曲普瑞林兴奋试验用于评价女性下丘脑-垂体-性腺轴功能研究

目的探讨黄体生成素释放激素(LHRH)类似物(曲普瑞林)兴奋试验在评价女性下丘脑-垂体-性腺轴(HPGA)功能中的价值及安全性。方法 2007年1月至2009年12月在北京协和医院内分泌科进行研究:(1)对30例育龄期女性行曲普瑞林兴奋试验,肌注曲普瑞林100μg后,在0、15、30、45、60、90 min测定血卵泡刺激素(FSH)和黄体生成激素(LH)水平,摸索其变化规律和峰值时间;(2)对79例女性性腺疾病患者行曲普瑞林兴奋试验,并随访直至确诊。分析不同疾病中LH峰值水平和诊断之间的相关性,评价兴奋试验在疾病诊断和治疗中的价值。结果 (1)育龄期女性,LH峰值在肌肉注射曲普瑞林后60～90 min出现。(2)80%的全垂体前叶功能减退症患者(10例)、100%的单纯乳房发育患者(12例)、100%的外源性雌激素导致假性性早熟患者(6例)、100%的低促性腺激素性性腺功能减退症患者(5例)和100%因真性性早熟接受GnRH类似物治疗的患者(11例),LH峰值均<6 U/L;100%真性性早熟患者(16例)和青春发育后(30例)的患者,LH峰值均>6 U/L,其中85%的青春发育后的女性,LH峰值>18 U/L。(3)试验过程中未发现局部和全身不良反应。结论曲普瑞林兴奋试验可用于评价不同生理和病理状态下女性患者的下丘脑-垂体-性腺轴功能,有助于性早熟等疾病的鉴别诊断和疗效评价,且安全性好。LH峰值>6 U/L可作为下丘脑-垂体-性腺轴功能开始启动的判断指标;而LH峰值>18 U/L,可作为性成熟女性下丘脑-垂体-性腺轴功能正常的指标。

Clinical value of triptorelin stimulating test in evaluation of hypothalamus-pituitary-gonad axis function in female patients

Objective To investigate the value and safety of LHRH analogue(triptorelin) stimulating test in evaluation of hypothalamus-pituitary-gonad axis(HPGA) function in female patients. Methods Between January 2007 and December 2009,the study was done in Endocrinology department of PUMC Hospital:(1)Firstly,LHRHα stimulating test was performed in 30 females with child bearing period by intra-muscular injection of 100 μg triptorelin.Thereafter,the FSH and LH levels were determined at 0,15,30,45,60 and 90 min and then explored the change lines and peak times;(2)For 79 female patients,the follow-up was done until the diagnosis was conformed.The association between LH peak index and diagnosis was analyzed in different diseases,and the value of stimulating test was then evaluated in diagnosis and treatment. Results(1)For females in child bearing period,LH peak index was present at 60~90 min after injection of triptorelin;(2)80%( n=10) of the patients were found with panhypopituitarism,100%( n=12) of the patients with isolated breast development,100%( n=6) of the patients with peripheral precocious puberty induced by exogenous estradiol,100%( n=5) of the patients with hypogonadotropic hypogonadism and 100%( n=11) of the patients with GnRHα treatment due to true precocious puberty,their LH peak indexes<6 U/L;100% of patients with true precocious puberty( n=16) and pubertal development( n=30),their LH peak indexes>6 U/L.Notably,85% of patients were found with pubertal development(LH peak indexes>18 U/L);(3)No local and systemic side effect was observed in the triptorelin stimulating test. Conclusion Triptorelin stimulating test can be used to evaluate HPGA function in female patients,which might be helpful in diagnosis of diseases and evaluation of efficacy,with favorable safety.LH peak index>6 U/L can be considered as the onset indicator of HPGA function,and LH peak index>18 U/L indicated the normal HPGA function in females of sexual maturity.