烧伤对垂体—睾丸轴影响的临床研究

目的探讨烧伤对垂体—睾丸轴功能的影响。方法采用 RIA 法测定了28例男性烧伤患者伤后30天内血清卵泡生成素(FSH)、黄体生成素(LH)、睾酮(T)及雌二醇(E_2)水平的动态变化。结果烧伤后血清 FSH、LH、T 水平明显降低,伤后2周左右开始有所回升,而 BSA>30％TBSA 两组患者,伤后30天仍未完全恢复正常水平;E_2水平伤后明显增高,尔后逐步下降至正常水平;死亡组平均 T 水平显著低于存活组,平均 E_2水平显著高于存活组。结论烧伤后垂体功能本身可能受抑制,E_2、T 之间的失衡有可能参与烧伤免疫抑制过程,E_2、T 水平变化幅度随烧伤严重程度增加而加剧,是反映烧伤程度较为敏感的指标。     

rhGH对烧伤患者垂体-睾丸轴影响的文献对照研究

目的：探讨重组人生长激素（rhGH）治疗对烧伤患者垂体－睾丸轴的影响。方法采用化学发光免疫测定法和竞争性化学发光酶免疫分析法测定9名男性特重度烧伤患者应用rhGH治疗后,在伤后30天内,血清黄体生成素（LH）、卵泡刺激素（FSH）、睾酮（T）、雌二醇（E2）水平的变化。通过与文献对照,比较rhGH治疗对烧伤患者垂体－睾丸轴的影响。结果文献报道特重度烧伤后患者血清LH、FSH、T水平明显降低,伤后30天,LH升高至正常水平,FSH、T仍未恢复正常水平;E2水平伤后明显增高,而后逐步下降,伤后30天至正常水平。本研究中应用rhGH治疗的特重度烧伤患者血清LH、FSH、T在伤后明显降低与文献一致,在伤后30天,血清LH、FSH已恢复到正常水平,血清T水平有显著的增高,但未达到正常水平。血清E2水平伤后明显升高,在伤后30天已明显下降但尚未降至正常对照组水平。结论特重度烧伤后垂体－睾丸轴功能受到抑制,合理的rhGH应用有利于LH、FSH水平恢复正常,有助于烧伤后垂体功能的恢复。     

酒精与性机能

饮酒能引起肝损害为人们所熟知,但饮酒能引起睾丸萎缩、男性乳房女性化及性腺功能不全等病理改变却不是众所周知的。酒精与脑下垂体一性腺间发生的病理生理以及与性激素和性机能的关系,根据最近资料分析如下。一、酒精摄取后的急性变化 Mendelson以16例正常男性为对象,在摄取酒精后对血中酒精浓度、睾丸及LH浓度分别进行测定。发现当血中酒精浓度上升时,睾酮浓度即降低。当酒精浓度达109mg/dl时,血中睾酮就开始降低,LH值上升。引起睾酮值降低的原因是睾丸合成睾酮的能力降低和肝脏对睾酮的转换亢进有关。睾酮合成降低是由于酒精使NAD/NADH的比值     

衰老对老年男性性腺功能的影响及其机理

在衰老过程中有相当比例的男性随着年龄的增长出现性腺功能减退的症状和体征，并伴有血清睾酮水平降低，称为老年男性雄激素缺乏(ADAM)或部分雄激素缺乏(PADAM)或男性更年期(andropause)。与腹型肥胖、血脂异常、骨质疏松、肌肉容积缩小、肌力减退、勃起功能障碍和抑郁及认知功能减退等疾病的发生与男性性腺功能减退相关。而且，睾酮补充治疗使血清睾酮水平在正常范围内，可以明显改善性激素缺乏的临床表现。因此衰老对男性性腺功能的影响及其发生机理越来越受到关注。     

白介素—2对大鼠下丘脑和血浆促性腺激素释放激素水平的影响

本研究运用放射免疫分析观察腹腔内注射不同剂量白介素－2（1000U、2000U）的雄性SD大鼠下丘脑和血浆中促性腺激素释放激素（LHRH）以及血清睾酮的含量变化。结果显示：①下丘脑LHRH水平呈下降趋势，但与对照组相比无统计学意义；②血浆LHRH水平下降，与对照组相比无显著性差别；③血清睾酮含量低于对照组，只有高剂量的1IL－2有明显差别；结果提示：IL－2可抑制下丘脑LHRH的分泌，降低血中睾酮水平。     

小睾丸症的激素治疗

目的探讨小睾丸症激素治疗的临床疗效。方法回顾分析从2000年3月～2006年3月,我院诊断为小睾丸症的66例患者。按性激素检测分为:(1)高促性腺激素组即促黄体激素(LH)和促卵泡成熟激素(FSH)升高,睾酮(T)水平低下组18例;(2)低促性腺激素组即LH、FSH和T水平低下组48例。低促性腺激素组使用人绒毛膜促性腺激素(HCG),人绝经期促性腺激素(HMG);高促性腺激素组使用安特尔,两组均治疗6个月。结果低促性腺激素组患者睾酮水平均升高或达到正常水平,第二性征改善,睾丸体积由治疗前的2～4ml增大到8～11ml,患者中2例获得生育,6例患者由于使用了HCG和HMG后出现乳房发育增大、胀痛,继而改用安特尔。高促性腺激素性组使用安特尔治疗后性欲改善,睾丸体积无增大。结论小睾丸症的发病机理较为复杂,根据不同类型分别采用HCG,HMG或睾酮联合应用是有效的治疗方法之一,但要达到正常男性化,需较长时间的持续治疗。     

严重烫伤对睾丸间质细胞影响的实验研究

采用大鼠30%Ⅲ度烫伤模型,应用光镜、电镜、3β-羟甾脱氢酶(3β-HSD)组织化学染色及其相对活性的测定和血清睾酮及黄体生成素(LH)浓度的检测,分不同时相对严重烫伤后30天内大鼠睾丸间质细胞的改变进行了动态观察。结果表明,烫伤后睾丸间质细胞有不同程度的变性、坏死;间质细胞内3β-HSD 活性迅速降低,伤后30天仍保持较低水平;血清睾酮水平迅速下降,并持续维持较低水平,伤后30天仍不回升,而血清 LH 浓度无明显改变。提示烫伤后血清睾酮下降的机理可能与睾丸间质细胞的受损及糖皮质激素升高有关。     

烧伤后二胺氧化酶活性的变化

为探讨烧伤对小肠结构和功能的影响，应用分光光度法，测定了２１例烧伤面积在６４．５％±２１．９％的病人及烧伤总面积在３０％的小型香猪、大鼠的血浆和小肠组织二胺氧化酶（ＤＡＯ）活性的动态变化。结果显示，烧伤病人血浆ＤＡＯ活性显著升高，伤后２１天恢复到正常水平；烧伤猪血浆ＤＡＯ水平不同程度升高，伤后７２小时显著升高；烫伤大鼠血浆ＤＡＯ水平显著升高，小肠ＤＡＯ显著降低。提示烧伤后小肠粘膜受损，ＤＡＯ释放入血增加，动态测定血ＤＡＯ活性的变化，可反映小肠粘膜的结构和功能的变化。     

烧伤后二胺氧化酶活性的变化

为探讨烧伤对小肠结构和功能的影响,应用分光光度法,测定了21例烧伤面积在64.5%±21.9%的病人及烧伤总面积在30%的小型香猪、大鼠的血浆和小肠组织二胺氧化酶(DAO)活性的动态变化。结果显示,烧伤病人血浆 DAO 活性显著升高,伤后21天恢复到正常水平;烧伤猪血浆 DAO 水平不同程度升高,伤后72小时显著升高;烫伤大鼠血浆 DAO 水平显著升高,小肠 DAO 显著降低。提示烧伤后小肠粘膜受损,DAO 释放入血增加,动态测定血 DAO 活性的变化,可反映小肠粘膜的结构和功能的变化。     

人类性交活动对生殖激素水平的影响

本课题研究性交对促性腺激素与性腺激素水平的影响，并观察激素变化与性高潮的发生有无相关。结果男子性交后睾酮（Ｔ）水平升高２．１９±０．９０μｇ／Ｌ（ｘ±ＳＥ，Ｐ＜０．０５，ｎ＝９），而女子性交后雌二醇（Ｅ２）水平降低５２．００±１４．４６ｍｇ／Ｌ，Ｐ＜０．０２，ｎ＝７），其它激素水平无显著意义的变化。９男中６名出现性高潮，１名性高潮未出现者Ｔ亦升高６．６μｇ／Ｌ，而１名性高潮出现者的Ｔ反降低０．４μｇ／Ｌ。７女中６名未出现性高潮，但７人的Ｅ２均降低。可见激素变化与性高潮间未见相关。性交后性腺激素变化的意义有待进一步研究。     

烧伤对垂体—睾丸轴影响的临床研究

OBJECTIVE: To investigate the effects of burn trauma on pituitary-testis axis. METHODS: The changes in serum estradiol(E2), testosterone(T), luteinizing hormone(LH), and follicle stimulating hormone(FSH) levels were dynamically investigated by RIA in 30 days after thermal injury in 28 burnt men. RESULTS: The serum FSH, LH, and T levels significantly decreased after injury, and there was some increase from PBD(postburn day) 14 to 30. In patients in group II and III (BSA > 30% TBSA), not all of their FSH, LH, and T levels reached the normal control on the PBD 30. Serum E2 levels were elevated after injury, then returned gradually to normal. In three patients who died, their mean T levels were significantly lower than patients who survived, but mean E2 levels were significantly higher than that of survivors. CONCLUSION: The activity of pituitary might be depressed after burn trauma. The imbalance between E2 and T might play a role in the processes of immuno-depression after injury. The changed extent of E2 and T levels was correlated to burn size. They could be sensitive indicators of burn stress.     

严重烧伤患者应用重组人生长激素对糖和蛋白质代谢的影响

目的 分析重组人生长激素（rhGH)对严重烧伤患血糖及蛋白质代谢的影响。方法 对24例应用rhGH治疗的严重烧伤患的血清总蛋白、白蛋白及血糖升高发生率进行比较分析。并对同期未用rhGH患血糖及蛋白质的变化进行对比分析。结果 严重烧伤患应用rhGH后血清总蛋白、白蛋白较用药前明显升高,并高于同期对照组。伤后2周内血糖升高,特别是伤后1周内明显升高,伤后0－3d、4－8d、8－14d的血糖升高发生率分别为52．38％、50．24％、20．00％。伤后1周内、2周内及2周后开始应用rhGH其血糖升高发生率分别为100％、50％、0。结论 严重烧伤患应用rhGH能促进机体蛋白质合成,但伤后早期应用rhGH对血糖影响较大,伤后2周应用rhGH是较适合的时机。     

Effect of psychological stress on fertility hormones and seminal quality in male partners of infertile couples

The present study evaluated the effect of psychological stress on male fertility hormones and seminal quality in male partner of infertile couples. Seventy male partners of infertile couples were evaluated for level of psychological stress using Hospital Anxiety and Depression Score (HADS) questionnaire, serum total testosterone, luteinising hormone (LH) and follicle‐stimulating hormone (FSH) by electrochemiluminescence assay and serum GnRH by ELISA. Seminal analysis was performed as per WHO guideline. Nineteen (27%) of them had HADS anxiety and depression score ≥8 (abnormal HADS score). The persons having abnormal HADS had lower serum total testosterone, higher serum FSH and LH than those of persons having normal HADS. Serum total testosterone correlated negatively with HADS, but LH and FSH correlated positively. There was no change in GnRH with the change in stress or testosterone levels. Sperm count, motility and morphologically normal spermatozoa were lower in persons having abnormal HADS. Sperm count correlated positively with total testosterone and negatively with FSH and LH. Abnormal sperm motility and morphology were related to lower testosterone and higher LH and FSH levels. Psychological stress primarily lowers serum total testosterone level with secondary rise in serum LH and FSH levels altering seminal quality. Stress management is warranted for male infertility cases.     

烧伤患者能量消耗变化相关因素的分析

目的　动态监测烧伤后能量消耗 (简称能耗 ) ,探讨影响伤后能量消耗的因素。　方法　应用间接测热仪对 45例烧伤患者进行能耗的动态监测并分析其能耗变化。　结果　烧伤后能耗即刻升高 ,一周左右达高峰 ( 1144 3.78± 32 95 .32 )kJ/d ;烧伤面积越大 ,能耗越高 ;能耗与烧伤后病程有关 ;伤后能耗有变异且接近早期 ,烧伤面积越大变异程度越高 ;中等面积烧伤合并吸入性损伤患者能耗较无吸入性损伤患者高 ;大面积烧伤切痂术后能耗明显下降 ;男性患者能耗高于女性患者。　结论　烧伤后能耗有一定规律性变化 ,但深度烧伤面积、伤后时间、吸入性损伤、切痂手术、性别及个体差异均影响烧伤后能耗     

Modulation of inflammatory and catabolic responses in severely burned children by early burn wound excision in the first 24 hours

HYPOTHESIS: Early burn wound excision modulates the hypermetabolic response in severe pediatric burn injuries. DESIGN: Before-after trial. SETTING: A 30-bed burn referral center in a private, university-affiliated hospital. METHODS: We studied 35 severely burned children who were divided into 2 groups. One group (n = 20) was treated with early burn wound excision within 24 hours after the injury. The second group (n = 15) was treated conservatively with silver sulfadiazine in other burn facilities for 5 days, and burn wounds were surgically excised when patients were admitted to our burn center on day 6 after the injury. Data compiled included oxygen consumption and acute-phase protein, interleukin 1beta; interleukin 6, interleukin 10, tumor necrosis factor alpha, and anabolic hormone (growth hormone, insulinlike growth factor type 1) levels preoperatively and 24 hours and 5 days postoperatively. MAIN OUTCOME MEASURES: Acute-phase and hypermetabolic responses. RESULTS: Early burn wound excision abrogated the hypermetabolic response in pediatric burn patients. Patients who underwent conservative treatment had a significantly more severe inflammatory and hypermetabolic response at the same time interval and significantly lower levels of anabolic hormones. CONCLUSIONS: Early burn wound excision is a safe therapeutic approach that modulates the hypermetabolic response after burn injury. It was superior to the conservative treatment of silver sulfadiazine and delayed excision, and it should be considered when treating all severe full-thickness burns.     

Effect of epidural anesthesia on the function of hormonal regulation in the hypothalamic-pituitary-testicular axis

To evaluate the effects of epidural anesthesia on the hypothalamic-pituitary-testicular axis, we examined the concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone (T). The effects of epidural anesthesia on plasma levels of LH, FSH and T were investigated in 8 men aged from 64 to 87 years, suffering from untreated prostate cancer. There were no significant differences in plasma levels of LH, FSH or T between patients under epidural anesthesia and patients under no anesthesia. The effects of epidural anesthesia on plasma levels of LH, FSH and T after LH releasing hormone (LH-RH) administration were studied in 10 men between 65 and 84 years with diagnoses of untreated prostate cancer. Plasma LH and FSH levels increased significantly after LH-RH administration under epidural anesthesia or no anesthesia. Plasma LH and FSH were lower under epidural anesthesia than under no anesthesia. No change in plasma T level was observed after LH-RH administration under epidural anesthesia. We conclude that there is no effect of epidural anesthesia on the hypothalamic-pituitary-testicular axis.     

Monocyte chemoattractant protein-1 (MCP-1) and macrophage infiltration into the skin after burn injury in aged mice

Clinical observations and laboratory studies have shown a delay in dermal wound healing in aged subjects. Since macrophages play a key role in wound healing, we investigated age related differences in MCP-1 production and monocyte recruitment to the wound following burn injury using a murine model. The present study shows that there is an increase in MCP-1 levels in the burned-normal skin interface at 1-day post burn in both young and aged burned mice compared to sham injured mice. However, the levels of MCP-1 in aged burned mice (133.16+/-36.55pg/mg protein) were approximately half the levels of young burned mice (286.15+/-45.36pg/mg protein, P<0.05). Additionally, at 4 days post burn, MCP-1 levels in aged mice (290.73+/-101.98) reached the same levels as in young mice (243.97+/-36.71). There was no difference in macrophage accumulation into the wound between young and aged at either time point. These data demonstrate that the difference in dermal MCP-1 levels between the young and aged is not associated with a difference in macrophage infiltration to the wound following burn injury, suggesting that the lower MCP-1 content in the aged is possibly affecting other phases of wound healing in the aged.     

Antiproteolytic action of insulin in burn-injured rats

BACKGROUND: Negative nitrogen balance is a typical metabolic response to burn injury resulting in decreased muscle mass and activity. Since insulin is an anabolic hormone, using insulin as a prophylactic agent in burned patients has received some attention. The present study was carried out to investigate the systemic effect of insulin on burn injury-induced muscle wasting. PATIENTS AND METHODS: A 15-20% total body surface area (TBSA) scald burn injury was inflicted on the shaved dorsum of rats. Rats were treated with a daily subcutaneous insulin injection for 3 days (0.25-1.0 U/day). After the treatment, a variety of insulin-dependent physiological parameters were monitored. Overall body protein degradation rates were determined by measuring the urinary tyrosine. Also, protein degradations were measured in diaphragm muscles, splenocytes, and peripheral blood mononuclear cells to directly confirm the antiproteolytic activity of insulin. RESULTS: Administration of insulin to burn-injured rats restored body weight primarily by reducing accelerated protein degradation and regaining the intracellular protein content in individual skeletal muscle. The measured physiological parameters showed no possible side effects. Protein degradation in immune cells was also suppressed after the therapy. CONCLUSION: Results indicate that lower dose insulin particularly suppresses protein degradation without causing secondary effects. It may be a useful approach to preventing burn injury-induced muscle wasting and also has a potential to improve immune response.     

Clinical characteristics of hypertension in burned children.

Although systemic arterial hypertension has been recognized as a common complication of thermal injury in children, its clinical characteristics have not been defined. This review of 987 burned children, treated over an 11-year period, documents development of hypertension in 195 patients (19.8%). The problem occurs most frequently in males and in the 7--10-year age group, but does not correlate with racial origin. Incidence increases with burn severity up to a 40% total surface burn. The incidence did not vary with the year of treatment when changes in patient population were eliminated. Fifteen of the 195 patients had hypertensive encephalopathy and seizure problems. No other complication or change in mortality could be related to hypertension. The problem could not be related to location of the burn wound, drug treatment, or differences in transfusion and fluid therapy. Comparison of the highest daily blood pressure measurements between matched hypertensive and normotensive groups demonstrated that the hypertensive and normotensive groups demonstrated that the hypertension is limited to the acute phase of burn wound treatment and that blood pressures are normal after complete autografting. The encephalopathy and seizure problems indicate the need for careful blood pressure monitoring and effective antihypertensive therapy in the treatment of burned children.