慢性肾功能衰竭患者血清生长激素水平的观察

Serum levels of growth hormone (GH) in the fasting and postprandial state were observed in 27 patients with chronic renal failure (CRF) [and in 27 normal controls. The results showed that serum levels of GH were significantly higher in CRF patients than in normal controls. Most patients exhibited a "paradoxical rise" of GH following an oral glucose load. There was no difference between GH concentrations in those with impaired glucose tolerance (IGT) and those with normal glucose tolerance (NGT) in the CRF cases. Elevation of GH could be returned to normal by kidney transplantation with the disappearance of the "paradoxical rise" of GH. The mechanism of these abnormalities and the relationship between abnormalities of GH and IGT were discussed.     

生殖器疱疹患者合并TP、HIV、HCV感染状况分析

目的:了解生殖器疱疹(genital herpes,GH)患者的梅毒螺旋体(treponema pallidum,TP)、艾滋病病毒(human immunodeficiency virus,HIV)、丙型肝炎病毒(hepatitis C virus,HCV)抗体水平,为性病门诊制订性病防控措施提供科学依据.方法:对所研究对象抽血并分离血清,用梅毒螺旋体明胶凝集试验(TPPA)检测梅毒特异性抗体,用ELISA法检测HCV抗体、HIV抗体,并用蛋白质印迹法对HIV抗体进行确认.结果:GH患者组TPPA阳性率为30.99%,HIV抗体阳性率为4.23%,HCV抗体阳性率为5.63%,均高于非GH患者组(分别为χ2=99.75,P=0.000;χ2=14.72,P=0.000;χ2=9.30,P=0.002).结论:GH患者组TPPA、HIV、HCV抗体阳性率明显高于非GH患者组,对GH患者应加强干预,以进一步控制TP、HIV、HCV的传播.     

运动负荷对糖尿病性视网膜病变病人血清生长激素水平的影响

本文观察了20例非胰岛素依赖型糖尿病病人(有、无视网膜病变各10例)25min中等运动负荷前后血清生长激素的变化,同时测定了其血糖及血清C—肽水平。结果发现:运动负荷后血清生长激素仅在有视网膜病变的糖尿病病人中显著升高,提示生长激素对非特异性刺激反应性的异常增高可能是致糖尿病性视网膜病变的重要因素之一。     

94例肢端肥大症住院患者的临床病理及疗效分析

目的整理94 例肢端肥大症住院患者的临床资料，探讨诊断准确性与疗效，阐明其临床特征。方法采用回顾性研究，应用SPSS 22.0统计软件进行分析。结果94例患者中，男性31 例（33.0%）、女性63 例（67.0%），就诊年龄14～72 岁，以41～50岁比例最大（35.1%）。首发症状中，容貌改变或手足改变78 例（83.0%），头痛43例（45.7%），视力下降或视野缺损41 例（43.6%），闭经或泌乳11 例（11.7%），不育或性功能障碍2 例（2.1%）。影像学检查，CT检出10 例（10.6%），MRI检出84例（89.4%），明确描述肿瘤大小66例，大腺瘤及巨大腺瘤占93.94%，微腺瘤仅为6.06%。血清生长激素（GH）水平与肿瘤大小呈正相关（P <0.05）。93 例行手术治疗，除微腺瘤外，术后血清GH 水平较术前下降。行手术治疗同时完善免疫组织化学检查共90 例，GH 表达阳性占94.45%；ROC 曲线显示，术前血清GH 水平与术后免疫组织化学GH 表达情况无关。结论94 例患者，女性多于男性，就诊年龄主要集中于31～60 岁，首发症状以容貌改变或手足改变、头痛、视力下降或视野缺损多见，大腺瘤及巨大腺瘤居多。GH水平与肿瘤大小呈正相关，且手术治疗可使GH水平降低。免疫组织化学GH 表达情况与术前血清GH 水平不完全符合，GH 水平对免疫组织化学GH 表达阳性患者的诊断准确性较低。     

急性心肌梗死与血清生长激素水平的关系研究

目的探讨急性心肌梗死（AMI）患者血清生长激素（GH）水平的变化规律及其临床意义。方法采用放射免疫分析法测定48例AMI病人和40例健康对照组血清GH水平,并作比较。结果急性左心衰组与非急性左心衰组、对照组比较及大范围梗死组与小范围梗死组比较,CH明显降低（P分别为0.035,0.008,0.027）。结论血清GH水平可作为反映AMI严重程度的敏感指标。     

INHIBITORY EFFECTS OF ATROPINE ON GROWTH HORMONE RELEASE IN NORMAL SUBJECTS AND ACROMEGALY

Growth hormone (GH) secretion is mediated by hypothalamic factors, mainly growth hormone releasing factor (GRF) and somatostatin (SS). The hypothalamic hormones, under direct neurotransmitter control, stimulate GH secretion through different central mechanisms. Atropine, an anticholinergic agent, can cross the blood-brain barrier and inhibit GH secretion stimulated by exercise and sleep in normal persons. In order to study the inhibiting effect of atropine on GH release and whether glucose can be replaced by atropine, normal persons and acromegaly patients were observed during exercise, after atropine, and 100 g glucose loading. The results confirmed that GH secretion increases after exercise and that this GH elevation can be inhibited by atropine in normal subjects. But in acromegaly patients high basal GH levels can not be inhibited by 100 g glucose loading or 0.6 mg atropine during the active phase of the disease. Blood sugar levels remained unchanged during the atropine test. It is suggested that the atropine test can be used as a GH inhibitory test in acromegaly patients with overt diabetes.     

生长激素在体外授精-胚胎移植卵巢低反应患者中的应用

【目的】探讨重组人生长激素（GH ）对卵巢储备功能低下患者体外授精‐胚胎移植（IVF‐ET ）的作用。【方法】收集行IVF‐ET的卵巢储备功能低下不孕患者78例,根据患者意愿分为两组：GH组36例（GH组）,采用超长方案,同时加用GH ;对照组42例,仅采用超长方案。比较两组超排卵过程及妊娠结局。【结果】 G H组促性腺激素（Gn）用量及Gn使用时间显著低于对照组;GH组临床妊娠率高于对照组,流产率低于对照组,其差异均有统计学意义（ P＜0．05）。【结论】GH对卵巢储备功能低下患者可减少 Gn使用量,改善卵子质量,提高临床妊娠率。     

Prader-Labhart-Willi syndrome: auxological response to a conventional dose of growth hormone in patients with classical growth hormone deficiency

The aim of the study was to evaluate the effect of growth hormone (GH) (14 IU/m2/week) on height, body mass index and predicted adult height in children with Prader-Labhart-Willi (PLWS) syndrome and GH deficiency. - By auxological criteria GH deficiency was suspected in 10 patients (age: 7-16 years). In 9 patients two GH provocative testings and MR imaging of the pituitary were performed. IGF-I measurements, bone age determinations, body mass index (BMI), height standard deviation score, height velocity -SDS and predicted adult height (PAH) were determined before and during GH treatment. Nine patients could be followed for up to 2 years, 3 patients for 4 years and 2 patients for 5 years of GH treatment. - Predicted adult height could be calculated in all after 1 year of treatment and was on average 11.6 cm below target height (-17.6 to +2.5 cm). GH treatment in a conventional dose (14 IU/m2/week) in daily subcutaneous injections was performed. Height SDS improved from -3.47 to -2.27 after 2 years of treatment, height velocity SDS from -1.74 to +2.65 after 1 year and remained +1.78 after 2 years. PAH increased on average by 5.1 cm. BMI was unchanged during 2 years. Bone age development was appropriate with +2.13 years after 2 years. In 2 patients who were treated with GH for up to 5 years and in 1 who was treated up to 4 years, the positive effect on height SDS and height velocity SDS persisted. - In conclusion GH treatment in a conventional dose (14 IU/m2/week) in PLWS patients with GH deficiency is effective over a period of 2 years in regard to height development and predicted adult height but ony limited in regard to changes in BMI.     

HSV型特异性糖蛋白抗体检测及其意义

[目的]探讨以HSV型特异性糖蛋白gG-1和gG-2为抗原的酶免疫方法检测生殖器疱疹(GH)HSV抗体的应用价值.[方法]以确诊复发性GH38例、初发GH8例为病例组,以31例健康献血者为对照组,用ELISA方法分别检测血清标本HSVgG1-IgG抗体及HSVgG2-IgG抗体,并进行结果评价.[结果]复发性GH患者血清HSVgG2-IgG阳性率为94.7%,初发GH患者阳性率为25%,对照组阳性率为9.7%.复发性GH血清HSVgG2-IgG阳性率明显高于初发GH及对照组的阳性率(P<0.05).复发性GH与对照组血清HSVgG1-IgG抗体阳性率相近,元明显统计学差异.[结论]以HSV的型特异性糖蛋白gG-1和gG-2为抗原检测血清HSV抗体是高敏感性和特异性的新一代酶免疫实验方法.通过病毒分离培养及血清学检测均说明HSV-2是本地区GH的主要病原体,用ELISA方法检测血清HSVgG2-IgG抗体可以检测出无症状HSV感染者,有助于对不典型GH患者的诊断并可作为流行病学调查的手段.     

垂体非生长激素瘤病人术后生长激素储备功能观察

目的了解垂体非生长激素瘤病人术后生长激素(GH)储备功能状况。方法对23例垂体非生长激素瘤术后6个月以上病人行胰岛素耐量试验(ITT),在试验前30 min及试验后0、30、45、60、90、120 min分别采血测葡萄糖(GLU)和GH,试验前30 min的血标本加测胰岛素样生长因子-1(IGF-Ⅰ)和胰岛素样生长因子结合蛋白-3(IGFBP-3)。结果垂体非生长激素瘤病人术后IGF-Ⅰ的浓度平均为(0.32±0.14)g/L,与年龄呈负相关关系(r=-0.555,P<0.05)。IGFBP-3的平均浓度为(5.92±1.15)g/L,与年龄无相关关系(r=0.036,P>0.05)。GH峰值平均为(3.92±4.71)μg/L,仅有4例病人GH峰值>5.0μg/L,其余19例病人GH峰值均<5.0μg/L,其中15例GH峰值<3.0μg/L。GH峰值<5.0μg/L的病人中有8例IGF-Ⅰ与IGFBP-3水平在正常值范围。GH峰值高度与GLU水平最低值不相关(r=-0.352,P>0.05)。结论多数垂体非生长激素瘤病人术后会发生GH缺乏或严重缺乏,对于垂体瘤术后垂体前叶功能低下者应注意评估GH储备功能。在常规补充糖皮质激素、甲状腺激素的同时,对GH缺乏或严重缺乏者应重视GH的长期替代治疗。     

Bromocriptine therapy in acromegaly. A long-term review of 35 cases.

Bromocriptine (CB-154, Parlodel, Sandoz) was given to 35 acromegalic patients for a period of 6-36 months. Basal and post-therapy endocrine functions including estimation of serum growth hormone (GH) profile; and GH kinetics during oral glucose tolerance test, augmented insulin tolerance test and thyrotrophin releasing hormone test were determined. The pituitary tumour size was delineated by a pneumoencephalogram. The mean GH levels ranged from 14 micrograms/l to 316 micrograms/l. Bromocriptine suppressed GH values to 5 micrograms/l or less in 16 patients and less than 10 micrograms/l in a further 6 patients. In 33 patients GH values fell to 50% of the basal value or less. There was no significant GH reduction in 2 ''nonresponders''. Bromocriptine did not block the stress-induced GH secretion. It did not disturb pituitary functions other than prolactin which was suppressed much earlier and was maintained with smaller doses. GH suppression on the other hand was shortlived and rebounded when the drug was omitted. It had no adverse effect on tumour size in 2 patients having suprasellar extension of the tumour. Bromocriptine improved carbohydrate tolerance and sexual function although it did not affect insulin and gonadotrophin values. It seems reasonable to offer a trial of bromocriptine in all patients with acromegaly where therapy is deemed necessary as it is well tolerated, has insignificant side effects and no adverse drug interactions. Its high cost and prolonged course are obvious disadvantages. Caution should be exercised in cases with suprasellar extension and visual field involvement.     

Spontaneous remission of acromegaly or gigantism due to subclinical apoplexy of pituitary growth hormone adenoma

Background  Subclinical apoplexy of pituitary functional adenoma can cause spontaneous remission of hormone hypersecretion. The typical presence of pituitary growth hormone (GH) adenoma is gigantism and/or acromegaly. We investigated the clinical characteristics of patients with spontaneous partial remission of acromegaly or gigantism due to subclinical apoplexy of GH adenoma.

Methods  Six patients with spontaneous remission of acromegaly or gigantism were enrolled. The clinical characteristics, endocrinological evaluation and imageological characteristics were retrospectively analyzed.

Results  In these cases, the initial clinical presences were diabetes mellitus or hypogonadism. No abrupt headache, vomiting, visual function impairment, or conscious disturbance had ever been complained of. The base levels of GH and insulin growth factor-1 (IGF-1) were normal or higher, but nadir GH levels were all still >1 μg/L in 75 g oral glucose tolerance test. Magnetic resonance imaging detected enlarged sella, partial empty sella and compressed pituitary. The transsphenoidal surgery was performed in 2 cases, and the other patients were conservatively managed. All the patients were in clinical remission.

Conclusions  When the clinical presences, endocrine evaluation, biochemical examination and imageology indicate spontaneous remission of GH hypersecretion in patients with gigantism or acromegaly, the diagnosis of subclinical apoplexy of pituitary GH adenoma should be presumed. To these patients, conservative therapy may be appropriate.

     

阻塞性黄疸患者生长激素/生长激素结合蛋白检测的临床意义

目的　探讨阻塞性黄疸患者生长激素 /生长激素结合蛋白变化及其临床意义。方法　对本院 1 999年 8月至 2 0 0 0年 1 0月期间 6 0例男性阻塞性黄疸住院患者 (黄疸组 )术前 1d ,术后 1、3、7d的血清生长激素、生长激素结合蛋白、胰岛素样生长因子 Ⅰ、内毒素、肝功能及前白蛋白水平进行检测 ,并与同期住院的 40例男性单纯性胆囊结石患者 (对照组 )进行比较。结果　生长激素、生长激素结合蛋白、胰岛素样生长因子 Ⅰ在黄疸组较对照组显著降低 (P <0 .0 1 ) ,并与黄疸程度、内毒素水平、前白蛋白相关 (P <0 .0 1 )。结论　阻塞性黄疸患者生长激素 /生长激素结合蛋白轴存在明显下调 ,其原因可能与营养障碍、内毒素血症引起的生长激素受体表达受抑有关 ,并可进一步加重营养障碍和内毒素血症 ,是介导阻塞性黄疸病理生理改变的重要因素     

乳腺癌患者血清GH和IGF-I水平及其临床意义

目的：探讨生长激素（GH）、胰岛素样生长因子-I（IGF-I）在乳腺癌患者血清中的表达情况及其临床意义。方法：采用酶联免疫吸附试验（ELISA）检测乳腺癌组、乳腺良性病变组、对照组的血清GH、IGF-I水平。结果：①乳腺癌组、乳腺良性病变组和对照组血清GH、IGF-I表达差异无统计学意义（P〉0.05）;②血清IGF-I表达乳腺癌组绝经前高于绝经后（P=0.005）;③GH表达与肿块大小和雌激素受体（ER）表达有关（P=0.002,P=0.006）,IGF-I表达和肿块大小有关（P=0.010）。④IGF-I表达与肿块〉2cm呈负相关（r=-0.393,P=0.022）,血清GH、IGF-I表达与乳腺癌年龄和ER表达无相关关系（P〉0.05）。结论：血清GH、IGF-I的表达可能与乳腺癌增殖和进展有关。     

Growth Hormone and Prolactin Secretion after External Cranial Irradiation for Extrasellar Tumours

Background

Deficiency of one or more anterior pituitary hormones may follow treatment with external radiation when hypothalamo-pituitary axis lies within the field of radiation. Patients with brain tumours who are treated with radiation frequently have growth hormone (GH) deficiency, other neuro-endocrine abnormalities are presumed to be uncommon. The present study has been undertaken with the aim to study GH and prolactin secretion, their relationship with dose of radiotherapy and duration after radiotherapy in patients who have received extracranial radiation for extrasellar tumours.

Method

In this study, 96 patients who underwent cranial radiation before 12 months, were evaluated. Basal 8 a.m. venous blood samples were taken for estimation of prolactin and GH. Insulin tolerance test was performed for stimulated GH levels.

Result

GH deficiency was present in 59% patients. Isolated GH deficiency was present in 12 (21%) cases, whereas others had associated hormone deficiency. Height percentiles of prepubertal and pubertal patients were 10^th to 25^th (-1.5 to -0.5SD). Patients with isolated GH deficiency had received significantly higher radiation dose than normal pituitary function (5795 ± 24 vs 4908 ± 71, p=0.001). Proportion of patients with GH deficiency increased with increasing dose of radiation (p=0.12), fractional dose of radiation (p=0.08) and increasing duration after radiotherapy (p=0.038). GH levels among all decreased significantly with increasing dose of radiation (p=0.02). Hyperprolactinemia was present in 21% of cases. GH deficiency is more common with lower (<5ng/ml) and higher (>15ng/ml) prolactin levels.

Conclusion

GH deficiency is common after extracranial radiation for extrasellar tumours. GH deficiency is related to dose of radiation, fraction of radiation, and duration after radiotherapy. All prepubertal and pubertal patients with GH deficiency had their height percentile within normal range. Relation of prolactin and GH deficiency indicates that radiation affects both hypothalamus and pituitary.Key Words: Cranial radiation, Growth hormone deficiency, Hyperprolactinemia     

Clinical and biochemical characteristics of growth hormone-secreting pituitary tumors

It has been confirmed that gsp oncogene is oneof the main cause of growth- hormone secreting pitu-itary tumor in native acromegaly patients[1] ,but dif-ference in clinical and biochemical characteristics be-tween gsp- positive and gsp- negative patients re-mained unknown. We selected 1 8cases of growthhormone( GH) - secreting pituitary tumors to studytheir clinical and biochemical characteristics.All pa-tients also underwent pituitary function combinativestimulating testto evaluate the pituita…     

万乃洛韦治疗生殖器疱疹和带状疱疹的疗效观察

目的 观察万乃洛韦治疗生殖器疱疹及带状疱疹的临床疗效。方法 生殖器疱疹和带状疱疹患者各60例,其中32例生殖器疱疹和30例带状疱疹患者采用口服万乃洛韦治疗,28例生殖器疱疹和30例带状疱疹患者采用口服阿昔洛韦治疗,连续观察10 d,进行疗效分析比较。结果 万乃洛韦治疗组和阿昔洛韦治疗组治愈率分别为81.25％和53.57％,复发率为6.25％和28.57％,两组比较差异明显(P<0.05,P<0.01)。在各项临床指标的改善程度方面,万乃洛韦也明湿优于阿昔洛韦。结论 与阿昔洛韦相比,万乃洛韦在治疗生殖器疱疹及带状疱疹时显示出更好的临床疗效。     

颅脑创伤后慢性垂体功能低下发病情况及替代治疗研究

目的 探讨颅脑创伤慢性期垂体各型激素低下发病情况及替代治疗的效果。 方法 以120名颅脑创伤慢性后遗症患者作为研究对象,收集患者一般临床资料和CT影像学资料,并于伤后6个月和12个月分别测定患者垂体生长激素(GH)、促肾上腺皮质激素(ACTH)、促甲状腺激素(TSH)、促性腺激素(LH/FSH)缺乏和抗利尿激素(ADH),使用多因素Logistic回归分析颅脑创伤后垂体功能低下的影响因素。另外对垂体功能低下患者行GH替代治疗,评估替代治疗的疗效。 结果 伤后12个月患者GH、ACTH、TSH、LH/FSH和ADH缺乏发病率分别为19.2%、3.3%、0%、12.5%和1.7%,与伤后6个月比,患者GH缺乏发病率无明显改变,而其他激素缺乏均有一定程度恢复。垂体功能低下组BMI、缺氧比例、弥漫性脑肿胀比例、经手术清除的脑内血肿比例和头颅CT总分数均显著高于非垂体功能低下组。多因素Logistic回归分析显示BMI、缺氧、弥漫性脑肿胀和头颅CT总分数是颅脑创伤后垂体功能低下的独立危险因素。进一步行GH替代治疗发现,治疗后垂体功能低下组患者残疾程度评分显著优于治疗前(P＜0.05)。 结论 颅脑创伤后GH和LH/FSH缺乏发生率高且持久,BMI、缺氧、弥漫性脑肿胀和头颅CT总分数是颅脑创伤后垂体功能低下的独立危险因素。GH替代治疗有利于垂体功能低下患者的恢复。      

Growth hormone neurosecretory dysfunction. A treatable cause of short stature

Pulsatile growth hormone (GH) secretion was assessed in a subgroup of short children to determine whether they had GH secretory abnormalities, and these results were compared with those of normal and GH-deficient children. This subgroup of children was defined as having GH neurosecretory dysfunction and met the following criteria: height, less than first percentile; growth velocity, 4 cm/yr or less; bone age, two or more years behind chronological age, normal findings from provocative GH tests (peak, greater than or equal to 10 ng/mL), low somatomedin-C level, and abnormal 24-hour GH secretory patterns. When compared with controls, both children with GH neurosecretory dysfunction and GH-deficient patients had a significant decrease in parameters relating to the total GH secretion during the 24-hour period. As with GH-deficient children, the group with GH neurosecretory dysfunction more than doubled their growth velocity after replacement therapy with exogenous human GH during the first year of treatment. As a result of these detailed studies on pulsatile GH secretion, we suggest that there is a spectrum of GH secretory abnormalities from absolute deficiency to an intermittent irregularity in GH secretion.     

PRE- AND POST-OPERATIVE HYPOTHALAMIC-PITUITARY- THYROIDAL AXIS FUNCTION IN PATIENTS WITH PROLACTINOMA, GROWTH HORMONE TUMOUR AND ACTH TUMOUR

Pre- and postoperative hypothalamic-pituitary-thyroid axis function was studied in 38 patients with pituitary adenomas (PRL, GH and ACTH tumours), of whom 35 were surgically confirmed and three diagnosed by clinical signs, CT scanning and hormone assessments. About ten days after operation, the same study was repeated in 10 patients with prolactinoma and 7 with growth hormone (GH) tumour. The preoperative abnormal serum TSH response to TRH was found in 8/20 patients with prolactinoma, 9/16 with GH tumour, and 2/2 with Cushing's disease due to ACTH microadenoma. The incidence of abnormal TSH response to TRH was not significantly increased in patients with larger adenoma in either PRL or GH tumour group. In 8 cases of prolactinoma, metoclopramide (MCP, 10 mg, P.O.) test was also performed and there was a significant positive correlation between TSH responses to TRH and to MCP. Serum TT3 in the GH tumour group was within normal ranges, but significantly higher than that of the normal and prolactinoma groups. After operation, TT3 was significantly decreased as compared with that before operation and there were marked changes in TSH response to TRH. In conclusion, there were some abnormalities in TSH control in patients with non-TSH pituitary tumour, and in serum TT3 control in patients with GH tumour. The surgical treatment of pituitary adenoma can lead to transient decrease in TSH reserve and serum TT3 level probably resulting from both stress and/or destruction of thyro-trophs by the operation.