促性腺激素治疗男性低促性腺激素性性功能减退症的疗效评估

目的应用人绒毛膜促性腺激素(hCG)和绝经期妇女尿促性腺激素(HMG)治疗男性低促性腺激素性性腺功能减退症,评价其疗效.方法 64例低促性腺激素性性腺功能减退症患者中Kallmann综合征19例,特发性低促性腺激素型性腺功能低下41例,颅咽管瘤手术后性腺功能低下症4例.33例患者采用hCG 1500 IU肌肉注射,每周2次;31例患者采用hCG 1500 IU + HMG 75 IU联合肌肉注射,每周2次.疗程均6个月以上.结果治疗后所有患者体力改善,体质增强;42例患者出现胡须、阴毛和(或)腋毛.睾丸体积治疗前(3.08±2.44)ml, 治疗后(8.92±5.37)ml(P<0.01);血清卵泡刺激素、黄体生成素和睾酮水平有所提高(P<0.05);6/64患者出现遗精现象,2例有精子生成.以睾丸体积增大为判断疗效的标准,12例无效,52例有效,有效率达81.2%,hCG+HMG组效果明显好于hCG组.结论对男性低促性腺激素性性腺功能减退症患者,用hCG和HMG治疗能促进青春期第二性征发育,体力增加,外生殖器和睾丸进一步发育,并可望部分恢复睾丸产生雄激素和生成精子两项功能,明显优于以往单纯使用或者过早使用雄激素替代的治疗方案.

The application of gonadotropin in treatment of male central hypogonadism

OBJECTIVE: To observe the efficacy of human chorionic gonadotrophin (hCG) and hCG plus human menopausal gonadotropin (HMG) for central hypogonadism in male patients. METHODS: 64 men with central hypogonadism were recruited in this study, including 19 patients with Kallmann syndrome, 41 patients with idiopathic hypogonadotrophic hypogonadism (IHH) and 4 patients with hypogonadism after brain surgery. 33 patients were treated with hCG 1500 IU intramuscularly twice a week, whereas 31 patients were treated with intramuscular hCG 1500 IU plus HMG 75 IU twice a week, for at least 6 months. RESULTS: After treatment, all patients felt stronger physically and 42/64 patients developed beard, pubes or armpit hair. The testis volume enlarged significantly [(3.08 +/- 2.44) ml vs (8.92 +/- 5.37) ml, P < 0.001], and serum follicle-stimulating hormone, luteinizing hormone and testosterone concentrations were higher significantly than those before treatment (P < 0.05). 6/64 patients underwent spermatorrhea and 2 patient were found to have spermatogenesis. If judged by the testis volume, 52 patients (81.2%) were effective and 12 patients were ineffective. CONCLUSIONS: For male patients with the central hypogonadism, hCG and hCG plus HMG can promote the pubertal development and maturation of second sex characteristics, as well as enhance the physical strength; in some patients both androgen production and spermatogenesis can be achieved.