促性腺激素释放激素泵治疗成年男性特发性低促性腺激素性性腺功能减退症的临床疗效与安全性观察

目的探讨促性腺激素释放激素(GnRH)泵治疗成年男性特发性低促性腺激素性性腺功能减退症(IHH)患者的疗效与安全性。方法对确诊为IHH的27例成年男性患者进行GnRH泵脉冲式皮下输注治疗,比较观察患者治疗前后性激素、第二性征、外生殖器、性功能、生育能力的变化情况和不良反应情况。结果平均随访时间13.3(2~38)个月,治疗1年以上18例,6个月~1年2例,3~6个月3例,3个月以下4例。患者治疗前平均睾丸体积(3.38±2.03)mL,阴茎静息长度(3.63±1.10)cm,阴茎牵长(5.73±1.53)cm,阴茎周径(5.13±1.38)cm,黄体生成素(LH)(0.67±0.63)IU/L,卵泡刺激素(FSH)(1.27±0.88)IU/L,睾酮(T)(0.50±0.53)ng/mL;用泵治疗6个月患者睾丸体积(6.48±2.14)mL,阴茎静息长度(4.85±0.83)cm,阴茎牵长(7.90±1.27)cm,阴茎周径(7.27±1.33)cm,LH(6.72±5.35)IU/L,FSH(5.48±3.23)IU/L,T(2.36±1.37)ng/mL,均较治疗前显著提高(P0.01)。用泵治疗1年以上患者睾丸体积(8.78±2.24)mL,阴茎静息长度(5.78±0.75)cm,阴茎牵长(9.31±1.31)cm,阴茎周径(7.94±0.84)cm,LH(6.56±3.89)IU/L,FSH(5.04±2.49)IU/L,T(3.57±1.08)ng/mL,均较治疗前显著提高(P0.01),外生殖器、T较6个月前有显著提高(P0.05)。治疗前25例患者无手淫,无遗精,仅有2例患者有遗精(精液中无精子),治疗6个月以上20例患者均相继出现遗精并伴经常性勃起,其中18例患者取得精液,13例出现精子,2例已婚患者配偶自然妊娠。所有患者治疗期间未见明显不良反应,患者依从性良好。结论 GnRH泵治疗成年男性IHH疗效显著且安全性好,值得临床推广应用。

Study on the efficacy and safety of pulsatile GnRH pump for the treatment of adult male idiopathic hypogonadotropic hypogonadism

Objective To explore the therapeutic effect and safety ofpulsatile GnRH (gonadorelin) pump on male patients with idiopathic hypogonadotropic hypogonadism (IHH).Methods Pulsatile GnRH pump was used for the treatment of 27 cases of male IHH patients.The sex hormones,secondary sexual characteristics,external genitalia,changes of fertility and sexual function were observed before and after treatment,and adverse event during treatment were also observed.Results The mean follow-up time was 13.3 (2-38) months,18 patients were followed up with the treatment of subcutaneous pulsive GnRH infusion for over 1 year,2 cases were followed up for 6 months,3 cases were followed up for 3 6 months and 4 cases were followed up under 3 months.Before treatment,the average testicular volume of IHH patients was (3.38 ± 2.03) mL,the resting length of penis was (3.63 ± 1.10) cm,stretch length of penis was (5.73 ± 1.53) cm,the circumference of penis was (5.13 ± 1.38) cm,luteinizing hormone (LH) was (0.67 ± 0.63) IU/L,follicle-stimulating hormone (FSH) was (1.27 ± 0.88) IU/L,testosterone (T) was (0.50 ± 0.53) ng/mL.After half a year consistent treatment,the average testicular volume of 20 cases of IHH patients was (6.48 ± 2.14) mL,the resting length of penis was (4.85±0.83) cm,stretch length of penis was (7.90± 1.27) cm,the circumference of penis was (7.27 ± 1.33) cm,LH was (6.72 ± 5.35) IU/L,FSH was (5.48 ± 3.23) IU/L,T was (2.36 ± 1.37) ng/mL,which were significantly increased than those before treatment (P＜0.01).After 1 year consistent treatment,the average testicular volume of 18 cases ofIHH patients was (8.78 ± 2.24) mL,the resting length of penis was (5.78 ± 0.75) cm,stretch length of penis was (9.31 ± 1.31) cm,the circumference of penis was (7.94 ± 0.84) cm,LH was (6.56 ±3.89) IU/L,FSH was (5.04 ± 2.49) IU/L,T was (3.57 ± 1.08) ng/mL,which were significantly increased than those before treatment (P＜0.01).Extemalia and T were significantly improved compared with 6 months ago (P＜0.05).All the 20 patients who had over 6-month treatment present ejaculations.Thirteen of the 18 patients who had over 6-month treatment present sperms in their ejaculations,2 married patients who accepted over 1 year treatment made their wife be pregnant.No obvious adverse events were found and patients showed good adherence during treatment.Conclusion The GnRH pump is effective and safe in treating male IHH and worthy of clinical application.