成年男性尿液邻苯二甲酸二乙基己酯代谢物与性腺激素关系的meta分析

目的采用meta分析评价成年男性尿液邻苯二甲酸二乙基己酯[di(2-ethylhexyl)phthalate,DEHP]代谢物邻苯二甲酸单-2-乙基己酯[mono(2-ethylhexyl)phthalate,MEHP]与性腺激素的关系。方法通过国内外主要数据库,检索2016年3月以前发表的关于塑化剂与男性性腺激素包括雌二醇(E2)、睾酮(T)、游离睾酮(f T)、促黄体生成素(LH)、卵泡刺激素(FSH)及性激素结合球蛋白(SHBG)的文献,按照纳入排除标准筛选文献、提取资料并评价纳入研究的质量后,采用Rev Man 5.2软件进行meta分析。结果共纳入7篇英文文献,文献质量总体较好。meta分析结果显示,成年男性尿液MEHP暴露与E2、T、f T成负相关,合并rs及其95%CI分别为-0.09(-0.15~-0.03)、-0.11(-0.16~-0.06)、-0.16(-0.22~-0.10)。但经亚组分析发现,职业暴露男性的MEHP与E2成正相关,合并rs及其95%CI为0.18(0.02~0.34),均有统计学意义。结论 MEHP暴露在一定程度上可能会干扰成年男性性腺激素分泌,从而影响生殖功能。     

SRY基因检测对性分化异常诊断和分类的意义

对１６例性腺发育不全患者的外周血白细胞、皮肤和双侧性腺的基因组ＤＮＡ标本，采用多聚合酶链式反应检测ＳＲＹ基因保守序列，以期从分子水平揭示性分化异常的原因。１６例中雄激素不敏感综合征５例、１７ａ羟化酶缺乏症１例、真两性畸形４例、４５，Ｘ性腺发育不全１例、ＸＹ单纯腺发育不全１例、睾丸退化１例、血核型４６，ＸＹ但已娩正常儿１例以及ＸＯ／ＸＹ性腺发育不全２例。１６例性分化异常血ＳＲＹ阳性１５例，１３例性腺病理有睾丸与外周血ＳＲＹ相符，２例性腺为卵巢或卵巢间质；ＳＲＹ阴性１例性腺也有发育不全睾丸。４６，ＸＹ女性且生育的患者进行了外周血ＳＲＹ基因保守序列的测定，未发现突变位点。测定ＳＲＹ可预示有睾丸的存在。结果显示ＳＲＹ基因检测比外周血核型能更好地预示睾丸的存在；性腺的病理取决于性腺部位的染色体核型和ＳＲＹ基因；除ＳＲＹ基因外，可能存在有其它决定性别的基因。     

胰岛素抵抗和非胰岛素抵抗多囊卵巢综合征患者的对比研究

目的探讨多囊卵巢综合征(PCOS)胰岛素抵抗(IR)患者的临床特征。方法选取48例PCOS患者,将稳态模型胰岛素抵抗指数(HOMA-IR)>3.8或葡萄糖及胰岛素曲线下面积比值(AUC葡萄糖/AUC胰岛素)<1.0的PCOS患者作为IR组(30例),上述两个标准均不符合的PCOS患者作为非IR组(18例)。比较IR组和非IR组患者的体质指数(BMI)、血脂水平及各项性激素水平。结果 (1)IR组患者BMI及肥胖者所占比例均显著高于非IR组,差异有统计学意义(P<0.05);(2)IR组患者三酰甘油、载脂蛋白B水平均显著高于非IR组,而高密度脂蛋白、载脂蛋白AⅠ水平则显著低于非IR组,差异均有统计学意义(P<0.05);(3)IR组患者黄体生成素水平显著低于非IR组,睾酮水平则显著高于非IR组,差异亦有统计学意义(P<0.05)。结论 (1)存在IR的PCOS患者更容易出现血脂异常;(2)PCOS患者性激素有不同改变,存在IR者以睾酮升高为主而非IR患者则以黄体生成素升高为主。     

育龄期女性性腺功能减低60例临床分析

目的探讨育龄期女性性腺功能减低的临床特征。方法对2011年5月-2012年4月收治的60例育龄期女性性腺功能减低患者的临床资料进行回顾性分析。结果 60例女性性腺功能减低患者中,多囊卵巢综合征(PCOS)33例(55.0%),卵巢早衰(POF)10例(16.7%),原发性甲状腺功能减退症(含亚临床甲状腺功能减退症)6例(10.0%),泌乳素瘤5例(8.3%),其他6例(10.0%)。PCOS患者中超质量27例(81.8%);POF患者中FSH40～129.3(83.4±23.3)U/L,E_2 2.1～52.2(26.0±16.2)pmol/L;原发性甲状腺功能减退患者TSH均>100mIU/L,伴T_4、FT_4降低,亚临床甲状腺功能减退患者TSH>5 mIU/L,平均(12.8±2.0)mIU/L;泌乳素瘤患者PRL为89.5～126.9(105.3±12.6)ng/ml。结论育龄期女性性腺功能减低常见原因依次为:PCOS、POF、原发性甲状腺功能减退(含亚临床甲状腺功能减退)、泌乳素瘤等。故在女性性腺功能减低患者中应常规行内分泌检查,提高确诊率。     

46,XY单纯性腺发育不全的治疗(附2例报告)

目的 探讨46,XY单纯性腺发育不全病人的病因、临床表现及治疗方法 .方法 对2例染色体核型为46,XY单纯性腺发育不全病人的临床资料进行分析.结果 2例病人的生长和智力发育均正常,两臂与地平行伸展开两手中指的距离等于身高.原发闭经,青春期有女性第二性征发育,有阴毛、腋毛,乳房发育可.病人均有阴道, 行人工周期月经治疗有效.2例行腹腔探查术,术中均可见到发育不良的子宫、发育欠佳的输卵管、条索状性腺组织以及实性包块.手术切除包块及条索状性腺组织,病理诊断均为无性细胞瘤.结论 对生殖器官发育不良病人应常规行染色体检查;对46,XY单纯性腺发育不全病人应尽早切除性腺,通过性激素替代治疗提高病人生活质量.     

肥胖型PCOS患者的生物学特征和临床特征

多囊卵巢综合征（polycystic ovary syndrome,PCOS）是一种内分泌代谢紊乱综合征,临床表现高度异质性。肥胖是PCOS异质性临床表现之一,超过50%的PCOS患者超重或肥胖。肥胖型PCOS主要表现为高雄激素血症、中心型肥胖和糖脂代谢紊乱,非肥胖型PCOS主要表现为黄体生成激素（luteinizing hormone,LH）水平异常升高。尽管肥胖型和非肥胖型PCOS均存在内分泌代谢异常,然而肥胖可加重PCOS糖脂代谢紊乱;肥胖型PCOS还表现脂肪代谢的异常。综述肥胖型PCOS患者的临床特征、性激素水平、糖脂代谢特征,旨在为肥胖型和非肥胖型PCOS患者新的分型诊治提供参考。     

性激素对中枢甲硫氨酸脑啡肽含量的影响

用放免法测定大白鼠脑之纹状体、海马、下丘脑、垂体前叶与后叶中甲硫氨酸脑啡肽(metenkephalin,MEK)的含量,显示去势雌鼠纹状体、海马、下丘脑、垂体前叶MEK明显下降,去势雄鼠下丘脑、垂体前叶也明显下降,注射已烯雌酚,黄体酮及睾丸酮的雌鼠,下丘脑MEK明显降低而垂体后叶明显升高,注射睾丸酮的雄鼠,垂体前叶与后叶MEK下降,雄鼠注射已烯雌酚,未见有显著改变,提示性腺与性激素对中枢MEK含量有影响。     

多囊卵巢综合征神经内分泌病因机制的研究进展

多囊卵巢综合征(PCOS)是女性常见的生殖内分泌疾病,PCOS的典型特征是高雄激素血症、排卵障碍和卵巢多囊样改变.高雄激素血症通常是由垂体黄体生成激素(LH)脉冲分泌增加所致.多数PCOS女性表现为血清LH水平升高,LH脉动分泌频率升高.LH脉动分泌频率异常升高反映了促性腺激素释放激素(GnRH)神经回路异常活跃,提示...     

LHRH analogues do not protect the germinal epithelium during chemotherapy

Summary The protective effect of Decapeptyl, a d-Trp⁶-LHRH analogue, on the germinal epithelium of rats during chemotherapy was examined in an experimental animal study. Four groups were formed consisting of 15 (groups A and B) and 20 (groups C and D) Sprague-Dawley rats, respectively. The animals were treated as follows: group A (control group) was given 0.9% NaCl i.m.; group B (LHRH group) d-Trp⁶-LHRH analogue (Decapeptyl); group C (LHRH + chemotherapy group) Decapeptyl +_cyclophosphamide; group D (chemotherapy group) cyclophosphamide. The gonads were removed before therapy was initiated and on days 13, 52, and 182 after treatment and examined histologically. In addition, follicle-stimulating hormone (FSH) levels in the serum, a sensitive indicator of tubular damage, were determined. The most damaging effects of chemotherapy on histology and hormone levels were observed in the animals in group C, which were additionally treated with LHRH analogues. Therefore, it is not possible to protect the germinal epithelium of the rat with LHRH analogues during chemotherapy.     

Behavioral sensitization: Characterization of enduring changes in rotational behavior produced by intermittent injections of amphetamine in male and female rats

Factors influencing the behavioral sensitization (reverse tolerance) produced by intermittent amphetamine (AMPH) injections were studied by quantifying rotational behavior in rats that had a unilateral 6-hydroxydopamine lesion of the substantia nigra. The results indicate that (1) a single injection of a low dose of AMPH enhances rotational behavior induced by a second injection of AMPH for up to 12 weeks; (2) multiple, weekly injections of AMPH produce a progressive enhancement in rotational behavior, over-and-above that produced by a single injection; (3) female rats show more robust sensitization than males following single or multiple injections of AMPH; (4) this sex difference may be due to the suppression of sensitization by an androgen, because removal of testicular hormones potentiates sensitization; (5) the long-lasting sensitization of rotational behavior produced by infrequent injections of AMPH is not due to drug-environment conditioning effects, but perhaps to a persistent AMPH-induced change(s) in brain catecholamine systems; and (6) a simple change in DA receptors is probably no involved, because the sensitization produced by infrequent injections of AMPH does not influence the rotation produced by a subsequent injection of apomorphine. The results illustrate an intriguing example of neuroplasticity that may have clinical relevance.