151例男性精浆和血浆FSH、LH、T和PRL的放射免疫测定

本文报告151例男性精浆和血浆FSH、LH、T和PRL放射免疫测定结果。被检对象:正常生育力男性49例,少精症27例、精子活率低下症12例,无精症12例,输精管结扎8例及服棉酚避孕药者43例。测定结果:精浆激素正常值:FSH2.251±0.945mIU/ml,LH14.665±3.904mIU/ml,T 0.483±0.327ng/ml,PRL 11.901±7.012ng/ml;在少精症、无精症中血浆和精浆FSH的比值(B/S)升高;各组精浆LH值均无明显变化,精浆中T和PRL在少精症、精子活率低下症及服棉酚避孕药者有明显升高;输精管结扎后的男性精浆中FSH、LH、T和PRL值和正常生育力男性比较无明显变化。本文对血浆和精浆FSH、LH、T和PRL的测定结果及临床意义进行讨论。     

不同病因无精子症的生殖激素水平

目的 :探讨不同病因无精子症患者生殖激素水平及病变部位和睾丸生精功能的关系。方法 :采用 RIA法检测 6 5 1例患者血清中的生殖激素 FSH、LH、T、PRL值。结果 :FSH值升高者 ,病变在睾丸 ,且生精功能受损 ;而在正常值上限 2倍以上 ,则生精功能丧失。病变不在睾丸和特发性无精子症者 ,FSH值水平正常或低下 ,LH、T、PRL值不一 ,部分患者生精障碍可随疾病的治愈而恢复。结论 :生殖激素水平可表示无精子症的不同病因 ,FSH值的升高是睾丸生精功能损伤的指标     

153例月经过少患者的性激素检测结果分析

目的:通过了解月经过少患者性激素情况,为临床诊疗提供重要参考。方法:对153例月经过少患者的性激素即雌二醇(E_2)、睾酮(T)、催乳素(PRL)、促黄体生成激素(LH)、促卵泡激素(FSH)、孕酮(P)等结果进行回顾性分析。结果:实验组与对照组比较,PRL结果的差异有统计学意义(P<0.05),LH、E_2、P、T、FSH结果的差异无统计学意义(P>0.05)。但有24例(15.7%)的患者E_2检测结果低于正常对照的下限;有28例(18.3%)的患者T检测结果比正常对照上限高。结论:性激素检测结果对月经过少的的诊治有重要意义。     

输卵管硅橡胶塞绝育术受术者的生殖激素水平

为了研究输卵管硅橡胶塞绝育术对女性生殖内分泌功能的影响,本研究测定了138例健康对照者和76例受术者血清中的6种生殖激素:FSH、LH、E_2、P、T、PRL的水平.结果发现,除PRL外,无论是月经正常的受术者,还是哺乳期闭经的受术者,其FSH、LH、E_2、P的水平与正常对照组相比较均无显著性差异.本研究表明,输卵管硅橡胶塞绝育术对女性生殖内分泌功能的影响不大.受术者PRL的升高只是暂时性的.     

腹腔镜卵巢打孔对PCOS耐氯米芬患者的疗效研究

目的:观察腹腔镜手术治疗耐氯米芬(CC)多囊卵巢综合征(PCOS)不孕患者疗效的影响因素。方法:对46例耐氯米芬的PCOS患者行腹腔镜卵巢打孔术,按术后6周内是否恢复排卵分有效组(排卵)和无效组(无排卵)。分析两组间患者的年龄、不孕年限、体重指数(BMI)、性激素水平对临床疗效的影响。结果:术后有38例患者发生排卵,26例成功妊娠;8例即使在加用CC后仍无排卵与妊娠。有效组术前患者血清LH、LH/FSH的水平明显比无效组高,而不孕年限、BMI明显比无效组低;术后血清LH、LH/FSH及T水平明显下降,FSH及PRL水平无明显变化。无效组手术前后患者血清LH、LH/FSH水平无明显变化,术后血清FSH及PRL水平有上升的趋势。结论:对耐氯米芬PCOS患者行腹腔镜治疗时,术前患者不孕年限、BMI、LH、LH/FSH水平及术后LH、LH/FSH及T水平的下降幅度是预测术后排卵有效的指标,同时应该全面考虑患者的FSH、PRL水平的变化。     

长期食用粗棉籽油的男子垂体及睾丸功能的研究

本文报道45例长期食用粗棉籽油男子血清生殖激素基础水平及LHRH和hCG刺激实验结果,并分别与4例正常对照进行比较。患者分为两组:A组17例精子计数正常或少精症;B组28例无精子症。A组血LH和FSH基础值在正常范围,B组明显升高。T基础值在两组间无统计学差别,但均低于正常水平。A组垂体LH和FSH对LHRH和睾丸T对hCG的反应正常。B组对LHRH反应过强,对hCG反应明显减弱,其反应特点酷似原发性睾丸功能衰竭或KlInefelter′s综合征。结论:1)尚保留生精过程的A组患者的垂体及睾丸内分泌功能并无明显异常改变;2)一旦出现持续性无精子症必然导致全睾丸功能衰竭。     

抗苗勒管激素和抑制素B预测卵巢储备功能的临床研究

目的:探讨血清基础抗苗勒管激素(AMH)和抑制素B(INHB)与卵巢储备功能的关系及其临床价值。方法:将卵巢储备功能不同的148例患者作为研究对象,分别为正常组41例,多囊卵巢综合征(PCOS)组39例,卵巢功能减退(DOR)组38例,卵巢早衰(POF)组30例。检测4组患者的血清基础AMH、INHB、卵泡刺激素(FSH)、E2、黄体生成激素(LH)、孕酮(P)、催乳激素(PRL)、睾酮(T)水平及窦卵泡数(AFC),并做相关性分析。结果:AMH和INHB水平在PCOS组最高,在POF组最低,AMH和INHB水平在4组间比较,差异均有统计学意义(P0.001;P0.001)。AMH和INHB与AFC、E2、T呈正相关(P0.001),与FSH、LH呈负相关(P0.001)。AMH和INHB呈正相关(P0.001)。结论:血清AMH和INHB水平与卵巢储备功能密切相关,结合窦卵泡计数及基础内分泌指标的检测能更准确地评估卵巢储备功能。     

成年男性生育与不育血清中生殖内分泌激素含量的研究

<正> 促卵泡成熟激素(FSH)和促黄体生成激素(LH)是糖蛋白类。FSH 主要作用于睾丸曲细精管的生精作用与支持细胞,LH 主要通过刺激睾丸间质细胞(Leydig)分泌睾酮(T)促进精子形成。因而测定血清中 FSH、LH、T含量可以间接评估男性生育力。我们通过50例正常生育男性和68例男性不育患者血清中 FSH、LH、T 含量测定进一步探讨 FSH、LH、T 浓度与精子密度,睾丸功能,睾丸体积的关系及其测定的临床意义。     

抗米勒管激素对多囊卵巢综合征的诊断价值及其与临床特征相关性分析

目的探讨血清抗米勒管激素(anti-mullerian hormone,AMH)对多囊卵巢综合征(polycystic ovary syndrome,PCOS)的诊断价值及其与各临床特征的相关性。方法选取2014年8月至2016年10月于广东省计划生育专科医院就诊并按照美国生殖医学学会(ASRM)鹿特丹工作组修正的PCOS诊断标准确诊的146例患者为病例组(PCOS组),另选取同期来院进行体检且月经规律、有正常生育史的37名女性为对照组。收集所有研究对象的年龄、身高、体重等一般资料,计算体重指数(body mass index,BMI);空腹抽血查血糖(FPG)、胰岛素(FINS)及血清AMH和卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成激素(luteinizing hormone,LH)、雌二醇(estradiol,E_2)、睾酮(testosterone,T)、泌乳素(prolactin,PRL)等指标,比较PCOS组与对照组的一般特征、血清AMH质量浓度、性激素及各代谢参数差异;分析AMH诊断PCOS的截断值(cut-off值)以及与各临床特征的相关性。结果 PCOS组与对照组的BMI及血清LH、LH/FSH、T、AMH、FINS、FPG、胰岛素抵抗指数(HOMA-IR)差异有统计学意义(P0.05);年龄、FSH、E_2、PRL差异无统计学意义(P0.05)。AMH预测PCOS的cut-off值为6.545μg/L,敏感度为67.81%,特异度为72.97%;在PCOS人群中,AMH值与T、HOMA-IR呈正相关关系(P0.05),与BMI无相关性。结论血清AMH质量浓度能反映高雄激素血症和胰岛素抵抗的程度,可作为PCOS诊断与监测指标之一。     

子宫和/或单侧附件切除术对受术者性激素水平的影响

目的:观察子宫和/或单侧附件切除手术后对受术者性激素的影响及其恢复途径。方法:138例良性妇科肿瘤患者按不同术式分为5组:Ⅰ组行单纯次全子宫切除术,Ⅱ组行单纯全子宫切除术,Ⅲ组行次全子宫切除术加一侧附件切除术,Ⅳ组行全子宫切除术加一侧附件切除术,Ⅴ组行单侧附件切除术。各组于术前、术后1周、3月、1年后测定血清性激素水平,比较手术前、后FSH、LH、E2、P、T、PRL的变化。结果:术后1周各组E2水平均降低,PRL水平上升,手术前后比较,差异有显著性(P<0.01)。FSH、LH、P、T未见明显差异。术后3月,各组E2水平均高于术后1周,差异有显著性(P<0.01,P<0.05)。各组PRL水平较术后1周下降,差异亦有显著性(P<0.01,P<0.05)。Ⅰ、Ⅱ、Ⅲ、Ⅳ组FSH水平均较术后1周上升,差异有显著性(P<0.01,P<0.05),Ⅴ组未见明显升高,差异无显著性(P>0.05)。手术1年后,各组E2水平继续上升,接近或达到术前水平,与术前差异无显著性(P>0.05)。Ⅱ、Ⅲ、Ⅳ组FSH水平继续上升,高于术前水平,差异有显著性(P<0.05)。Ⅰ组有上升趋势,但差异无显著性(P>0.05)。Ⅴ组术后3月就已下降至术前水平,与术前差异无显著性(P>0.05)。结论:子宫和/或单侧附件切除术后,近期对内分泌功能有不同程度的影响,以E2、PRL最敏感,E2水平明显下降,PRL显著上升,以后逐渐恢复。     

Comparison of changes of serum gonadotropins and steroid hormones in azoospermic men caused by gossypol and other factors]

The plasma FSH, LH, PRL, T, E2, and F levels were compared in normal men (group 1), azoospermic men with different etiologies including gossypol treatment (group 2), men with uncertain diagnoses (group 3), and men with Klinefelter's syndrome (group 4) in order to determine whether differences in hormonal changes and their extent could be discerned in affected subjects. Results show that the average FSH and LH levels in azoospermic men as a whole group (n=50) were significantly higher than those in normal men (P0.001). There was no significant difference in PRL, T, E2, and F levels from the control group (P0.05). It was interesting to note the extent to which hormone changes were observed in different groups of affected subjects. Normal FSH levels were found in groups 2 and 3 in 50% of the patients while FSH levels in the rest of the patients were markedly higher (P0.001). The changes in serum LH levels were parallel with FSH levels in groups 3 and 4; in group 2, both LH and T/LH ratio remained unchanged but T, E2, and F levels were elevated while PRL decreased significantly. Patients in groups 3 and 4 have shown a very low T and T/LH ratio when compared with the control group and group 2 (P0.001). It was concluded that the contraceptive dose of gossypol did not cause obvious damage in Leydig cell function in terms of T production. High FSH levels indicated the severe damage in germinal epithelium of the testis. In order to minimize side effects and to avoid irreversibility in spermatogenesis, the minimal effective dose of gossypol must be used as a contraceptive. Some objective reference parameters were recommended to monitor the contraceptive dosage of gossypol. (author's modified)     

An examination of blood steroid and gonadotropin concentrations in relation to fertility status and testicular function in men

Plasma concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), testosterone (T), and 17 beta-estradiol (E2) have been measured in men complaining of infertility in comparison with men of proven fertility. Subgrouping of patients was achieved on the basis of the presence or absence of sperm in the ejaculate and further by the concentration of sperm or by testicular score. The levels of plasma LH, FSH, PRL, and T were found to be significantly different in the fertile men, compared with both infertile men with sperm in their ejaculates and azoospermic men. There were no significant differences between the groups for E2. There appeared to be an inverse relationship between LH concentrations and sperm count in both fertile and infertile men. FSH levels did not vary significantly in the fertile men in relation to sperm count grouping but were significantly less than those found for the infertile men with sperm. Azoospermic patients with high testicular scores had FSH levels indistinguishable from those of the fertile men. The results are discussed in terms of testicular abnormalities and on the interrelationship between the hormones examined.     

Exaggerated prolactin response to thyrotropin-releasing hormone and metoclopramide in primary testicular failure

Twenty-eight severely oligospermic and azoospermic men aged 20 to 42 years were challenged with luteinizing hormone (LH)-releasing hormone (LHRH), thyrotrophin-releasing hormone (TRH), and the dopaminergic antagonist, metoclopramide, given at 30-minute intervals. According to basal gonadotropin levels, the patients were subdivided into three groups: those with severe testicular failure (basal LH > 20 mIU/ml and FSH > 14 mIU/ml); those with moderate testicular failure with predominant seminiferous tubule involvement (LH < 20 mIU/ml and FSH > 14 mIU/ml) and those with mild testicular failure (LH < 20 mIU/ml and FSH < 14 mIU/ml. With one exception, mean basal prolactin (PRL) levels were normal in all patients. In all three groups, however, there was an exaggerated PRL response to TRH, the response in severe and moderate testicular failure being greater than that in mild testicular failure. The response to metoclopramide was increased only in the first two groups, not in the group with mild testicular failure. When individual patients and control subjects were considered together, the peak PRL response to TRH correlated with both basal and peak gonadotropin responses to LHRH. However, the PRL responses did not correlate with 17 beta-estradiol, estrone, testosterone, or the estradiol-testosterone ratio. It is concluded that oligospermic and azoospermic subjects with the most severe testicular failure and the highest gonadotropin levels have the greatest PRL increases after TRH and metoclopramide, indicating that the PRL response is related to the degree of testicular failure.     

Follicle-stimulating hormone, luteinizing hormone, and testosterone levels found in human seminal plasma

Radioimmunoassays were performed on the seminal plasma of normospermic, oligospermic, and azoospermic men to determine the levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone. FSH levels in the seminal plasma of all three groups were found to be similar to the levels normally found in blood serum. LH levels in the seminal plasma of azoospermic and oligospermic men were within the normal range found in blood serum but were elevated in the normospermic samples. Testosterone levels in the seminal plasma of all three groups tested were considerably lower than the normal range found in blood serum.     

Marked suppression of gonadotropins and testosterone by an antagonist analog of gonadotropin-releasing hormone in men

To study the dose response characteristics of a gonadotropin-releasing hormone (GnRH) antagonist ([Ac-D2-Nal1,D4-Cl-Phe2,D3-Pal3,Arg5,dGlu6 (AA), d-Ala10] GnRH; Nal-Glu), 1.5 or 5.0 mg of Nal-Glu were administered to two groups of five normal men by daily subcutaneous injection for 21 days. Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone (T) were determined on multiple occasions before, during, and after the antagonist treatment. Five milligrams Nal-Glu markedly suppressed mean serum immunoreactive LH to a mean of 1.5 +/- 0.4 IU/L (+/- SEM), immunoreactive FSH to the limit of assay detection (1 IU/L), and lowered basal mean serum T to castrate range (less than 2 nmol/L). Serum bioactive LH levels also showed a marked decrease in the 5.0-mg group similar to that seen in immunoreactive LH levels. Amplitude of immunoreactive LH pulses was markedly reduced in the 5.0-mg group on day 21. A 1.5-mg dose of Nal-Glu transiently suppressed serum immunoreactive LH levels on day 1. There was a subsequent escape on the rest of the days sampled. Serum immunoreactive FSH levels were not significantly changed over the 21-day treatment period. Serum T levels were transiently suppressed only on day 1 paralleling immunoreactive LH suppression. No adverse systemic side effects occurred. Thus, the 5.0-mg dose of this GnRH antagonist provides a pharmacological means of markedly suppressing the hypothalamic-pituitary-gonadal axis and, therefore, has potential as a male contraceptive.     

米非司酮对早孕妇女内分泌的影响

共征集２４名停经≤４９ｄ、要求中止妊娠的健康妇女，分４组，各组依次口服米非司酮５０ｍｇ（组Ⅰ）、５０ｍｇＱ１２ｈ×６（组Ⅱ）、２００ｍｇ（组Ⅲ）和６００ｍｇ（组Ⅳ），首次服药后７２ｈ行人流术（组Ⅰ）或阴道内放置卡前列甲酯栓（ＰＧ０５）１ｍｇ（组Ⅱ～Ⅳ）。结果显示各组之间临床效果及临床经过差异均无统计学意义（Ｐ＞０．０５）。血清β－ｈＣＧ、Ｅ２Ｐ变化趋势亦基本一致。β－ｈＣＧ在用药前２４ｈ内上升５０％～１００％（Ｐ＜０．０１），服药后至孕囊排出前仍呈上升趋势，口服首剂米非司酮后，各组Ｅ２水平亦持续高于服药前，而Ｐ水平则缓慢下降。妊娠中止后，上述三种激素急剧下降。服药期间，各组ＰＲＬ和皮质醇明显上升，孕囊排出后前者下降缓慢，而后者下降迅速，ＡＣＴＨ、Ｔ３、Ｔ４和ＴＳＨ变化均无统计学意义。本研究结果表明来非司酮（５０ｍｇＱ１２ｈ×６，２００ｍｇ和６００ｍｇ）抗早孕时无明显量效关系；其主要作用部位似不在卵巢和绒毛；但对垂体一肾上腺轴有一定影响，尤其是大剂量时；对垂体一甲状腺轴影响不明显；ＰＲＬ水平变化似为药物直接作用所致，其临床意义尚待进一步研究。