控制性超排卵中低LH的发生及其结局与特殊类型病例LH添加治疗

<正> 在女性的卵巢周期中,卵泡的正常发育是由垂体分泌的卵泡刺激素(FSH)和黄体生成素(LH)两种激素控制的,两者对于正常卵泡雌二醇(E_2)的生物合成均有重要作用,也就是所谓的"两种细胞,两种促性腺激素"学说,即FSH刺激卵泡发育,LH结合于卵泡膜细胞上的受体,激发雄激素前体从膜细     

精原细胞期精子生成受阻不能单用hCG治疗

人类精子生成需要高浓度男性激素。男性激素的生物合成受LH控制。间质细胞内甾体激素缺乏及促性腺激素有效刺激不足,均可导致精子生成障碍。在一些病例,通过外源性hCG治疗,产生内源性男性激素,以增加精子生成。一例26岁男性患者,一年前性欲低下,精子数下降并发展为无精症,婚后两年不育。血清FSH和T降低,LH和Pra(催乳素)正常。LHRH(促黄体生成素释放激素刺激试验)显示FSH低而LH增加。睾丸活检     

促性腺激素释放激素激动剂和拮抗剂垂体降调节作用仅针对促黄体生成素吗?

促性腺激素释放激素(GnRH)概述 GnRH是一种由下丘脑神经内分泌细胞合成的、以脉冲形式分泌进入垂体的神经十肽,其作用是刺激垂体腺细胞合成卵泡刺激素(FSH)和黄体生成素(LH),影响性腺的激素与配子生成.     

控制性促排卵周期合适的LH水平

<正> 经典的两细胞两促性腺激素理论告诉我们:黄体生成素(LH)、卵泡刺激素(FSH)在卵泡发育、卵子成熟、排卵和类固醇激素合成等活动中是必需的,但对各自作用的阈值、极限水平和时空效应没有具体的说明。卵泡早、中期LH刺激卵泡膜细胞合成     

女性血清FSH和LH与骨转换生化指标的关系

目的了解女性卵泡刺激素(FSH)和黄体生成素(LH)水平的变化与各种骨转换生化指标之间的关系。方法健康女性694例,年龄20～82岁。放射免疫法测定血清FSH和LH,ELISA测定血清骨特异性碱性磷酸酶(BAP)、骨钙素(OC)、骨Ⅰ型胶原N末端肽(sNTX)和C末端肽(sCTX)、尿骨Ⅰ型胶原N末端肽(uNTX)和C末端肽(uCTX)、尿骨Ⅰ型胶原交联脱氧吡啶酚(uDPD)。结果血清FSH和LH与BAP、OC、sCTX、uNTX和uDPD之间的关系,采用复合曲线模型拟合优度最佳,与sNTX和uCTX之间的关系采用线性模型拟合优度最佳,FSH和LH与BAP(R2=0.392和0.382,P=0.000)之间的决定系数最大,与uDPD(R2=0.027和0.017,P=0.002)之间的决定系数最小。多元线性回归分析显示,BAP43.0%、OC22.1%、uCTX11.8%、sNTX8.2%、uNTX8.2%、sCTX6.6%和uDPD1.9%的变化是由FSH决定的,LH只能解释0.7%～2.1%的变化,FSH对各种骨转换指标的决定性作用大约是LH的7～20倍。结论女性FSH和LH水平与骨转换速率有关,血清FSH和LH水平增加者骨转换增加,FSH对骨转换的作用远大于LH,对骨形成指标的作用远大于骨吸收指标。     

控制性促排卵中特殊人群添加重组人黄体生成素的临床应用

成功的辅助生殖结局与适宜的卵巢刺激紧密相关。FSH和LH在卵泡发生和激素合成过程中扮演协同作用。LH是E2生成、卵泡最适发育、排卵和黄素化的必须因素。多数学者认为1.2U/L≤LH≤5.0U/L是卵泡发育和卵母细胞成熟的治疗窗。控制性促排卵(COH)中低LH是否需要添加重组人黄体生成素(r-hLH)一直广受争议。本文就COH中可能通过添加r-hLH获益的特殊人群及添加的剂量和时机进行综述。     

促性腺激素释放激素激动剂降调对垂体内外的影响

降调是促激素下调自身的受体以调节靶组织对激素的反应性,是促激素调节其自身作用的机制之一.除受体的升调和降调外,促激素还可通过自分泌/旁分泌、激素的异质性来调节自身的作用.降调的机制是通过受体与调节亚单位G蛋白解耦联、受体内在化进入细胞、以及腺苷酸环化酶的调节和催化亚单位解耦联3种途径来实现的.降调对卵泡刺激素(FSH)和黄体生成素(LH)的直接作用是使40％～60％的FSH分泌受到抑制,而90％的LH分泌受到抑制,目的是抑制过早内源性LH峰.降调对FSH、LH旁分泌调节的作用需要通过FSH和LH发挥作用,旁分泌调节因子本身并没有促使卵泡发育的作用.由于类固醇激素的负反馈是通过下丘脑垂体发挥作用,而降调是在促性腺激素释放激素(GnRH)的受体水平,因此取消了类固醇激素正常的正负反馈.由于卵巢颗粒细胞、膜细胞、黄体细胞均有GnRH受体,理论上推测GnRH对卵巢可能有直接作用.动物实验及体外试验均提示GnRH对卵巢颗粒细胞有直接作用,体现在类固醇的合成和卵泡的发育两方面.因此,促性腺激素释放激素激动剂(GnRH-a)提高妊娠率的作用除了来自于抑制过早LH峰,降低过高LH的不利作用外,还可能来自GnRH-a对卵泡发育、卵母细胞成熟、子宫内膜的容受性等直接作用,但目前的研究方法尚无法证实.     

尿卵泡刺激素、黄体生成素全定量测定在促性腺激素释放激素激动剂降调节后的应用价值

目的探讨尿卵泡刺激素(FSH)、黄体生成素(LH)全定量测定在促性腺激素释放激素激动剂(GnHR-a)降调节后的应用价值。方法回顾性分析2012年10月至2013年4月在昆明医科大学第二附属医院生殖医学科接受长方案体外受精-胚胎移植(IVF-ET)和卵胞浆内单精子注射(ICSI)治疗的不孕症患者共208个周期,测定促性腺激素(Gn)启动日当天血清FSH、LH水平和尿FSH、LH全定量水平,分析两种测量方法的相关性以及血、尿FSH、LH与获卵数及妊娠结局的关系。血、尿FSH各分为三组(≤3 IU/L,>3⁵ IU/L,>5 IU/L),分析各组间年龄、获卵数、正常受精数、卵裂数、Gn使用总量、妊娠率等的差异。结果尿FSH与血FSH显著相关(r=0.508,P<0.01),尿LH与血LH相关(r=0.328,P<0.05)。通过Logistic回归分析,尿FSH各组间随尿FSH水平的升高,获卵数≤4枚的可能性增高1.95倍;将血FSH、LH、FSH/LH和尿FSH、LH、FSH/LH与卵巢反应性的关系进行Logistic回归分析,在逐步引入变量的过程中,只有尿FSH全定量水平与卵巢反应性有密切相关性。结论尿FSH、LH全定量水平与血清FSH、LH水平相关;尿FSH全定量可作为辅助判断降调节的指标并能预测卵巢的反应性。     

卵泡刺激素、黄体生成素对卵母细胞成熟的调节作用

遵循两细胞两促性腺激素的理论,卵泡刺激素(FSH)、黄体生成素(LH)对于卵泡成熟和卵巢性腺类固醇的产生都是必需的。在体内FSH启动卵泡生长,LH促进卵母细胞成熟。FSH及LH的应用显著缩短了卵母细胞体外成熟(IVM)的时间,提高卵母细胞成熟及发育的潜能,提高妊娠率。因此揭示卵母细胞核质成熟的影响因素,对提高IVM卵母细胞的质量至关重要。     

原发性上尿路结石患者激素检测及其意义

目的探讨原发性上尿路结石患者体内激素的变化及其临床意义。方法测定34例男性、18例女性原发性上尿路结石患者和男女各20例健康对照者血清睾酮（Testo）、雌二醇（E2）、催乳素（PRL）、促黄体生成激素（LH）、促卵泡成熟激素（FSH）及甲状旁腺素（PTH）水平。结果男性结石组Testo、PRL、LH及PTH明显高于男性对照组（P〈0．05），E2明显低于男性对照组（P〈0．05），FSH差异无统计学意义；女性结石组PRL、PTH明显高于女性对照组（P〈0．05），其余四项指标差异无统计学意义。结论性激素对男性原发性上尿路结石患者有一定影响，而对女性原发性上尿路结石患者影响尚不明显，有待进一步研究。甲状旁腺素对男女原发性上尿路结石患者均有影响。     

Ultrastructural changes in the pituitary gonadotropic cells under the action of estrogens in rats. Contribution to the study of the topical origin of gonadostimulins

Ultrastructural changes in the pituitary gonadtropic LH and FSH cells have been studied in 4-day cyclic female rats injected with estradiol benzoate (EB) on the morning of diestrus I. A granular release in both LH and FSH cells was observed during the night following diestrus II in the females which displayed estrogen-induced luteinization. LH cells only appeared degranulated in the females unresponsive to EB. These results confirmed previous light microscopic observations (Hassani and Plas-Roser, 1975). The origin of LH and FSH from one or two categories of pituitary cells was discussed in the light of these observations. The FSH cell was assumed to be involved in the secretion of both gonadotropic hormones. However a role of LH cells in the production of LH was suggested by the present observations.     

Individual differences in LH and FSH responses to orchidectomy and testosterone replacement therapy in rams

Profiles of LH and FSH levels and pituitary LH responses to exogenous luteinizing hormone releasing hormone (LHRH) have been characterized in rams, castrated rams (wethers), and wethers implanted with testosterone. Rams were castrated when adult, and, at the time of castration, two groups of wethers were implanted with either four or eight testosterone capsules. Rams showed random pulses of LH and testosterone which were temporally related. The number of LH and testosterone pulses per 24 hours differed among rams, giving rise to large differences in the mean levels of these hormones. Mean FSH levels and pituitary LH responses to LHRH also differed among rams and were positively correlated to differences in LH levels. All three nonimplanted wethers showed a rhythmic pulsatile pattern of LH secretion and had elevated mean LH and FSH levels. There were, however, appreciable differences between wethers with regard to mean LH and FSH levels and pituitary LH responses to LHRH. Both four and eight testosterone capsules were effective in suppressing pulsatile LH secretion and mean LH and FSH levels in two out of three wethers. In a third animal within each of these groups, however, LH and FSH profiles and LH responses to LHRH were characteristic of nonimplanted wethers. These data suggest that individual rams have different inherent capacities to secrete gonadotropins which influence LH and FSH responses to castration and testosterone replacement therapy.     

绝经后骨质疏松妇女血清相关激素水平的改变

目的　通过分析绝经后骨质疏松妇女某些骨代谢相关激素的血清水平的改变 ,探讨其与绝经后骨质疏松的关系。方法　 6 2名绝经 2年以上妇女 ,测量腰椎骨密度 ,分为骨质疏松组 (30名 )和对照组 (32名 )。隔夜空腹取血测定血清LH、FSH、E1、E2 、DHEA、DHEA S、SHBG、GH、CT、PTH、2 5 (OH)D3 。结果　绝经后妇女骨质疏松组和对照组在年龄上无差异 (5 9 5 6± 6 6 5vs 5 9 35± 7 6 3,P>0 0 5 )。骨质疏松组体重指数BMI (2 4 2 7± 2 4 6 )低于对照组 (2 6 83± 4 16 ,P <0 0 5 )。绝经后妇女血清E1(r= 0 6 0 0 ,P <0 0 0 1)、DHEA(r= 0 70 8,P <0 0 0 1)、DHEAS(r = 0 5 82 ,P <0 0 0 1)与年龄负相关。骨密度与LH负相关 (r= 0 4 39,P <0 0 5 )。骨质疏松组与对照组相比 ,LH、SHBG显著增高 (P<0 0 5 ) ,DHEA、DHEAS显著降低 (P <0 0 5 )。FSH、CT、PTH、2 5 (OH)D3 、GH、E1、E2 差异无显著性。结论　绝经后妇女骨代谢相关激素血清水平的改变参与了绝经后骨质疏松的发病     

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。     

Testicular gametogenic and steroidogenic activities in chlorpyrifos insecticide-treated rats: a correlation study with testicular oxidative stress and role of antioxidant enzyme defence systems in Sprague-Dawley rats

The present works examined an adverse effect of chlorpyrifos insecticide on testes and lipid peroxidation at low doses (5 mg-10 mg kg(-1) body weight) and the role of antioxidant enzymes systems at higher doses (20-30 mg kg(-1) body weight) in albino rats. At low doses, reduction in plasma levels of testosterone and FSH and LH hormones along with the significant shrinkage of seminiferous tubules and gametogenic changes in germ cells were noticed. But these changes were restored with the revival of serum testosterone, FSH and LH along with regression of testis at higher doses. Similarly, level of testicular lipid peroxidation was elevated, whereas levels of antioxidant enzymes (superoxide dismutase, catalase and glutathione peroxidase) and steroidogenic enzymes activities (Δ(5) , 3β-hydroxysteroid dehydrogenase and 17β-hydroxysteroid dehydrogenase) were reduced significantly at low doses. But, rat testes showed a significant decrease in lipid peroxidation and concomitant increase in antioxidant enzymes and steroidogenic enzymes activities at higher doses. Results showed that at higher doses of chlorpyrifos treatments, rat testes were shown to trigger their natural defence mechanism which became operative possibly through corrective measure of synthesis of antioxidant defence enzymes and steroidogenic enzymes and pituitary gonadotrophins hormone feedback mechanisms.     

性激素三项(E2、FSH、LH)与乳腺癌分子亚型及复发风险的相关性研究

目的探讨乳腺癌患者性激素三项(E2、FSH、LH)与ER、PR、HER-2、Ki-67临床病理特征以及分子分型、复发风险的关系。方法对2011年11月~2013年5月在我院收治的86例乳腺癌患者,其中绝经患者(绝经组)31例,未绝经患者(未绝经组)55例,采用吖啶酯化学发光法检测性激素三项(E2、FSH、LH),采用SP免疫组化法检测ER、PR、HER-2及Ki-67的表达。通过两独立样本t检验、Spearman秩相关、秩和检验等方法研究性激素三项与ER、PR、HER-2及Ki-67临床病理特征及复发风险的关系。结果经两独立样本t检验和Spearman秩相关分析,患者性激素三项与ER、PR表达水平无相关性(P均>0.05)。患者整体FSH水平与HER-2状态正相关(t=2.167,P=0.034),绝经组FSH水平与HER-2状态无明显相关(t=1.751,P=0.102),但较E2和LH的t值大,而未绝经组FSH水平与HER-2状态正相关(t=2.172,P=0.036)。在绝经组LH的水平与Ki-67的表达水平呈正相关(相关系数=0.546,P=0.043)。绝经组FSH及LH的水平与分子分型呈显著性正相关(相关系数分别为0.644和0.632,P分别为0.013和0.015,均<0.05)。绝经组患者FSH与复发风险存在统计学意义(χ2=7.610,P=0.022,P<0.05);未绝经组患者FSH与复发风险存在统计学意义(χ2=6.030,P=0.049,P<0.05)。结论 ER、PR的表达状态及表达水平与E2、FSH及LH这三项性激素无关,相对恒定;在未绝经的乳腺癌患者中,FSH水平与HER-2的表达呈正相关;在已绝经的乳腺癌患者中,LH水平和Ki-67的表达呈正相关,FSH、LH水平与分子分型明显相关;无论绝经与否,乳腺癌患者FSH水平与其复发风险明显相关。     

The reproductive system of male rats exposed to very low doses of ionizing radiation, 1: Hormonal profile of animals exposed after sexual maturity

Adult male rats were treated with a single, whole body exposure to a dose of 0.001, 0.01 or 0.1 Gy (1 Gy = 100 rad). The animals were sacrificed 1, 7, 30, 100 or 180 days following exposure. Serum testosterone, serum and hypophyseal LH, FSH and prolactin as well as hypothalamic LHRH were measured. In the 0.1 Gy irradiated rats, serum LH and FSH were 100% higher and serum prolactin was 30% lower as compared to controls, 30 days after irradiation. The concentrations of these hormones remained significantly different from control values even after 180 days after exposure. On the other hand, the hypophyseal content of LH, FSH and prolactin decreased in the 0.1 Gy treated rats, 100 days after irradiation. In the group of the 0.01 Gy irradiated rats, serum FSH increased by 70% and hypophyseal FSH decreased. No changes were observed in serum testosterone and hypothalamic LHRH in any of the irradiated groups and no changes were observed in the group exposed to 0.001 Gy. It may be concluded that a long term damage to the reproductive system of the male rat was induced by a single, whole body exposure to 0.1 Gy of gamma radiation.     

Estrogens in the Feedback Regulation of Gonadotropin Secretion in Men: Effects of Administration of Estrogen to Agonadal Subjects and the Antiestrogen Tamoxifen and the Aromatase Inhibitor δ''-Testolactone to Eugonadal Subjects

To elucidate the specific role of estrogens in the feedback regulation of gonadotropin secretion in men, basal and LRH-stimulated gonadotropin levels were studied in: Six agonadal subjects Six agonadal subjects continuously treated with 50 micrograms ethinylestradiol Six eugonadal subjects, treated with the aromatase inhibitor delta'-testolactone, which induced a reduction of estrogen levels, independently of testosterone. Further, to determine whether estrogens exert differential effects in time on LH and FSH secretion, the anti-estrogen tamoxifen was administered to: Six eugonadal subjects for two weeks and Six eugonadal subjects for six weeks. It was found that estrogens have a strong suppressive effect on both LH and FSH secretion. However, changes in estrogen levels and blocking of estrogen receptors are followed more rapidly by FSH than LH. Estrogens affect LRH-induced LH release more than basal LH levels; basal and LRH-stimulated FSH are approximately equally influenced. Basal and LRH-induced LH secretion are known to be more dependent upon previous LRH stimulation than FSH secretion. Since FSH followed changes of estrogens more rapidly than LH did, we postulate that the negative feedback action of estrogens on: LH secretion is predominantly exerted at the level of the hypothalamus, through inhibition of LRH secretion FSH secretion predominantly at the level of the pituitary through a direct action on the gonadotroph.     

精子发生的内分泌激素调节

下丘脑-垂体-睾丸轴系对男性生殖功能起着关键性作用,精子发生是这个轴系精密调节的结果。下丘脑促性腺激素释放激素(GnRH)脉冲式释放控制了卵泡刺激素(FSH)和黄体生成素(LH)的波动性分泌,GnRH脉冲频率的变化调节垂体促性腺细胞分泌两种不同的激素,是一种独具一格的机制。促性腺激素抑制激素(GnIH)于2000年首次从鹌鹑垂体鉴定出来。GnIH的发现使我们更深入地了解下丘脑激素对垂体促性腺细胞的调节。哺乳动物的GnIH神经元定位于下丘脑背内侧核,轴突延伸至正中隆突。GnIH通过其受体GPR147抑制垂体促性腺细胞的功能。成年男子的精子发生需要FSH和睾酮的共同作用,任何二者之一缺失会损害Sertoli细胞的分化和功能以及生精细胞在精子发生过程的发育。睾酮至少从4个方面促进精子发生:(1)紧密连接(tight junction)的形成和功能;(2)附睾的发育和功能;(3)生精细胞的发育;(4)精子释放。在体研究提示,雌激素亦对精子发生起重要作用,雌二醇调节小鼠精原细胞系和精母细胞系调亡和抗调亡之间的平衡。     

Decreased levels of testosterone and gonadotrophins in men with long-standing tetraplegia

STUDY DESIGN: Blood samples were frequently collected during a 24-h period from six tetraplegic men. The results were compared with those of eight able-bodied controls. OBJECTIVE: Previous studies have reported conflicting results regarding the plasma concentrations of testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in tetraplegia. The objective of this study was to examine the pituitary-gonadal axis by determining the plasma concentrations and circadian variations of these hormones in men with long-standing tetraplegia. SETTING: Sunnaas Hospital, Norway. METHODS: The plasma concentrations of hormones were measured with standardized assays. RESULTS: All three hormones and free testosterone index were decreased in the tetraplegic subjects compared with the able-bodied controls (P<0.05). We also determined the morning levels of hormones with regulatory effects on testosterone, LH and FSH. Whereas plasma leptin was significantly higher in the tetraplegic group, no significant differences in the morning plasma values for insulin, SHBG, GH or IGF-1, or in the 24-h urine concentrations of cortisol were detected between the two groups. The plasma concentration of LH displayed a circadian variation (P<0.05) in the tetraplegic group, but not among the able-bodied. No circadian variation was noted for the plasma concentrations of testosterone and FSH in either group. CONCLUSION: Our data indicate that, over time, tetraplegic male subjects might be at risk of developing hypogonadism.