抗生殖免疫抗体及性激素与子宫内膜异位症发病的关系研究

目的 探讨患者抗生殖免疫抗体及性激素的变化与子宫内膜异位症(endometriosis,EMS)发病的关系.方法 回顾性分析268例EMS患者(其中年龄＞35岁组的EMS患者90例;年龄≤35岁组的EMS患者178例)和200例非子宫内膜异位症患者(其中年龄＞35岁组的非子宫内膜异位症患者72例,为同龄对照组;年龄≤35岁组的非子宫内膜异位症患者128例,为同龄对照组)的临床资料.用化学发光免疫分析法检测两组患者血清卵泡刺激素(follicle-stimulating homone,FSH)、黄体生成素(homone,LH)、睾酮(testosterone,T)、雌二醇(estradiol,E2)孕酮(progesterone,P)和泌乳素(prolactin,PRL)水平;采用酶联免疫法检测抗卵巢抗体(anti-ovarian antibodies,AOAb)、抗心磷脂抗体(anticardiolipin antibody,ACL)、抗子宫内膜抗体(anti-endometrial antibodies,EMAb)水平.结果 年龄＞35岁组和年龄≤35岁组EMS患者的P、PRL水平均高于同龄对照组,差异有统计学意义;年龄＞35岁组的EMS患者LH水平也显著高于同龄对照组,差异也有统计学意义(P＜0.05).其他激素各项指标比较,差异无统计学意义(P＞0.05).年龄＞35岁组和年龄≤35岁组EMS患者的抗生殖免疫抗体AOAb、ACL、EMAb阳性率明显高于同龄对照组,差异有统计学意义(P≤0.05).结论 ENS患者存在抗生殖免疫抗体变化,高孕激素、高泌乳素水平可能与EMS发病有关.     

Electroencephalogram spectral edge frequency,lower esophageal contractility,and autonomic responsiveness during general anesthesia

Both the electroencephalogram (EEG) spectral edge frequency (SEF) and lower esophageal contractility (LEC) indices have been reported to be useful indicators of anesthetic depth. We designed a prospective study to evaluate the relationship between changes in these two variables and objective measurements of physiologic responsiveness to surgical stress (i.e., changes in hemódynamic variables and plasma levels of norepinephrine, epinephrine, total catecholamines, and vasopressin). Eighty-nine consenting adult males undergoing radical prostatectomy procedures under a standardized general anesthetic technique were studied according to a randomized, single-blinded protocol. General anesthesia was induced with 30 µg/kg intravenous (IV) alfentanil, 2.5 mg/kg IV thiopental, and 0.1 mg/kg IV vecuronium, and subsequently maintained with 0.5 µg/kg/min alfentanil, nitrous oxide (N₂O) 67% in oxygen, and 0.8 µg/kg/min vecuronium. Following retropubic dissection, 81 patients (92%) manifested acute hypertensive responses, with mean arterial pressure increasing from 90±14 to 122±14 mm Hg (mean ± SD). This acute hypertensive response was treated with one of three different treatment modalities (20 to 60 µg/kg IV alfentanil, 0.5 to 2.0% inspired isoflurane, or 0.05 to 0.15 mg/kg IV trimethaphan) to return the mean arterial pressure to within 10% of the preincisional (baseline) value within 5 to 10 minutes. Although the mean arterial pressure, heart rate, and plasma levels of catecholamines and vasopressin significantly increased following the surgical stimulus, and decreased after adjunctive therapy, the EEG-SEF and LEC index (LECI) values did not significantly change during these study intervals. Furthermore, using a logistic regression analysis, we observed that preincision EEG-SEF and LECI values could not predict whether patients would manifest a hypertensive response. Therefore, the EEG-SEF and LECI were unreliable indicators of anesthetic depth.This study was supported in part by a grant from the Ambulatory Anesthesia Research Foundation, Los Altos, CA. (Dr White is a member of the Board of Directors.)The authors would like to thank Dan Kuni (Baxter Healthcare) for his assistance in obtaining the equipment used to perform the study; Vinod Kothapa, MD, for his valuable assistance with the anesthetic management of the study patients; Alex K. Mills, MD, for his assistance with the EEG interpretation; and Steven A. Bai, PhD, for his assistance with the plasma alfentanil analyses.     

乳腺癌内分泌治疗发展与未来

乳腺癌是激素依赖性肿瘤,内分泌药物的选择除了根据患者的年龄、病灶部位、手术到复发的间隔时间以及受体测定等因素外,还要根据不同药物的作用机制以及副反应而定。随着对内分泌治疗药物作用机制的深入研究和大规模临床研究的证实,激素受体阳性乳腺癌的内分泌治疗疗效将不断提高。     

What do you need to know about mass spectrometry? A brief guide for endocrinologists

In routine hormonology, liquid chromatography mass spectrometry (LCMS) is now an established technique for androgen, urinary cortisol and metanephrine assay. It has the undeniable advantage of great analytical specificity, but with sensitivity that clearly depends on financial investment in a very high-end spectrometer. We describe the general principles of LCMS and the routine applications so far developed in hormonology. The purpose is to familiarise endocrinologists with the techniques under development and their pros and cons.     

The effect of a high calory diet on hormonal changes in young men during prolonged physical strain and sleep deprivation

Summary Major changes occur in the serum level of several hormones during 5 days of heavy and continuous physical activities, with less than a total of 2 h of sleep. The present investigation was designed to evaluate the importance of caloric deficiency, energy requirement being about 8,000–10,000 kcal/24 h. A comparison between well fed subjects and those with food deprivation revealed significantly higher levels of (T₃) triiodothyronin, insulin and thyroid stimulating hormone (TSH) in the well-fed subjects, who also had lower levels of growth hormone (hGH) and cortisol, whereas no difference was found between the two groups for thyroxin (T₄). Increased levels were found for T₃ and T₄ in both groups during the first day of activity, with a concomitant decrease in TSH and a subsequent decrease of T₄ during the next 2 days. T₃ decreased only in the low-calory group whereas increased levels were found in the iso-calory group throughout the course. The resting levels of insulin decreased during the course in the low-calory group whereas it increased in the iso-calory group. High levels were maintained throughout the course for hGH. Cortisol showed high levels just before the start of the course and then decreased from day 2 to day 4. No difference was found between the morning and evening levels for cortisol, indicating disappearance of the circadian rhythm. The present investigation has shown that energy deficiency during prolonged physical strain is responsible for the decreased serum levels of T₃ and insulin and may contribute to the decrease in TSH and the increase in hGH and cortisol.     

穴位埋线治疗更年期综合征及其对性腺激素、β-内啡肽的影响

目的:探索穴位埋线治疗更年期综合征的临床疗效及其机制.方法:将60例患者随机分为埋线组和西药组,每组30例.埋线组选取肾俞、子宫、三阴交进行穴位埋线治疗,西药组每天口服己烯雌酚片,观察比较两组的临床疗效及其对患者血清促卵泡生成激素(FSH)、促黄体生成激素(LH)、雌二醇(E_2)及β-内啡肽的影响.结果:埋线组总有效率为93.3%,西药组总有效率为70.0%,埋线组优于西药组(P<0.05);埋线组β-内啡肽较治疗前明显上升;同时FSH降低,E_2水平升高,与西药组比较差异均有统计学意义(P<0.05,P<0.01).结论:穴位埋线治疗更年期综合征疗效显著,可明显改善患者卵巢功能,对内源性阿片肽类递质具有良性调整作用.     

多西他赛联合泼尼松治疗激素难治性前列腺癌

目的 观察多西他赛联合泼尼松3周方案治疗激素难治性前列腺癌的疗效.方法 2004年9月至2007年1月对13例激素难治性前列腺癌患者行多西他赛联合泼尼松3周方案化疗.患者69～82岁,平均75岁.入选标准：全雄激素阻断治疗失败,排除抗雄激素撤除综合症,并至少经过1次抗雄药物撤退以外的二线内分泌治疗无效.治疗方案：化疗第一天用多西他赛75 mg/m2,泼尼松5 mg,2次/d;从化疗第二天起泼尼松5 mg,2次/d,连续应用,21 d为1疗程.观察终点为血PSA、可测量病灶和疼痛的变化.结果 13例入组患者中1例失访,11例可评价疗效,PSA有效率为54%（6/11）,有效患者PSA从治疗前的23.6 ng/ml、515.5 ng/ml、150.0 ng/ml、16.4 ng/ml、152.7 ng/ml、12.3 ng/ml,下降到治疗后最低2.4 ng/ml、139.9 ng/ml、42.3 ng/ml、6.7 ng/ml、67.5 ng/ml、5.7 ng/ml.有效持续时间4个月、3个月、8个月、3个月、2个月、2个月.可测量病灶2例为稳定.骨痛改善率为50%（3/6）.12例可评价不良反应,主要不良反应为骨髓抑制,Ⅲ度白细胞减少占50%.12例中位随访194 d.死亡5例,已死亡患者从诊断激素非依赖性前列腺癌起中位生存期36个月.结论 多西他赛联合泼尼松3周方案治疗激素难治性前列腺癌有一定疗效,毒性可耐受.     

Analysis of heritability of hormonal responses to alcohol in twins: beta-endorphin as a potential biomarker of genetic risk for alcoholism

BACKGROUND: Hormonal responses to alcohol have been reported to differ in subjects with and without a family history of alcoholism which suggests that alcohol-induced hormonal changes might be used to identify individuals who are at elevated genetic risk for developing alcoholism. However, before a biological response can be used as a marker of genetic risk for disease, it must first be demonstrated that the response is, in fact, heritable. The present study was designed to determine whether hormonal responses to alcohol are heritable. METHODS: The adrenocorticotropic hormone (ACTH), beta-endorphin (beta-E), cortisol (CORT), and prolactin (PRL) responses to alcohol were examined in male and female identical (monozygotic or MZ) and fraternal (dizygotic or DZ) twin pairs. Male subjects consumed 0.35 g ethanol/kg body weight (BW) and females consumed 0.325 g ethanol/kg BW in each of two alcohol drinking sessions administered 1 hr apart (total dose of 0.7 g/kg BW in males and 0.65 g/kg BW in females). Plasma hormone content was analyzed in samples collected before (resting conditions) and at 15, 60, 75, 120, 180, and 240 min after onset of drinking. Hormonal responses to alcohol were examined with twin analyses using the TWINAN90 program. A separate analysis was performed for each of the four hormones. A subset of subjects from each zygosity was seen on two separate occasions to establish retest reliability. Heritability of hormonal responses to alcohol was estimated using the intraclass correlation approach before and after removing the contribution of covariates that have the potential of influencing the plasma levels of these hormones. RESULTS: Resting plasma levels of all four hormones were within the expected range, and the beta-E, ACTH, and PRL responses to the alcohol challenge evidenced good test-retest reliability. Of the four hormones examined, the only one that showed significant heritability after alcohol drinking was beta-E. Heritability estimates were not altered for any of the four hormones after removal of the variance contributed by covariates, such as gender and age. CONCLUSIONS: Taken together with other recent findings, the results suggest that the beta-E response to alcohol may represent a new biomarker that can be used to identify individuals who are at elevated genetic risk for developing alcoholism.     

Hormones and breast cancer: can we use them in ways that could reduce the risk?

Many hormones promote or inhibit breast cancer in different ways. These effects and the mechanisms involved are reviewed in order to suggest a potentially safer use of hormones. Natural estrogens, administered transdermally, and natural progesterone may be the safest combination of female hormones. Increased intake of cruciferous vegetables could provide additional safety by improving 2-hydoxyestrone and diminishing 16 alphahydroxyestrone. Testosterone and dehydroepiandrosterone (DHEA) may directly inhibit breast cancer, but could potentially stimulate it by being aromatized into estrogen in the breast. Modest doses with blood level monitoring appear logical. Melatonin and oxytocin are inhibitory to breast and other cancers. Insulin is a growth factor for breast cancer. Managing insulin resistance before the onset of diabetes could reduce the risk. Tri-iodothyronine (T3) has multiple anti-breast cancer effects. Synthroid may not increase T3 levels adequately. Human growth hormone does not appear to increase risk; but it should not be given for performance enhancement.     

Physical and hormonal profile of male sexual development in epilepsy

PURPOSE: This study was designed to investigate the effect of epilepsy and antiepileptic drugs (AEDs) on both the physical and hormonal aspects of the sexual development of male patients with epilepsy. METHODS: One hundred thirty male subjects with epilepsy, their age ranging between 8 and 18 years (mean, 14 +/- 2.9 years), entered the study; all were taking AEDs. Anthropometric measurements [height, weight, and body mass index (BMI)], testicular volume, penile length, and pubarche were assessed in the studied groups, as well as measurement of the levels of testosterone (T), free testosterone (FT), estradiol (E2), lutenizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin (PRL), and the results were compared with those of a control group. RESULTS: In this study, male patients older than 16 years were significantly shorter than their matched controls. The mean values of testicular volume and penile length were significantly lower in the patients in the different age subgroups, and the pubic hair staging (pubarche) was delayed in the patients older than 16 years. The mean values of total testosterone, estradiol, LH, and FSH serum levels were significantly higher, whereas the mean values of free testosterone, total-T/E2, total. T/LH, and FT/E2 ratios were lower in the patient subgroups compared with their age-matched controls. There were no significant changes in the mean basal PRL serum levels in the patients compared with the controls. The present study demonstrated a reduction in the testicular volume and penile length, significantly lower mean values of free testosterone and total-T/E2, and a higher mean value of E2 in the patients receiving polytherapy in the age subgroup older than 16 years compared with those on monotherapy; however, there was no demonstrable effect of seizure control or the duration of illness in any of the studied parameters. CONCLUSIONS: There is a delay in the sexual development of male patients with epilepsy in the different age subgroups, with endocrine changes in the form of increase in the total testosterone, but the free testosterone is lower, and an increase in estradiol, with lower T/LH levels. Patients receiving polytherapy, especially those older than 16 years, were more likely to have delayed gonadarch and disturbances in their hormonal profile.