前列腺阶段性增长的雄激素基础研究——唾液睾酮放免测定

应用放射免疫技术对３７９ 例年龄在１～９２ 岁之间的男性唾液睾酮水平进行了检测,并应用超声前列腺定量研究的方法,对其前列腺体积进行了研究。结果显示,唾液睾酮随年龄变化的生理曲线有３ 个不同时相,同时前列腺体积随年龄增长而增长的曲线也有与之相对应的波段。（１） 前列腺体积伴唾液睾酮水平的上升而快速增长;（２）前列腺体积增长与唾液睾酮增长趋于缓慢平坦;（３） 前列腺体积伴唾液睾酮水平的下降而再加速增长。两条曲线相交的年龄是５５ 岁。前列腺体积两次快速增长的年龄分别是１５ 岁和５５ 岁,相对应的唾液睾酮浓度分别是７６ ｎｇ／Ｌ和７４ ｎｇ／Ｌ。本文论证了唾液睾酮和前列腺增长随年龄变化的自然规律和相互关系。提出体内雄激素随年龄的波动及由此引起的激素内平衡的改变,可能是前列腺阶段性增长的基础。     

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。     

重视中老年男性性腺功能减退的研究

一、概述 衰老是自然界一切生命必然要经历的过程,表现为各个器官形态结构和生理功能的退行性变化,睾酮水平下降是男性性腺功能减退最直接的表现,是衰老的特征之一.影响睾酮水平的原因既有中枢性亦有睾丸性.     

雄激素性脱发患者血清激素水平及治疗效果评估

目的:了解男性雄激素性脱发(AGA)患者血清激素水平及治疗效果与多种因素的关系.方法:回顾935例门诊男性AGA患者,定期检测血清睾酮水平,予非那雄胺治疗,对定期随访的患者进行疗效及相关性评估.结果:935例AGA患者中,80％患者血清睾酮水平处于正常范围,106例复查睾酮的患者治疗6月后血清睾酮水平较治疗前增高,定期随访患者中,疗效与治疗时间、病程、脱发严重程度呈及家族史呈一定相关性.结论:男性AGA患者血清睾酮水平对脱发的影响较小,治疗疗效与治疗时间、病程、脱发严重程度及家族史有一定相关性.     

正常男性唾液睾酮含量与年龄的关系研究

本文应用碘标放射免疫法检测了339例正常男性唾液睾酮浓度,探讨了唾液睾酮与年龄的关系,并就唾液睾酮的临床应用进行了讨论,提出了不同年龄阶段唾液睾酮的正常值:3～8岁唾液睾酮浓度均值为3.1pg/ml;9岁,4.5pg/ml;10～12岁,24.6pg/ml;13岁,41.7pg/ml;14～16岁,60.3pg/ml;17岁,86.9pg/ml;18～55岁,114.1pg/ml;51～55岁,88pg/ml;56～78岁,70.7pg/ml。     

男性乳腺发育与相关激素及雌孕激素受体之间关系的临床研究

目的　研究男性乳腺发育与全身相关激素和雌激素受体 (ER)、孕激素受体 (PR)之间的关系 ,探讨男性乳腺发育患者临床药物治疗机理。方法　用放射免疫法检测了 2 2例男性乳腺发育患者及正常对照者 16例的血清雌二醇 (E2 )、睾酮 (T)、孕酮 (P)、泌乳素 (PRL)水平 ,再通过t检验统计学处理分析 ;同时用免疫组织化学 (辣根过氧化酶标记的链霉素亲和素 生物素法 )测定了男性乳腺发育患者乳腺导管上皮细胞的ER、PR。结果　男性乳腺发育患者比正常对照者血清E2 水平明显增高(P <0 0 5 ) ,而血清睾酮、P、PRL水平 2组差异无显著意义 (P >0 0 5 ) ;并且男性乳腺发育患者的乳腺导管上皮细胞ER、PR阳性率较高。结论　男性乳腺发育与雌激素水平及乳腺ERPR相关 ,可能是以雌激素水平升高为全身因素、乳腺组织雌孕激素受体阳性率较高为局部因素共同作用引起 ;雌激素受体阻滞剂及降低雌激素水平的芳香化酶抑制剂可用于临床治疗男性乳腺发育     

男性乳腺发育症

男性乳腺发育症较常见。很多男性在某一时期可出现生理性乳腺增大。一些药物、肿瘤、肝肾功能衰竭和激素异常也可导致乳腺发育。有效雌激素:睾酮比率增高是其根本原因。通常有血清水平的变化,某些病例则表现为组织水平即乳腺局部酶活性的改变。乳头下可扪及一圆盘状实性组织。多数为双侧性,有些先为单侧,数月后发展为双侧,约10%为单侧。镜下早期在疏松结缔组织中见有乳小管,以后则代之以致密透明样纤维组织。     

迟发性性腺功能减退症的研究进展

正迟发性性腺功能减退(late-onset hypogonadism,LOH)是一种与年龄增长相关的临床和生物化学综合征,又称为年龄相关的睾酮缺乏综合征,是指老年男性血睾酮水平低于正常年轻男性参考值,伴随有体能下降、性功能障碍及心理障碍等睾酮不足的临床表现,并逐渐导致生活质量下降和多器官的损害[1]。随着我国步入老龄化社会,作为严重影响中老年男性生活质量和健康的重要疾病之一,LOH已成为研究的热     

男性科门诊人群血清总睾酮水平特征分析

目的:分析男性科门诊人群血清总睾酮水平的分布特征。方法:收集近5年来我院男科门诊就诊的患者和体检者性激素检测数据,分析血清总睾酮及其他各项性激素指标与年龄的相关性。结果:共纳入6545例性激素齐全的男性人群,平均年龄(32.24±7.69)岁,总睾酮水平为(15.78±7.11)nmol/L。血清总睾酮含量随年龄的增长而下降,年龄与总睾酮呈显著负相关(r=-0.118,P<0.001)。≥35岁组与<35岁组间雄激素不足(睾酮<12.0 nmol/L)的比例存在显著差异(P<0.001)。结论:男科门诊人群血清总睾酮水平随年龄增长而逐渐降低,>35岁人群雄激素不足的比例显著升高。     

154例中青年男性器质性勃起功能障碍患者与代谢综合征关联分析

目的:探讨中青年男性勃起功能障碍(erectile dysfunction,ED)与代谢综合征(metabolic syndrome,MS)及睾酮水平的相关性。方法:2012年2月至2014年1月,调查门诊154例20~59岁男性器质性ED患者与103例性生活正常男性的一般情况、腰围、血压、空腹血糖、总甘油三酯、高密度脂蛋白、血清总睾酮、国际勃起功能评分5项以及勃起功能指标,比较ED组与非ED组,以及ED患者中MS者与非MS者各项指标差别。结果:中青年ED组MS患病率显著高于非ED组MS患病率(P0.05),ED组与非ED组腹围、血压、腹围、空腹血糖、高密度脂蛋白及总睾酮均有有显著性差异(P0.05)。ED组中MS者与非MS者勃起功能各项指标及总睾酮有显著性差异(P0.05)。多元logistic回归分析MS各项指标及总睾酮与ED相关性分析,发现腰围与ED密切相关(P0.01)。结论:中青年ED患者并发MS患病率较正常人群明显增高,ED患者中并发MS者睾酮水平较低、勃起功能较差。中心性肥胖与中青年ED密切相关。     

Semen characteristics in pubertal boys. III. Semen quality and somatosexual development

The biological quality of semen in 134 pubertal boys was contrasted with somatosexual development. The absence or sparcity of pubic and axillary hair, the absence of facial hair, and infantile-type penile growth are prominent characteristics in azoospermic and cryptozoospermic boys. Sparse or meager pubic hair, absence or sparcity of axillary and facial hair, and puerile penile type are characteristics in oligozoospermia. Female or male pubic hair, meager or normal axillary hair, sparse facial hair, and puerile penile type are characteristic of asthenozoospermia. Female or male pubic hair, meager or normal axillary hair, sparse facial hair, and adult penile type are characteristic in normospermia. Along with the improvement of semen quality the area of the testis expanded and was the largest in normospermia.     

Plasma testosterone and estradiol levels in unilateral cryptorchidism

This research was conducted to investigate the relationship between plasma hormone level during activation of hypothalamic-pituitary-testicular axis at the postnatal period and at puberty in unilateral cryptorchidism. Plasma testosterone and estradiol levels of 80 patients with unilateral cryptorchidism at different ages (range: 6 months-12 years) were measured. The mean plasma testosterone level is 40 (15-60) pg/ml at 6 months of age, 55 (30-120) at ages between 9 and 12 years, and 20 (11-22) at ages between 1 and 9 years. The mean plasma estradiol level is 12, 11 and 11 (5-24) pg/ml, respectively, in these groups. The patients with unilateral cryptorchidism do not have similar peaks of plasma estradiol level as plasma testosterone level at the postnatal period and at puberty. Peak of plasma testosterone at puberty occurs if the patients were not operated on.     

Pubertal development in children treated for nephroblastoma

Recent improvements in the treatment of children with nephroblastoma have led to an increase in the disease-free survival rate. The late effect of treatment on long-term survivors requires assessment to determine whether avoidable iatrogenic disorders are appearing. The onset of puberty is one measurement of physical development and has been used in the study to assess the progress of 16 children over the age of 12 yr who were treated for nephroblastoma. The method consisted of the measuring body height, weight and testicular size, estimating serum levels of luteinizing hormone, follicular stimulating hormone and testosterone, recording the age at menarche, and staging of pubic hair and breast development. There was evidence of complete ovarian suppression in 3 out of 10 girls and of delayed and testicular function in 1 out of 6 boys. Analysis of the treatment received by the children implicated radiotherapy as the responsible factor causing gonadal suppression.     

HCG、FSH联合治疗低促性腺激素性性腺功能减退症29例报告

目的 探讨人绒毛膜促性腺激素(HCG)和促卵泡激素(FSH)联合治疗男性低促性腺激素性性腺功能减退症的有效性和安全性.方法 29例男性低促性腺激素性性腺功能减退症23例,Kallmann综合征6例.治疗方案:采用联合HCG 2000 IU,2次/周;FSH 75 IU,3次/周,肌肉注射,连续用药至少3个月. 结果治疗后所有患者体力改善,体质增强;22例患者出现胡须、阴毛和(或)腋毛.睾丸体积治疗前(2.68±1.44)ml,治疗后(8.93±3.24)ml(P<0.01);促卵泡激素(FSH)、促黄体激素(LH)和睾酮(T)水平有所提高(P<0.05);12例患者出现遗精现象,8例有精子生成.结论 对男性低促性腺激素性性腺功能减退症,用HCG和FSH治疗能促进青春期第二性征发育,并可使部分睾丸恢复产生雄激素和生成精子功能.     

Efficacy of changing testosterone gel preparations (Androgel or Testim) among suboptimally responsive hypogonadal men

The study objective was to evaluate the efficacy of changing testosterone gel preparations among suboptimally responsive hypogonadal men. The records of all hypogonadal men on gel (Testim or Androgel) testosterone replacement therapy (TRT) were reviewed to identify men who underwent a brand substitution in gel TRT due to initial suboptimal response. Total and free serum testosterone levels and the presence of hypogonadal symptoms (ADAM) were compared pre- and post-gel substitution. Of the 370 hypogonadal men on testosterone gel replacement therapy, 75 (20%) underwent a brand substitution. Prior to substitution, among patients initially treated with Androgel, the mean total and free testosterone levels were 311 ng dl(-1) and 10.4 pg ml(-1), respectively. Total testosterone levels were below 300 ng dl(-1) in 58% of these patients. Following a change to Testim, mean total and free testosterone levels increased to 484 ng dl(-1) (P<0.001) and 14.6 pg ml(-1) (P=0.01), respectively. Total testosterone levels remained below 300 ng dl(-1) in only 17% of these patients. Among patients initially treated with Testim, the mean total and free testosterone levels were 544 ng dl(-1) and 18.0 pg ml(-1), respectively. Total testosterone levels were below 300 ng dl(-1) in 15% of men. Following testosterone gel change to Androgel, mean total and free testosterone levels were 522 ng dl(-1) (P=0.7) and 16.1 pg ml(-1) (P=0.6), respectively. Total testosterone levels remained below 300 ng dl(-1) in 27% of these patients. Hypogonadal symptoms improved in a significant proportion of men who underwent a brand substitution following an initial suboptimal biochemical or symptomatic response. A change in testosterone gel preparation among initially unresponsive hypogonadal men is justified prior to abandoning or considering more invasive TRT. Changing from Androgel to Testim offers hypogonadal men the potential for improved clinical and biochemical responsiveness. Changing from Testim to Androgel is indicated to eliminate or minimize unwanted side effects.     

Y-autosome translocation associated with male infertility: a case report

A 40-year-old man was referred to our hospital with a 12-year history of infertility. He was a well developed male weighing 78 kg with a height of 171 cm. Physical examinations revealed male habitus with normal adult pubic and axillary hair. The penis, epididymides, spermatic cords and prostate were normal. The right testis was about 15 ml in volume and left ne was approximately 12 ml, respectively. Repeated semen analyses showed azoospermia except for only one time when 4 immotile sperm were detected. The plasma levels of lactate hydrogenase, follicle stimulating hormone prolactin and testosterone were within normal limits. Chromosome analysis of peripheral lymphocytes revealed a balanced reciprocal translocation between the short arm of chromosome 12 and the long arm of the Y chromosome (46, X, t (Y ; 12) (q12 ; p13.3)). We performed microdissection testicular sperm extraction and retrieved 11 spermatozoa (10 progressive motile). Seminiferous epithelium showed maturation arrest at the stage of spermatid. Mean Johnsen's score count was 6. The etiology and clinical features of this rare disease were briefly discussed.     

Effects of epidural anesthesia on catecholamines, renin activity, and vasopressin changes induced by tilt in elderly men

Mean arterial pressure, heart rate, plasma catecholamines, renin activity, and vasopressin changes induced by a 30-degree head-up tilt were studied before and during epidural anesthesia with bupivacaine in eight elderly patients (ages 58-82 yr). The tilt performed before epidural anesthesia did not modify mean arterial pressure, heart rate, plasma catecholamines, renin activity, and vasopressin at 5 and 15 min. During epidural anesthesia, the superior level of analgesia ranged from T4 to T10. Epidural anesthesia induced significant (P less than 0.05) decreases from control values in mean arterial pressure and plasma norepinephrine (from 85 +/- 6 to 67 +/- 8 mmHg and from 600 +/- 108 to 307 +/- 77 pg/ml, respectively, mean +/- SEM) without significant changes in heart rate, plasma epinephrine, renin activity, and vasopressin. However 5 and 15 min after tilt, significant decreases from pretilt values were measured in mean arterial pressure (from 67 +/- 8 to 57 +/- 6 and 55 +/- 6 mmHg, respectively) and in heart rate (from 70 +/- 8 to 63 +/- 7 and 62 +/- 7 beats/min). Simultaneously, an increase in plasma vasopressin (from 14.8 +/- 5.5 to 36.2 +/- 10.3 and 40.0 +/- 10.5 pg/ml) was recorded, whereas plasma norepinephrine and epinephrine remained unchanged. Posttilt plasma renin activity values at 5 and 15 min were increased significantly when compared with the preepidural values (2,752 +/- 1,168, 2,410 +/- 1,214 and 713 +/- 190 pg X ml-1 X h-1, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of salivary epidermal growth factor in the pathogenesis of Barrett's columnar lined oesophagus.

Epidermal growth factor (EGF) is implicated in the regeneration of epithelial cells at the site of inflammation or ulceration in the gastrointestinal tract. Single parotid EGF concentration and production was studied in 64 patients with Barrett's columnar lined oesophagus (CLO), in 22 patients with severe reflux oesophagitis without columnar metaplasia and in 51 normal controls. In control patients, mean salivary EGF concentration was 2790 pg/ml (median 1450 pg/ml; range 450-16,500 pg/ml) and mean single parotid EGF production was 2550 pg/min (median 1750 pg/min; range 790-18,000 pg/min). Patients with severe reflux oesophagitis had a similar EGF concentration (mean 3112 pg/ml; median 1500 pg/ml; range 300-16,000 pg/ml) and production (mean 3100 pg/min; median 2200 pg/min; range 790-17,950 pg/min) to controls. Patients with CLO had a 62 per cent lower mean EGF concentration (mean 1197 pg/ml; median 640 pg/ml; range 233-4500 pg/ml) (P less than 0.001, Mann-Whitney U test) and a 60 per cent lower EGF production (mean 1254 pg/min; median 800 pg/min; range 170-3125 pg/min) (P less than 0.001, Mann-Whitney U test) than patients with severe reflux oesophagitis. A subpopulation with malignant change in CLO (n = 16) had a similar EGF concentration and production to the CLO group as a whole (mean 1240 and 1300 pg/min, respectively). Low salivary EGF levels are associated with Barrett's CLO but not with severe oesophagitis without columnar metaplasia. EGF levels do not identify those patients who will subsequently develop malignant change.     

输精管结扎干扰前列腺增生过程的机制探讨——精浆睾酮双氢睾酮的放射免疫测定

本文应用放射免疫测定的方法检测了13例输精管结扎后(平均15.3年,平均年龄50岁)的男性精浆双氢睾酮和睾酮的浓度,另取同年龄组男性13例作为对照。结果表明,精浆睾酮在结扎组(374.54p/ml)和正常对照组(315.64Pg/ml)中没有明显差异,而结扎组精浆中双氢睾酮(46.21pg/ml)却明显低子对照组(184.27pg/ml(p<0.01)。作者认为,输精管结扎对精浆DHT有长期影响,这可能是其对前列腺增生过程产生抑制作用的原因之一。