促黄体激素释放激素类似物治疗难治的子宫内膜异位症探讨

１９９３年６月至１９９５年６月，用国产促黄体激素释放激素类似物（ＬＨＲＨ－Ａ）或配合炔诺酮治疗１０例难治的子宫内膜异位症。ＬＨＲＨ－Ａ５００μｇ／ｄ肌注，炔诺酮３．１２５ｍｇ／ｄ口服，持续３～６月。所有患者痛经、性交痛、腹泻、阴道流血等症状迅速消失，卵巢巧克力囊肿及阴道壁结节缩小。血清ＩｇＡ水平显著下降。低剂量炔诺酮合并应用对肝、肾功能及血脂成份未见不良影响。ＬＨＲＨ－Ａ治疗后ＩｇＡ水平下降可能与异位内膜活动停止、炎性反应改善有关。ＬＨＲＨ－Ａ联合炔诺酮治疗效果满意且能克服低雌激素状态导致的骨丢失，有临床应用前景。     

促黄体激素释放激素类似物治疗难治的子宫内膜异位症…

１９９３年６月至１９９５年６月，用国产促黄体激素释放激素类似物（ＬＨＲＨ－Ａ）或配合炔诺酮治疗１０例难治的子宫内膜异位症。ＬＨＲＨ－Ａ５００μｇ／ｄ肌注，炔诺酮３．１２５ｍｇ／ｄ口服，持续３￣６月。所有患者痛经、性交痛、腹泻、阴道流血等症状词消失，卵巢七克力囊肿及阴道壁结节缩小。血清ＩｇＡ水平显著下降。低剂量炔诺酮合并应用对肝、肾功能及血脂成份未见不良影响。ＬＨＲＨ－Ａ治疗后ＩｇＡＩＩ ＧＵ ＧＨ     

促黄体激素释放激素类似物与低剂量炔诺酮联合治疗子宫内 …

目的 了解国产促黄体激素释放激素类似物（ＬＨＲＨ－ａ）与低剂量炔诺酮联合治疗子宫内膜异位症（内异症）的疗效及安全性。方法 将７例内异症患者随机分为两组，Ａ组３６例，采用ＬＨＲＨ－ａ１５０μｇ每日肌内注射（肌注）＋炔诺酮２．５ｍｇ每日口服治疗；Ｂ组４１例，单独应用ＬＨＲＨ－ａ肌注、疗程３－６个月。观察治疗前后症状、体征、肝、肾功能、血脂代谢、骨代谢生化指标及右侧胫骨超声速度（ＳＯＳ）变化。结果 Ａ组     

国产黄体生成素释放激素─A治疗子宫内膜异位症的临床研究

应用不同剂量（１００μｇ／ｄ，２００μｇ／ｄ）的国产黄体生成素释放激素－Ａ（ＬＨＲＨ－Ａ）治疗子宫内膜异位症６６例，其中Ⅰ期９例，Ⅱ期４７例，Ⅲ期１０例。合并不孕症２９例，子宫肌腺症１０例。结果表明，５００μｇ／ｄ组对卵巢内膜囊肿的疗效最佳，但对子宫腺肌症的效果不明显，停药后妊娠７例，占２４％（７／２９）。所用ＬＨＲＨ－Ａ的３种剂量均抑制Ｅ２，Ｐ，ＰＲＬ的分泌，使血中生殖激素下降，排卵抑制和卵巢内膜囊肿缩小，对血胆固醇有升高作用，临床主客观症状体征以５００μｇ／ｄ组变化最为明显。     

国产黄体生成素释放激素─A治疗子宫内膜异位症的临床研究

应用不同剂量（１００μｇ／ｄ，２００μｇ／ｄ）的国产黄体生成素释放激素－Ａ（ＬＨＲＨ－Ａ）治疗子宫内膜异位症６６例，其中Ⅰ期９例，Ⅱ期４７例，Ⅲ期１０例。合并不孕症２９例，子宫肌腺症１０例。结果表明，５００μｇ／ｄ组对卵巢内膜囊肿的疗效最佳，但对子宫腺肌症的效果不明显，停药后妊娠７例，占２４％（７／２９）。所用ＬＨＲＨ－Ａ的３种剂量均抑制Ｅ２，Ｐ，ＰＲＬ的分泌，使血中生殖激素下降，排卵抑制和卵巢内膜囊肿缩小，对血胆固醇有升高作用，临床主客观症状体征以５００μｇ／ｄ组变化最为明显。     

长期大剂量应用促黄体激素释放激素类似物对子宫内膜及雌孕激素受体的影响

长期大剂量应用促黄体激素释放激素类似物对子宫内膜及雌孕激素受体的影响耿力顾方颖张丽珠何洛文子宫内膜异位症是妇科常见病，长期大剂量应用促黄体激素释放激素类似物（ＬＨＲＨ－ａ）已取得良好疗效［１］。本研究结合血清雌二醇（Ｅ２）和孕酮（Ｐ）的变化，观察应用...     

促黄体激素释放激素激动剂的临床应用及对骨代谢的影响

应用促黄体激素释放激素激动剂（ＬＨＲＨ－Ａ）２００μｇ，每日肌内注射，连续３个月为１疗程，治疗轻、中型子宫内膜异位症、子宫肌瘤、子宫腺肌症共２０例。结果：用药结束时，促卵泡成熟激素（ＦＳＨ）、黄体生成素（ＬＨ）、雌二醇（Ｅ＿２）均受抑制，分别为４．８±２．９ＩＵ／Ｌ（Ｐ＞０．０５）、４．０±３．５ＩＵ／（Ｐ＜０．０５）、１６０．３±１１０．７ｐｍｏｌ／Ｌ（Ｐ＜０．００１）。临床上体征改善，痛经消失，副反应轻，易为病人接受。２０例用药前后骨钙素（ｏｓｔｅｏｃａｌｃｉｎ）与尿钙、磷测定比较，差异均无显著性（Ｐ＞０．０５）。双能Ｘ线吸收法（ＤＥＸＡ）测量腰椎２～４骨密度，用药３个月下降２％，停药３个月下降１％，尚属正常范围（Ｐ＞０．０５）；单光子吸收法（ＳＰＡ）测量桡、尺骨骨密度也未见影响（Ｐ＞０．０５）。     

子宫腺机病的激素受体免疫组织化学分析

对２４例子宫腺肌病病灶内腺上皮和２０例对照病例的子宫内膜激素受体行免疫组织化学分析，以研究正常子宫内膜与子宫腺肌病病灶内的腺上皮雌激素受体（ＥＲ），孕激素受体（ＰＲ），雄激素受体（Ａ），卵泡刺激素受体（ＦＳＨ－Ｒ）黄体生成受体（ＬＨ－Ｒ）和垂体泌乳素受体（ＰＲＬ－Ｒ）的表达，结果：子宫腺肌病病灶内的腺上皮ＬＨ－Ｒ，ＰＲＬ－Ｒ，ＰＲ和ＡＲ的水平明显高于正常子宫内膜腺上皮。     

子宫腺肌病的激素受体免疫组织化学分析

对２４例子宫腺肌病病灶内腺上皮和２０例对照病例的子宫内膜激素受体行免疫组织化学分析，以研究正常子宫内膜与子宫腺肌病病灶内的腺上皮雌激素受体（ＥＲ）、孕激素受体（ＰＲ）、雄激素受体（ＡＲ）、卵泡刺激素受体（ＦＳＨ－Ｒ）、黄体生成素受体（ＬＨ－Ｒ）和垂体泌乳素受体（ＰＲＬ－Ｒ）的表达。结果：子宫腺肌病病灶内的腺上皮ＬＨ－Ｒ、ＰＲＬ－Ｒ、ＰＲ和ＡＲ的水平明显高于正常子宫内膜腺上皮。     

雷公藤多甙治疗子宫肌瘤的临床研究

目的 观察雷公藤多甙治疗子宫肌瘤的疗效及副作用。方法 随机将虱分为两组,实验组服用雷公藤多甙４０ｍｇ／ｄ治疗３～６个月,对照组服用米非司酮２５ｍｇ／ｄ治疗３个月。治疗前后均用Ｂ超测量子宫及其肌瘤大小,用放射免疫法（ＲＩＡ）测血清促卵泡素（ＦＳＨ）、促黄体生成素（ＬＨ）、垂体催乳素（ＰＲＬ）、雌二醇（Ｅ２）、孕酮（Ｐ）和睾酮（Ｔ）水平。结果 实验组患者子宫肌瘤于服药３～４个月后６０．０％患者治疗有效     

Luteinizing hormone and follicle-stimulating hormone responses to intransal gonadotropin-releasing hormone

For determination of the dose-response relationships of plasma luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to the intranasal administration of gonadotropin-releasing hormone (GnRH), normal adult men were administered doses of 100, 200, 400, and 800 micrograms of GnRH on separate days, and plasma LH and FSH were measured before and after nasal insufflation of GnRH. Plasma LH was increased after a minimum dose of 200 micrograms GnRH. Median peak plasma LH levels occurred 30 minutes after intranasal GnRH and followed a log-dose relationship. When compared with intravenous GnRH, the biopotency of intranasal GnRH at the 200-, 400-, and 800-microgram doses was 1.1%, 2.3%, and 6.2%, respectively. Plasma FSH levels rose significantly only after the highest (800-micrograms) intranasal GnRH dose. From these data, we conclude that in eugonadal adult men the minimal effective dose of intranasal GnRH to elicit a significant pituitary (LH) response is 200 micrograms and that the relative efficacy of intranasal GnRH increases with the dose. In spite of the apparently low biopotency for intranasal GnRH, this route of administration may be considered as an alternative to the parenteral mode of GnRH delivery, and the lower biopotency can be partly overcome by increasing the dose.     

Luteinizing hormone releasing hormone analogues for contraception

Peptide contraception based on LH-RH analogues is an interesting, fundamentally new lead to fertility control in women and men. A major advantage of using peptides instead of steroids for contraception is the fact that the hypothalamic peptides exert specific actions on the hypothalamic-pituitary-gonadal system and lack systemic effects. They are therefore less likely to cause metabolic derangements and other generalized adverse effects. Antagonistic analogues of LH-RH have been synthesized but until recently they have not been potent enough for clinical trials. However, chronic treatment with low doses of superactive stimulatory analogues of LH-RH paradoxically results in desensitization of the pituitary processes responsible for gonadotrophin release. This leads to a reversible inhibition of gonadal function. In women, ovulation can be inhibited by continuous intranasal LH-RH agonist treatment. In men, higher doses of LH-RH agonists have to be administered to suppress the gonadotrophin secretion enough to affect spermatogenesis. Optimal gonadotrophin suppression is, however, accompanied by a depression of the serum concentration of testosterone with loss of libido and impotence. The superagonists of LH-RH therefore have to be administered in combination with testosterone to induce oligo- or azoospermia without impotence. The overall results of clinical trials with superagonists of LH-RH for induction of inadequate corpus luteum function, luteolysis or early abortion in women are not impressive. The contraceptive effectiveness of these approaches to peptide contraception remains to be demonstrated in the human female. Inhibition of normal ovulation can, however, be consistently achieved by daily intranasal superagonist administration in women. This approach to fertility control has already been shown to provide safe and effective contraception in women.     

Immunohistochemical localization of follicle-stimulating hormone, luteinizing hormone, growth hormone, adrenocorticotrophic hormone and prolactin in the human placenta

The sites of localization of luteinizing hormone (LH), follicle-stimulating hormone (FSH), growth hormone (GH), adrenocorticotrophic hormone (ACTH) and prolactin (PRL) within placental tissues have been studied by an immunoperoxidase technique. The syncytiotrophoblast is the sole significant site of localization of LH, FSH, GH and ACTH; PRL is found both in syncytiotrophoblast and in decidual cells. It is highly probable that the sites of localization of these peptide hormones represents their sites of synthesis in the placenta and thus that the syncytiotrophoblast is the sole site of synthesis of LH, FSH, LH and ACTH. PRL appears to be synthesized both in syncytiotrophoblast and decidua, but the latter is probably not the major site of synthesis of this hormone. Whether these placental peptide hormones have any physiological role to play during pregnancy or whether the placental capacity to synthesize such hormones is an atavistic phenomenon of no functional importance is currently a moot point.     

Clinical applications of gonadotropin-releasing hormone and gonadotropin-releasing hormone analogs

Investigations have proved the clinical importance of hypothalmic gonadotropin-releasing hormone (GnRH) and its agonistic and antagonistic analogs. A pulsatile pattern of stimulation of specific receptors in the anterior pituitary gonadotrope has been shown to activate pituitary-gonadal function; continuous administration inhibits it. Clinical research has shown promising results in the induction of ovulation using the pulsatile pattern of GnRH administration in patients with hypogonadotropic amenorrhea. Attempts to use GnRH and its agonists to activate the pituitary-gonadal system in patients with idiopathic delayed puberty has proved logistically impractical because of the duration of treatment required to achieve sexual maturation. Treatment of cryptorchidism by intranasal administration 6 times daily for 4 weeks resulted in complete descent in 38% of the 48 boys and partial descent in 28%. For GnRH nonresponders, sequential treatment with human chorionic gonadotropin produced an 86.2% success rate. Because of the ability of GnRH agonists to reversibly suppress the pituitary-gonadal axis without side effects, it can be used in diseases mediated by gonadal steroids. Successful halting of precocious puberty through the administration of GnRH to suppress the nocturnal release of gonadotropin has been demonstrated. Unlike treatment with progestational agents, no side effects are discerned. Continuous administration of GnRH agonist in patients with endometriosis reduces ovarian estrogens and androgens to castration levels, mimicking an ovariectomy. This castration effect highlights the potential use of GnRH agonists in the treatment of metastatic breast cancer. The use of GnRH agonists for the treatment of androgen-dependent prostatic carcinoma has induced clinical improvement with nonmetastatic stage 3 disease and pain relief in metastic stage D disease. In polycystic ovary syndrome, administration of GnRH agonist shows promising results. As a potential contraceptive, GnRH agonists have not yet demonstrated practical advantages. The actions under study include: ovulation inhibition, luteolysis induction, induction of luteal phase defect and reduction of testosterone production. Numerous antagonistic analogs of GnRH have been synthesized and have shown some potential contraceptive effects in animal studies.     

Anti-Mullerian hormone: a gonadal hormone with multiple diagnostics resources

Anti-Mullerian hormone (AMH) is a gonadal hormone synthesized by granulose cells of the ovary and Sertoli cells of the testis. Anti-Mullerian hormone is used to facilitate the evaluation of intersex disorders and as a marker in some ovarian tumors or ovarian reserve assessment in the infertility cases. Serum levels of AMH hold objective information, which is useful in the clinical practice. Therefore it is necessary to decimate the normal and the abnormal levels of AMH.     

Luteinizing hormone releasing hormone analogue in treatment of hypergonadotrophic amenorrhoea

The effect of a luteinizing hormone releasing hormone analogue (HOE 766) was studied in four patients with hypergonadotrophic amenorrhoea (resistant ovary syndrome). After an initial phase of stimulation, there was a uniform and sustained suppression of gonadotrophin concentrations in all the patients during the 20-24 days of treatment, presumably due to down-regulation of the pituitary receptors. One patient ovulated after stopping treatment.     

Luteinizing hormone releasing hormone analogue in treatment of hypergonadotrophic amenorrhoea

Summary. The effect of a luteinizing hormone releasing hormone analogue (HOE 766) was studied in four patients with hypergonadotrophic amenorrhoea (resistant ovary syndrome). After an initial phase of stimulation, there was a uniform and sustained suppression of gonadotrophin concentrations in all the patients during the 20–24 days of treatment, presumably due to down-regulation of the pituitary receptors. One patient ovulated after stopping treatment.