前列腺摘除术与去势术前后雄激素变化的研究

目的探讨和研究前列腺摘除术与去势术对血清中雄激素(T、FT、DHT)的变化。方法39例研究对象,其中23例前列腺摘除术,16例去势术在手术前后分别采集血清样本,用放射免疫法测定血清中T、FT、DHT浓度。结果 前列腺摘除术后血清中T、FT、DHT分别较术前下降34.45％,33.53％,50.41％;去势术后血清中T、FT、DHT分别较术前下降92.27％,92.26％,58.36％。两种手术前后血清中T、FT、DHT的变化都有显著的统计学意义(P<0.001)。结论 前列腺摘除术后血清中雄激素会发生明显的变化,以DHT改变为显著。而去势术能够去除绝大部分T、FT,而DHT仅下降58.36%,在雄激素依赖的前列腺癌病例应当继续使用雄激素受体竞争剂,阻止残存的雄激素作用。     

前列腺增生症手术前后雄性激素变化的研究

目的　为了研究、探讨前列腺增生症手术前后雄性激素的变化和对全身的影响。方法　 2 3例前列腺增生症病例分别在手术前 1周和手术后 2周 ,采集血清样本 ,以测定血清中T、FT、DHT浓度 :采用经膀胱耻骨上前列腺内腺体摘除术 ,观察手术前后病人雄激素的改变和性激素改变发生的一系列主诉症状。结果　在前列腺内腺体摘除手术前后 ,血清中T、FT、DHT存在着明显的差异 ,分别下降 34.4 5 % ,33.5 3% ,5 0 .4 1% ,以DHT下降尤为明显 (P <0 .0 0 1)。前列腺摘除术后由于体循环中主要的雄激素明显下降 ,病人有雄激素下降的临床症状。结论　前列腺内腺体摘除术以后血清中雄激素将发生明显的变化 ,对于这个变化临床上应引起重视     

雄激素对大鼠腹叶前列腺GDNF mRNA表达的影响

目的 :探讨雄激素对大鼠腹叶前列腺中胶质细胞源性神经营养因子 (GDNF)mRNA表达的影响。　方法 :2 4只SD大鼠分为 3组 ,其中A组 (n =8)为假手术对照组 ,B组 (n =8)为去势组 ,C组 (n =8)为雄激素替代组 (去势后肌注十一酸睾酮 5 0mg/kg) ;术后 3d处死 ,通过半定量RT PCR检测GDNFmRNA在去势前后和雄激素替代组大鼠腹叶前列腺中的表达变化。　结果 :去势后大鼠前列腺的体积萎缩变小 ;雄激素替代组出现前列腺增生变大 ;对照组正常的大鼠前列腺有GDNFmRNA表达 ,去势组GDNFmRNA表达量减少 ,雄激素替代组GDNFmRNA表达量增加。与正常对照组比较 ,去势组的GDNFmRNA表达量显著减少 (P <0 .0 5 ) ,雄激素替代组的GDNFmRNA表达量显著增加(P <0 .0 5 )。　结论 :雄激素可增加GDNFmRNA表达 ,促进前列腺细胞生长。     

不同前列腺组织中睾酮及双氢睾酮含量测定的研究

目的　研究雄激素在前列腺增生症及前列腺癌发生中的作用。　方法　分别测定正常人、前列腺增生症患者以及前列腺癌患者血清和前列腺组织中睾酮 (T)及双氢睾酮 (DHT)的浓度。　结果　表明随着年龄增长 ,正常人血清中T水平逐渐下降而DHT浓度保持相对稳定。前列腺增生症或前列腺癌患者血清中两种雄激素浓度与正常对照组相比差异无显著性意义 (P >0 0 5 )。长期服用非那雄胺治疗的前列腺增生症患者血清中的DHT水平明显降低而T水平基本不变。各种组织中DHT的含量均为T的几十倍以上 ,前列腺增生症及前列腺癌组织中DHT的含量明显高于正常组织 (P<0 0 1) ,而各组之间组织中睾酮含量差异无显著性意义 (P >0 0 5 )。长期应用非那雄胺治疗前列腺增生患者组织中DHT的含量没有明显降低 ,而且不同部位增生组织中DHT的含量差异有显著性意义。　结论　前列腺增生症及前列腺癌组织中DHT的高浓度积聚与其发病密切相关 ,组织中DHT的积聚可能是由于前列腺局部 5a 还原酶增高所致 ,而且前列腺组织中可能存在着不止一种 5a 还原酶的作用。     

前列腺移行区体积与年龄及性激素的相关性研究

目的:探讨前列腺总体积(TV)和移行区体积(TZV)与年龄和性激素之间的关系。　方法:82例男性分为 两组,A组31例,年龄≤59岁,B组51例,年龄≥60岁,采用经直肠前列腺超声测定前列腺TV、TZV,采用放射免疫 法测定血清中总睾酮(T)、游离睾酮(fT)、雌二醇(E2)浓度。应用指数回归分析法和单因素方差分析法(ANOVA) 进行统计学分析。　结果:年龄与前列腺TV、TZV,TZV/TV比值差异有显著性(P<0.01);fT浓度与TZV呈显著 正相关性,E2浓度与TZV呈负相关性(P均<0.01),而T的浓度变化与TZV大小无明显的相关性(P>0.05)。　 结论:TZV在60岁后有明显加速增长趋势,与血清中性激素浓度有关。     

中年男性雄激素部分缺乏症的睾酮补充治疗

目的　观察睾酮补充治疗对中年男子雄激素部分缺乏症的疗效。　方法　2001年12月至2004年4月男科门诊经雄激素部分缺乏问卷评分、血清总睾酮(TT)和游离睾酮(fT)测定筛选出雄激素部分缺乏症患者179例,平均年龄41. 8岁,无器质性疾病和病原体感染。136例作为治疗组予口服十一酸睾酮3个月, 80mg/次,每日早餐、晚餐时各1次, 43例作为对照组未予特殊治疗。观察比较治疗前后雄激素部分缺乏评分和性激素的变化。　结果　治疗组治疗后1、3个月雄激素部分缺乏评分总分和构成评分与治疗前比较明显改善(P均<0. 01 )。治疗前患者TT、fT、雌二醇分别为(11. 9±0. 9)nmol/L、(40. 6±11. 8)pmol/L、( 128. 1±40. 1 )pmol/L。治疗后3个月分别为( 19. 1±1. 2)nmol/L, (75. 2±17. 0)pmol/L, (100. 6±27. 5)pmol/L,差异均有统计学意义(P均<0. 01 )。对照组雄激素部分缺乏评分总分和构成评分及性激素水平无显著变化。　结论　中年男子雄激素部分缺乏症在临床上客观存在,睾酮补充治疗对中年雄激素部分缺乏症安全、有效。     

中药消癃通闭对犬前列腺组织中T、E_2、DHT、AR和5α-还原酶的影响

取前列腺增生老龄犬,经口喂给消癃通闭药粉32天后,用RIA技术测定前列腺组织中睾酮(T)、雌二醇(E_2)、双氢睾酮(DHT),并与血清中浓度对照;用Scatchard Plots方法及双复管单点法测定雄激素受体(AR);用酶学法测定5α—还原酶Ⅰ、Ⅱ型。结果发现:正常犬微粒体中5α—还原酶Ⅰ型的活性为97.145±45.729,Ⅱ型的活性为15.745±15.093(单位均为DHT Pmol/mg Pro—tein·30min~(-1),下同)。予消癃通闭lg/kg·d~(-1)组犬的测定值分别为92.454±57.703和11.328±10.060;给予消癃通闭2g/kg·d~(-1)组犬的测定值分别为42.837±31.909和9.288±11.209。各组的前列腺组织中AR的测定值无明显差异。提示消癃通闭治疗前列腺增生的机理为抑制前列腺组织中5α—还原酶的活性。     

PWS病灶皮脂腺增生与血液雄激素水平的相关性研究

目的探讨葡萄酒色斑(Portwinestains,PWS)病灶组织的增厚、皮脂腺增生与血液中雄激素睾酮水平之间的关系。方法选取39例头面部PWS的成年患者,根据病灶的大体和病理学检查结果,分为病灶平坦皮脂腺未增生和病灶增厚皮脂腺增生两组。检测患者血清雄激素睾酮浓度,按照不同性别比较,并进行统计学分析。结果女性PWS病灶平坦皮脂腺无增生组的血液雄激素睾酮浓度为0.415±0.122pg/mL;女性PWS病灶增厚皮脂腺增生组的血液雄激素睾酮浓度为0.625±0.245pg/mL;两组有显著性差异(P<0.05)。男性PWS病灶平坦皮脂腺无增生组的血液雄激素睾酮浓度为4.561±1.166pg/mL;男性PWS病灶增厚皮脂腺增生组的血液雄激素睾酮浓度为6.353±1.688pg/mL;两组有显著性差异(P<0.05)。结论 PWS病灶增厚皮脂腺增生的患者与同性别病灶平坦无皮脂腺增生患者的血液雄激素睾酮浓度存在有显著的统计学差异,提示病灶组织的增厚与血液中雄激素水平增高存在相关性。     

男性甲亢患者治疗前后血清性激素水平观察

目的:探讨男性甲亢患者治疗前后血清性激素水平的变化及其临床意义。方法:采用化学发光免疫法测定68例男性甲亢患者治疗前后血清卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)和雌二醇(E2)的水平,并与对照组比较,进行统计学分析。结果:男性甲亢患者治疗前血清T和E2的水平明显高于对照组,差异有显著性(P<0.05);FSH、LH的水平与对照组相比差异无显著性(P>0.05)。男性甲亢患者治疗后血清FSH、LH、T和E2的水平与对照组相比差异无显著性(P>0.05)。结论:男性甲亢患者存在性激素代谢紊乱;患者血清T和E2水平的增高是机体为了适应高代谢环境,下丘脑-垂体-性腺轴所产生的适应性变化;随着甲亢得到控制,其水平恢复正常。     

正常及低游离睾酮的阳萎病人用雄激素治疗的效果

作者评价性功能及血清游离睾酮(fT)水平(代表循环睾酮的活性成分)之间的关系。有轻度睾丸功能低下的两组阳萎病人用口服十一酸睾酮(Tu)治疗,这些男子的tT/LH比及总睾酮(tT)水平在正常低限。第一组血清fT在6.6mg/ml以下,     

Prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy

OBJECTIVE: We investigated the prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy. MATERIAL AND METHODS: Sixty American Society of Anesthesiologists Grade II and III patients scheduled for spinal anesthesia were randomized into one of two groups. Patients in Group I (n = 30) received oral ephedrine 50 mg in addition to premedication whilst those in Group II (n = 30) received only premedication 30 min before spinal anesthesia. Pre-infusion values were measured in order to obtain baseline readings after oral ephedrine administration in Group I and after premedication in Group II. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before and after infusion, during and 5 min after spinal anesthesia and intraoperatively. Hypotension was defined as SAP <100 mmHg and <20% of baseline value. Hypotension was treated with 3 mg ephedrine and bradycardia was corrected with atropine 0.5 mg, given as an i.v. bolus. RESULTS: SAP values were significantly lower in Group II during the spinal anesthesia, post-spinal and intraoperative periods (p < 0.0001). Fifteen patients received ephedrine in Group II and seven in Group I. Supplemental ephedrine was used at doses of 3.42 +/- 0.97 mg in Group I and 8.86 +/- 1.24 mg in Group II. The incidence of hypotension was halved in Group I compared to Group II (23.33% vs 50%, p = 0.003). Six patients received atropine in Group II because of severe bradycardia. Mean HR values were lower in Group II than Group I during the spinal anesthesia, post-spinal and intraoperative periods. CONCLUSIONS: We conclude that a prophylactic oral dose of ephedrine 50 mg is effective for minimizing and managing spinal anesthesia-induced hypotension during transurethral prostatectomy.     

紫草辅助米非司酮抗早孕对生殖激素的影响

为了探讨紫草辅助米非司酮抗早孕时对早孕妇女血中生殖激素的影响 ,88例早孕妇女随机分成服用米非司酮、紫草、米非司酮加紫草组和空白对照组 ,比较用药前后血人绒毛膜促性腺激素β亚单位 (β-h CG)、卵泡刺激素 ( F SH)、黄体生成素 ( L H)、雌二醇 ( E2 )、孕酮 ( P)和睾酮 ( T)的变化。结果 :单用米非司酮或紫草均对 β-h CG有一定的抑制作用 ,二者合用抑制作用更加明显 ;单用紫草对血中 FSH、 L H有较明显的抑制作用 ,对 E2 、P及 T无明显影响。认为紫草对绒毛功能有一定的影响 ,与米非司酮合用影响更明显 ;紫草对垂体生殖激素有明显的抑制作用。但是否与紫草能提高药物流产效果有关 ,尚需进一步研究。     

Andropause: incidence and pathogenesis

One hundred forty-five male volunteers, 60 to 91 years old, without any hepatic, renal, or metabolic pathology, and not under any steroid therapy for at least 1 year were studied. Plasma luteinizing hormone (LH), Follicle Stimulating hormone (FSH), Testosterone (T), 17-beta-Estradiol (E2), Androstenedione (A), Maximal increase (MI) of LH and FSH after luteinizing hormone releasing hormone (LHRH) (50 gamma iv), and pulsations (P) of LH and FSH over a 3 hr period were measured by radioimmunoassay (RIA). The patients were divided in four groups according to LH and T levels. Group I: (46% of our subjects) showed no signs of hypogonadism with normal LH, T, E2, A, MI of LH and FSH, and normal P-LH, P-FSH. Group II: (15%) with high LH but normal T, showed high FSH, MI-LH, MI-FSH, P-LH, and P-FSH, but normal A and E2. Group III: (22%) with classical signs of hypergonadotropic hypogonadism (high LH and low T) showed high FSH, MI-LH, MI-FSH, and P-FSH, normal P-LH and E2, but low A. Group IV: (16.5%) with signs of hypogonadotropic hypogonadism (low LH and low T) had also low MI-LH, MI-FSH and A, but normal FSH, P-LH, P-FSH, and E2. Contrarily to menopause in women, andropause is not an obligatory event in men, and when it does occur, its pathogenesis and hormonal aspects are very variable.     

精索静脉曲张不育患者手术前后血浆性激素变化

将６４例单纯精索静脉曲张源性不育患者随机分为手术组３３例与非手术组３１例，分别于术前及术后６个月测血浆卵泡刺激素（ＦＳＨ）、黄体生成素（ＬＨ）、睾酮（Ｔ），同时测４６名正常生育力男性性激素作为正常值对照，对两组不育患者还进行了睾丸体积测定和精液分析。手术组采用经髂窝腹膜外单纯精索内静脉高位结扎术。结果：６４例精索静脉曲张源性不育患者精子密度、精子存活率、睾丸体积低于正常组，ＦＳＨ、ＬＨ、Ｔ均在正常值范围，与正常组对照无明显差异。两组手术前后对照分析，手术组与非手术组手术前后血浆性激素虽无统计学差异，但手术组患者术后精液质量、睾丸体积明显改善，随访一年手术组妊娠率（２７％）显著高于非手术组（１３％）。术前ＦＳＨ较高的患者术后精液质量、睾丸体积无明显改善，而术前ＦＳＨ正常者有显著差异。认为，精索静脉曲张不育患者通过手术治疗确能提高其生育能力，而术前根据血浆ＦＳＨ、ＬＨ、Ｔ测定结合睾丸检查、精液分析可以初步估计睾丸受损程度，对手术预后的判断有一定参考价值。     

腹腔镜卵巢囊肿剥除术中电凝次数与卵巢储备功能的相关研究

目的:分析腹腔镜卵巢囊肿剥除术中电凝次数与患者卵巢储备功能的相关程度。方法:回顾分析65例接受腹腔镜卵巢囊肿剥除术患者的临床资料,根据术中电凝次数将患者分为两组,其中36例多于5次(多次组),29例不大于5次(少量组)。两组患者均于术前、术后第3个月检测血清性激素(FSH、LH、E2、T及P)浓度,并应用阴道彩超检测卵巢截面积、卵巢间质动脉血流的收缩期峰值(PSV),窦卵泡数(F0),并进行对比分析。应用Logistic回归分析电凝次数与上述各指标的相关性。结果:两组患者术前血清性激素(FSH、LH、E2、T及P)浓度及卵巢截面积、PSV与F0差异均无统计学意义(P>0.05)。与少量组相比,治疗后3个月,多次组FSH、LH浓度较高,E2浓度及卵巢截面积、PSV与F0则较低(P<0.05);而T、P两组相比差异无统计学意义(P>0.05)。Logistic回归分析显示,电凝次数与E2血清浓度呈负相关(OR=0.634,P=0.037),而与F0呈正相关(OR=2.527,P=0.022)。结论:腹腔镜卵巢囊肿剥除术中增加电凝次数可降低卵巢储备功能,应尽量减少使用次数。     

实验性水上漂浮和高强度运动对大鼠下丘脑-垂体-睾丸轴功能的影响

目的:探讨大鼠在经历水上漂浮和高强度运动后血清T、皮质酮(CORT)、LH、FSH的变化规律。方法:将大鼠随机分为对照组(C组)、水上漂浮组(A组)、水上漂浮并高强度运动组(B组)3组,每组12只,实验分为3个阶段:第一阶段为适应性训练阶段,3d,每天10min,对模拟水上漂浮装置和大鼠跑台进行适应性训练;第二阶段为水上漂浮阶段,共3h;第三阶段为水上漂浮并高强度运动阶段,共2h。A组大鼠和B组大鼠分别经历第一、二阶段和第一、二、三阶段。实验结束后测定血清T、CORT、LH、FSH水平。结果:血清T(呈非正态分布,经对数转换后分析)A组为0.17±0.07,B组-1.11±0.35,与C组0.67±0.26相比均显著下降(P<0.05);LHB组为(3.97±1.57)mIU/ml,与C组(6.49±1.56)mIU/ml相比显著下降(P<0.05);FSH无显著变化;CORTB组为(977.22±207.36)ng/ml,与C组(434.58±110.45)ng/ml相比明显上升(P<0.05)。结论:在水上漂浮阶段,大鼠血清T出现明显下降,说明严重的心理应激会抑制下丘脑-垂体-睾丸轴的功能。随着应激原的增多和应激强度的增加,LH明显下降,T进行性下降,说明下丘脑-垂体-睾丸轴功能受到进一步抑制。     

Advanced prostate cancer is associated with a decrease in serum luteinizing hormone

OBJECTIVE: Depletion of serum LH by LHRH agonists is used as a therapeutic treatment in hormone-sensitive prostate cancer (PCa). However, little information on serum LH in different patient groups is available. METHODS: Patients with biopsy-proven PCa, men with BPH (biopsy-proven absence of PCa), two subgroups (serum PSA <4 ng/ml; PCa and BPH), and a PCa cohort before and after radical prostatectomy were analyzed for serum LH, testosterone (T), dihydrotestosterone (DHT), total and free PSA by immunological procedures. RESULTS: PCa patients with cancer volumes >10 cm(3), or with advanced Gleason scores, had significantly lower LH values than men in a cancer-free control group (PSA <4 ng/ml). Eight weeks after radical prostatectomy, LH levels had returned to the level of the control group (p<0.0001). These alterations were not accompanied by corresponding changes of serum androgens. Introduction of a PSA/LH ratio appeared to increase the differences between BPH and PCA groups ranked according to Gleason scores, versus PSA or LH alone. However, the calculation of ROC curves indicated that PSA/LH ratios may not improve the discrimination of malignant and benign forms of the disease, compared to presently used parameters. CONCLUSIONS: A significant reduction of circulating LH is observed in the most advanced forms of PCa. The effect does not come about by T- or DHT-mediated feedback inhibition. Since LH values after prostatectomy returned to practically the same levels as seen in the control group (BPH with <4 ng/ml PSA), it appears that the healthy prostate has no marked influence on serum LH while advanced PCa induces a decrease in serum LH.     

前列腺增生症手术前后血中性激素浓度的观察

我们观察了50～80岁23例前列腺增生症的前列腺切除术前后的性激素的变化,发现前列腺增生症手术后LH、FSH、T、E_2和E_2/T比例有下降倾向,而PRL有上升倾向。其结果表明前列腺切除术干扰垂体-性腺轴,可能是前列腺切除术后阳萎的根本原因。     

Serum levels of dimeric and monomeric inhibins and the degree of seminal alteration in infertile men with varicocele

The aim of the present study was to establish the serum levels of inhibins and their relationship with the degree of seminal alteration in infertile men. Thirty-six patients with varicocele (Va) and seven non-obstructive azoospermic men (Az) were included. The Va group was divided into two subgroups: Va I (sperm concentration: >20 x 106; n = 21) and Va II (sperm concentration: < 20 x 106; n = 15). Twelve fertile men were included as a control group (Co). Semen analysis and serum follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), inhibin B and Pro-alphaC levels were determined. Serum inhibin B and T levels were significantly lower and FSH and LH significantly higher in group Az when compared with the Co. Inhibin B was unable to differentiate Va I from Va II groups. However, in Va II an increase in FSH levels was observed. An inverse correlation between inhibin B and FSH, a direct correlation between inhibin B and testosterone, sperm concentration, motility and morphology were found. No such correlations were seen when only the Va group was analysed. The lack of correlation between serum levels of inhibin B, gonadotrophins, sperm concentration and seminal parameters observed in Va, adds other factor to the complex pathophysiology of varicocele. Finally, further studies are needed to elucidate if oligozoospermic patients with varicocele have also an impaired negative feed-back mechanism that regulates FSH synthesis and secretion.     

The use of esmolol and magnesium to prevent haemodynamic responses to extubation after coronary artery grafting

BACKGROUND AND OBJECTIVE: The haemodynamic responses during extubation can cause complications after open-heart surgery. In this study, we aimed to examine the effect of esmolol and magnesium before extubation on these haemodynamic responses. METHODS: Following the approval of local Ethics Committee, 120 patients having coronary artery bypass grafting with extubation in the intensive care unit were included in the study. Patients were allocated to receive esmolol 1 mg kg-1 (group I, n = 40), magnesium 30 mg kg-1 (Group II, n = 40) or normal saline (Group III, n = 40). Study medication was administered as a 20-min infusion in a volume of 20 mL. Patients were extubated just after termination of the infusion. Heart rate, blood pressure and central venous pressure were recorded prior to drug administration, before extubation, during extubation and 1 min after extubation. RESULTS: Heart rate was lower in Group I than in Groups II (P < 0.05) and III (P < 0.001) and lower in Group II than in Group III (P < 0.05) during extubation. It was also lower in Group I than in Group III (P < 0.05) after extubation. Systolic blood pressure was lower in Group I than in Groups II and III (P < 0.001) during extubation. Diastolic blood pressure was higher in Group III than in Groups I and II during extubation (P < 0.001) and after extubation (P < 0.05). Mean arterial pressure was lower in Group I than in Groups II and III (P < 0.001) during extubation, lower in Group II than in Group III (P < 0.05) during extubation and lower in Group I than in Group III (P < 0.05) after extubation. CONCLUSION: We found that using esmolol before extubation following coronary artery bypass graft surgery prevents undesirable haemodynamic responses while magnesium reduces undesirable haemodynamic responses but does not prevent them.