁺/ROS	Enhances sperm motility	^[34]
635	VEGF	Reduces VEGF concentration, increases endothelial cell proliferation	^[35]

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