绝经后女性心脏X综合征患者性激素水平与血管内皮生长因子的相关性研究

摘要：目的 探讨绝经后女性心脏X综合征患者性激素、血管内皮生长因子（VEGF）关系 方法 选取绝经后女性心脏X综合征患者55例（实验组）和健康无心脏X综合征的绝经后女性50例（健康对照组）。所有入选对象均采用ELISA法测定性激素和血管内皮生长因子（VEGF）水平,其中测定的性激素主要包括雌二醇（E2）、促黄体生成素（LH）、促卵泡刺激素（FSH）、孕酮和睾酮。结果 CSX组血清E2及血清VEGF水平均显著低于健康对照组（P＜0.05）;而血清LH、FSH水平均显著高于对照组（P＜0.05）,CSX组雌二醇/睾酮比值明显降低（P＜0.05）;线性相关分析显示,CSX患者血清E2和VEGF呈显著正向相关性。以VEGF为因变量进行多元线性回归分析,结果提示E2与VEGF密切相关（P＜0.05）,而促黄体生成素（LH）、促卵泡刺激素（FSH）、孕酮和睾酮与VEGF无明显相关性。结论 绝经后女性CSX患者雌激素缺乏促使血管内皮生长因子表达降低,导致冠脉微血管的生成受限,进而导致冠脉微循环障碍发生。     

2型糖尿病患者并发骨质疏松的多因素分析

目的统计分析2型糖尿病患者并发骨质疏松的危险因素,寻求科学预防2型糖尿病患者并发骨质疏松的方法。方法以2010年2月—2014年2月在彭州市人民医院就诊的2型糖尿病并发骨质疏松患者97例作为实验组,以同期就诊的正常骨密度的2型糖尿病患者92例作为对照组,分析2组患者在性别、年龄、病程、体重指数、糖化血红蛋白、促卵泡生成激素、三酰甘油、促黄体生成素、低密度脂蛋白胆固醇、雌二醇、空腹血糖）、空腹胰岛素的差异是否有统计学意义。结果实验组与对照组相比,实验组的女性患者明显多于男性给患者、2组差异具有统计学意义（P〈0.05）;实验组患者在年龄、病程、糖化血红蛋白、促卵泡生成激素、促黄体生成素明显高于对照组,2组差异具有统计学意义（P〈0.05）,与骨质疏松有明显相关性（P〈0.05）;体重指数、雌二醇实验组明显低于对照组,2组差异具有统计学意义（P〈0.05）,与骨质疏松有明显相关性（P〈0.05）;空腹血糖、三酰甘油、低密度脂蛋白胆固醇、空腹胰岛素,2组差异无统计学意义（P〉0.05）,与骨质疏松没有明显相关性（P〉0.05）。结论 2型糖尿病患者并发骨质疏松在性别为女性、年龄、病程、糖化血红蛋白、促卵泡生成激素、促黄体生成素、体重指数、雌二醇有明显相关性,我们必须提前做好干预,预防患者骨质疏松的发生。     

绝经后性激素变化在糖尿病发病中的作用

测定绝经后妇女2型糖尿病患及相应对照的血清雌二醇（E2）、孕酮（P）、促卵泡刺激素（FSH）、促黄体生成素（LH）及睾酮（T）水平。结果显示：绝经后妇女2型糖尿病组E2水平明显低于对照组,而FSH、LH、T水平显高于对照组。提示：雌激素水平过低及雄激素水平过高可能是绝经后妇女2型糖尿病发病的危险因子。     

多囊卵巢综合征与血清瘦素抵抗的关系

用放射免疫法测定25例多囊卵巢综合征（PCOS）患者及21例正常对照组的血清瘦素、胰岛素、促卵泡激素、促黄体生成素、孕酮及睾酮等激素水平。结果PCOS患者血清瘦素水平与胰岛素、促黄体生成素及睾酮含量呈显著正相关（P〈0．01）。提示PCOS与血清瘦素抵抗有密切关系。     

四物汤对老龄雌性大鼠性激素水平的影响

目的探讨自然衰老的机理及四物汤对老年女性延缓衰老的作用和意义。方法选择老年对照组、四物汤组、维生素E组、成年对照组大鼠各10只,采用放射免疫法检测各组大鼠血清中促卵泡生成素（FSH）、黄体生成素（LH）、雌二醇（E2）和睾酮（T）的含量。结果四物汤能升高老年雌性大鼠T、E2水平,降低FSH、LH水平（P〈0.05或0.01）。结论四物汤可通过调节老龄雌性大鼠性激素水平而起到延缓衰老的作用。     

老年2型糖尿病患者性激素的变化

目的研究老年糖尿病患者性激素的变化。方法选择88例年龄≥60岁正常老年人为对照组及67例年龄≥60岁确诊为2型糖尿病的患者,测定睾酮（T）、黄体生成素（LH）、卵泡刺激素（FSH）、雌二醇（E2）的水平。结果男性糖尿病组LH、FSH、T、E2水平无差别（P〉0.05）;女性糖尿病组E2水平低于女性对照组（P〈0.05）,T、LH、FSH无差异（P〉0.05）。结论老年2型糖尿病患者存在性激素的紊乱。     

中老年男性雌、雄激素水平与血脂代谢的关系

目的 探讨雌、雄性激素水平对老年男性血脂代谢的影响.方法 根据颈动脉彩超检测结果,将60例中老年男性分为动脉硬化组32例,对照组28例.检测所有入选病例的血压、体重指数.清晨采集血样标本,离心后用放免法测定血清睾酮、雌二醇浓度,酶法测定血脂浓度.比较两组之间血清性激素水平、血脂的差异;分析两组血脂与雌、雄激素的相关性.数值变量两组间比较采用t-Student检验,血脂浓度与雌、雄激素水平之间的关系采用Pearson相关分析.结果 动脉硬化组血清睾酮水平显著低于对照组(P＜0.05);动脉硬化组血浆TC、TG、LDL-C水平高于对照组.相关分析显示:动脉硬化组男性血浆睾酮水平与TC和LDL-C水平呈负相关(P＜0.05),血清雌二醇水平与TC、LDL-C浓度显著正相关(P＜0.05);正常对照组男性血清睾酮水平与LDL-C浓度呈负相关(P＜0.01),血清雌二醇水平与LDL-C浓度显著正相关(P＜0.05).结论 男性血清睾酮水平与血浆TC、LDL-C水平呈负相关,血清雌二醇水平与血浆LDL-C水平呈正相关.动脉硬化组睾酮降低,提示内源性的雄性激素可能具有心血管保护作用.     

手传振动对凿岩工人生殖激素的影响

目的探讨手传振动对凿岩工人生殖激素的影响。方法以某煤矿60例男性井下凿岩工人为研究对象（观察组）,同一环境下60例男性非接振工人（井下运输工、维修工）为对照组,分别测定两组血清睾酮、黄体生成素和雌二醇浓度。结果与对照组相比,观察组血清睾酮、黄体生成素浓度降低,雌二醇浓度升高;两组血清睾酮浓度比较差异有统计学意义（P〈0．05）。结论手传振动可影响凿岩工人的生殖激素水平。     

男性低生育人群精浆锌、酸性磷酸酶及血清性激素水平及意义

目的评价低生育男性群体精浆锌、酸性磷酸酶（ACP）以及血清生殖激素水平及临床意义。方法选择68例低生育男性,其中弱精子症38例、少弱精子症30例。另择66例精液质量正常的已生育男性作为对照组。检测各组精浆锌、血清生殖激素水平,并对精浆锌水平低者进行补锌治疗,比较治疗前后的精子密度、精子活率和a级精子及畸形率。结果三组精浆锌和精浆ACP水平组间比较均有统计学意义（P〈0.05）;弱精子症组与对照组的血清睾酮（T）、促黄体生成素（LH）有统计学差异（P均〈0.05）,少弱精子症组与对照组的血清促卵泡刺激素（FSH）、T、LH有统计学差异（P〈0.05或〈0.01）。对精浆锌水平降低的低生育男性补锌治疗后,精子畸形率无明显变化（P〉0.05）,精子密度、精子活率和a级精子率有显著改善（P〈0.05）。结论低生育男性精浆锌水平降低与精子密度、精子活率和活力相关,与精子畸形率无关;精子活力减弱与ACP水平下降有关;血清生殖激素测定对低生育男性病因的诊断和治疗具有一定的临床意义。     

前列腺癌患者性激素与促性腺激素的变化

目的 探讨性激素和促性腺激素对前列腺癌的影响。方法对1996-01-01-2005-12-31解放军总医院内分泌科测定53例确诊未治的前列腺癌患者性激素：睾酮（T）、雌二醇（E2）与促性腺激素，包括黄体生成素（LH）、卵泡刺激素（FSH），同时测定了253名正常对照者的性激素与促性腺激素。结果前列腺癌组总睾酮和反映游离睾酮的指标睾酮分泌指数（TSI）以及FSH均低于正常对照组，且均有统计学意义（P〈0．05）。E2、LH两组比较无统计学意义（P〉0．05）。结论（1）前列腺癌患者处于低雄激素水平。（2）当睾酮（正常为15nmol/L）或睾酮分泌指数（正常为4、0）低于诊断标准时，前列腺癌的发病率可能升高。     

雄激素及其受体与老年男性冠状动脉粥样硬化性心脏病的相关性研究

目的 观察老年男性冠状动脉粥样硬化性心脏病(冠心病)患者性激素及雄激素受体水平的变化及相关性. 方法 横断面调查老年男性539例,其中健康人(对照组)400例,年龄62～92岁,平均(71.4±5.2)岁;冠心病患者139例,年龄60～88岁,平均(73.6±6.4)岁.测定总睾酮、游离睾酮、脱氢表雄酮硫酸酯(DHEAS)、性激素结合球蛋白(SHBG)、雌二醇、黄体生成素(LH)、卵泡刺激素(FSH)水平,同时采用流式细胞术检测外周血雄激素受体(AR)水平. 结果 老年男性冠心病患者DHAES、总睾酮、SHBG、游离睾酮、AR荧光强度均低于对照组(均为P<0.01),而FSH、E2高于对照组(均为P<0.01).年龄与总睾酮、游离睾酮呈负相关(r分别为-0.28、-0.17,P<0.01和P<0.05);与E2、SHBG呈正相关(r分别为0.33、0.14,P<0.01和P<0.05).AR荧光强度与收缩压呈负相关(r=-0.12,P<0.01).Logistic回归分析显示,总睾酮(OR=1.065,95%CI:1.012～1.121,P<0.05)、SHBG(OR=0.994,95%CI:0.990～0.998,P<0.01)和AR(OR=0.971,95%CI:0.956～0.986,P<0.01)与老年男性冠心病相关. 结论 老年男性冠心病患者存在低水平的DHEAS、总睾酮、SHBG、游离睾酮、AR,同时存在高水平的FSH、E2;低水平总睾酮、SHBG和AR可能是老年男性冠心病独立的危险因素.     

年龄依赖性胰岛素抵抗与睾酮水平的相关性

目的探讨健康男性年龄对胰岛素抵抗的影响和胰岛素抵抗与睾酮的关系。方法在北京、上海、西安和重庆四城市调查20～78岁健康男性1080例,同时测定空腹血糖、胰岛素、总睾酮、雌二醇、黄体生成激素(LH)、卵泡刺激激素(FSH)和性激素结合球蛋白(SHBG),计算稳态模型胰岛素抵抗指数(HOMA-IR)、游离睾酮(cFT)、睾酮分泌指数(TSI)和游离睾酮指数(FTI),将空腹血糖、胰岛素和HOMA-IR与其他检验结果进行相关分析。结果空腹血糖、胰岛素和HOMA-IR与年龄(r=0.1644、0.1536和0.1587;均为P<0.01)、LH(r=0.1909、0.1310和0.1920;均为P<0.01)和FSH(r=0.1 704、0.1543和0.1907;均为P<0.01)呈显著正相关,与总睾酮(r=-0.0825、-0.2187和-0.1619;P>0.05、P<0.01和P<0.01)、cFT(r=0.1238、-0.1 567和-0.1346;P<0.01、P<0.01和P<0.05)和TSI(r=-0.2143、-0.2098和-0.2488;均为P<0.01)呈显著负相关。结论健康男性随年龄增长伴有空腹血糖、胰岛素和HOMA-IR的逐渐升高,年龄依赖性雄激素水平降低对这种胰岛素抵抗的变化可能起着重要作用。     

Endocrine function of the testes, gonadotropic and lactotropic activity of the adenohypophysis in impotence among older men

Endocrine function of the testes, gonadotropic and lactotropic activity of the adenohypophysis have been studied in elderly men with functional sex disorders and during climacterium virile using a radioimmunoassay to determine the levels of testosterone (T), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin in the peripheral blood plasma. Pathological climacterium virile develops in the presence of sharply raised FSH and prolactin production, an elevated LH level, a decreased T level and a sharp rise of the E2 level.     

GONADAL-PITUITARY HORMONE LEVELS IN GYNAECOMASTIA

Plasma levels of LH, FSH, oestradiol 17 beta and testosterone were measured in twenty-two men with gynaecomastia. The group was divided by age into those under and those over 50-years-old and the mean hormone levels of the two groups were compared with two groups of age-matched normal men. In the young men with gynaecomastia LH and consequently the LH:FSH ratio was lower than in controls. Older patients with gynaecomastia had higher values of both LH and FSH than normal controls but the LH:FSH ratio was similar in the two groups. A pulsatile pattern of LH was present only in the young controls. Older controls had higher FSH levels than younger controls. In older men with gynaecomastia oestradiol levels and the oestradiol:testosterone ratio were higher than in those without.     

绝经后雌激素水平与阿尔茨海默病的关系分析

目的探讨绝经后雌激素水平与阿尔茨海默病(AD)的关系。方法绝经后AD女性患者35例,绝经后健康妇女42例,测定血浆雌二醇(E2)水平和黄体生成素(LH)、卵泡刺激素(FSH)水平。结果绝经后AD妇女E2水平较绝经后健康妇女明显下降,差异有显著性统计学意义(P<0.01);LH和FSH水平在AD组明显上升,AD组和对照组比较差异有显著性意义(P<0.01);而LH、FSH均与E2呈显著负相关(r=-0.902,-0.910,P<0.01)。结论随着血浆E2水平下降,LH、FSH水平上升,AD的发病率增高。     

In men, peripheral estradiol levels directly reflect the action of estrogens at the hypothalamo-pituitary level to inhibit gonadotropin secretion

CONTEXT: Estradiol inhibits gonadotropin release in men by an action at the hypothalamus and pituitary. Because of the tissue-specific regulation of aromatase, peripheral estradiol levels may not reflect brain estradiol concentrations. OBJECTIVE: We evaluated whether local aromatization of testosterone in the hypothalamus or pituitary is important for gonadotropin release and to what extent circulating estrogens affect gonadotropin levels and peripheral testosterone levels. DESIGN, SUBJECTS, AND INTERVENTIONS: We suppressed aromatase activity in 10 young healthy men with letrozole 2.5 mg once daily, restored plasma estradiol levels with estradiol patches (100 microg/d for the first week, 50 microg/d the second week, 25 microg/d the third week, and no estradiol patch the fourth week) and measured plasma testosterone, estradiol, LH, FSH, and SHBG levels. RESULTS: The mean estradiol and testosterone levels during the study ranged between 68.6 +/- 38.3 and 12.6 +/- 7.21 pg/ml for estradiol and 179 +/- 91 and 955 +/- 292 ng/dl (mean +/- sd) for testosterone. Levels of testosterone, LH, and FSH were inversely related to peripheral estradiol levels. During letrozole use, the mean plasma estradiol level needed to restore testosterone, LH, and FSH levels to baseline levels was not significantly different from the baseline mean estradiol level. CONCLUSIONS: Local aromatization of testosterone in the hypothalamo-pituitary compartment is not a prerequisite for expression of the inhibitory action of estrogens on gonadotropin secretion in men. Peripheral estradiol levels directly reflect the inhibitory tone exerted by estrogens on gonadotropin release and are a major determinant of peripheral testosterone, LH, and FSH levels.     

男性老年肺心病患者垂体促性腺激素的储备和排泌功能研究

我们对老年男性肺心病急性发作期(n=12)和缓解期(n=6)均进行血基础激素水平测定和黄体生成素释放激素(LHRH)兴奋试验。结果表明,急性发作期和缓解期睾酮(T)、黄体生成素(LH)均低于健康对照组(P<0.01);经LHRH兴奋后LH反应峰值、绝对升高值(△LH)、峰值上升速率(△LH/△t)、峰值增高倍数均非常显著或显著低于对照组。     

The effects of aging in normal men on bioavailable testosterone and luteinizing hormone secretion: response to clomiphene citrate

Serum testosterone (T) levels in men decline with age while serum LH levels, as measured by RIA, increase. To assess if the decline in serum T levels in healthy aging men is paralleled by an age-related decline in the bioavailable non-sex hormone-binding globulin (SHBG)-bound fraction of T and to determine whether there are age-related changes in LH secretion or LH control of T production, we studied 29 young (aged 22-35 yr) and 26 elderly (aged 65-84 yr) healthy men. All men had single random blood samples drawn, and 14 men in each age group underwent frequent blood sampling for 24 h, both before and after 7 days of clomiphene citrate (CC) administration. Both mean 24-h serum total T levels and non-SHBG-bound T were reduced in elderly men compared to those in young men (P less than 0.05), while estradiol and SHBG levels were similar in the 2 age groups. Serum FSH determined by RIA and LH by RIA and bioassay were higher in the elderly men compared to those in young men (P less than 0.05), but the ratios of LH bioactivity to immunoreactivity and the LH pulse frequency and amplitude were similar. After CC administration, mean serum total T and non-SHBG-bound levels in young men increased by 100% and 304%, respectively, while in older men these values increased by only 32% and 8%, respectively. However, CC-stimulated LH pulse characteristics and serum levels of estradiol, SHBG, FSH, and bioactive and immunoreactive LH were similar in the 2 groups. Thus, both at baseline and after CC stimulation, elderly men had significantly lower serum total T and non-SHBG-bound (bioavailable) T levels than did young men, despite similar or increased levels of bioactive LH and similar bioactive to immunoreactive LH ratios and LH pulse characteristics. These results suggest that major age-related changes in the hypothalamic-pituitary-testicular axis occur at the level of the testes and are manifested by decreased responsiveness to bioactive LH. Administration of CC to young and elderly men resulted in similar changes in LH pulse characteristics and LH bioactivity and immunoreactivity, suggesting preserved hypothalamic-pituitary responsiveness in the elderly.     

Studies of the role of sex steroids in the feedback control of FSH concentrations in men

Studies on the role of sex steroids in the feedback control of follicle stimulating hormone (FSH) concentrations in 22-35 year old men are reported. 10 normal volunteers and 8 men undergoing evaluation for azoospermia or oligospermia received steroids by constant infusion for 96 hours at twice the estimated daily production rate of normal men to obtain stable levels in peripheral blood. 15 mg of testosterone increased plasma testosterone and estradiol levels 2-fold and suppressed FSH and luteinizing hormone (LH) approximately 40% during infusion Days 3 and 4. 90 mcg of estradiol/day caused similar suppression of FSH and LH and the addition of 4.5 mg of 17 alpha-hydroxyprogesterone had no additive effect. 7.5 mg of dihydrotestosterone/day produced no detectible changes in FSH or LH. No evidence for a selective effect of any of the steroids on FSH secretion was seen. These data support the concept that although there is a specific seminiferous tubular factor regulating FSH secretion, testicular steroids also modulate FSH secretion.     

Gonadal dysfunction and changes in sex hormones in postnecrotic cirrhotic men: a matched study with alcoholic cirrhotic men.

To investigate the gonadal dysfunction and changes in sex hormones in male patients with postnecrotic cirrhosis, and to compare them with those in alcoholic cirrhotic men, three age-matched groups of men (hepatitis B virus-related postnecrotic cirrhosis 27, alcoholic cirrhosis 21, normal controls 30) were studied. Twelve of the 21 (57%) alcoholic cirrhotics and 16 of the 27 (59%) postnecrotic cirrhotics had a history of impotence. Both alcoholic and postnecrotic cirrhotic patients had significantly lower basal testosterone, but higher estradiol and prolactin levels than the control group (p less than 0.05). However, no differences were noted between the two cirrhotic groups. The degree of reduced testosterone and increased prolactin levels correlated with the severity of the cirrhosis. Despite the low testosterone concentration, basal levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) were not increased in the cirrhotic patients. All the three groups studied had normal FSH and LH responses to the stimulation of exogenous gonadotropin releasing hormone. On the basis of these results, we conclude that: (1) impotence and low testosterone level are not infrequent findings in men with hepatitis B virus-related postnecrotic cirrhosis, especially in those with decompensated liver function. (2) The liver disease per se is important for the development of male sexual dysfunction. (3) The derangement of hypothalamic-pituitary function may play a role in the sexual dysfunction and changes in sex hormones in male patients with cirrhosis.