尿毒症透析患者的卵巢功能

为了解女性尿毒症患者卵巢功能障碍的发病情况,明确发病部位,探索其发病机理。方法 应用酶免疫法(EIA)检测了25例更年期前尿毒症透析患者的泌乳素(PRL)、促卵泡素(FSH)、促黄体素(LH)、雌二醇(E_2)及孕酮(P)的基础水平,并观察了部分患者服用克罗米酚(CC)及溴隐停后以上激素的变化。结果 与近龄健康妇女相比RPL明显升高,FSH、LH亦升高,而孕酮值显著下降。闭经者服用CC后,血LH、FSH和E_2水平上升,谓之CC试验结果阳性。虽PRL广泛升高,用嗅隐停可使之暂时下降,但效果很不稳定,排卵率亦很低。结论 (1)尿毒症女性普遍的月经无周期和缺乏E_2、LH峰,以及孕酮值低下,证实了存在下丘脑-垂体-卵巢轴损害;(2)尿毒症女性CC刺激试验阳性,说明垂体-卵巢轴是正常的,损伤部位在下丘脑;(3)尿毒症女性PRL显著升高,主要是垂体泌乳细胞分泌增加,溴隐停治疗,效果不稳定;(4)尿毒症女性月经紊乱应给对症处理,但无需促排卵治疗,而成功肾移植是最好的治疗方法。

Ovarian function in uremic patients receiving dialysis

In order to evaluate the pathogenisis, definite the position and mechanism of ovarian dysfunction. Methods Pi-tuitarygonadal hormones ,-.P and prolactin (PRL) were measured in 25 premenopausal hemodialysis women using enzyme im-munoassay (E3A). Results Patients' serum PRL levels significantly elevated, FSFKLH levels also elevated, whereas P levels were obviously lower compared with normal women. Conclusion (1) Hypothalamic-pituitary-ovarian axis was impaired in uremia women as indicated by the prevalence of acydicity and the failure of LH,E2 levels and marked low P levels. (2)In uremia women clomiphenum stimulation test was positive suggested that the pituitary-ovarian axis were normal, whereas hypothalamic was impaired. (3) Hyperprolactinemia, owing to increased pituitary prolactin secretion. Suppression with bromocriptine was unstable. (4) During dialysis, symptom treating is suitable rather than trigger the ovalation. Successful renal transplantation is the best treatment.