雄激素对男性性腺功能低减病人促红细胞生成素的影响

目的 :观察雄激素替代治疗对性腺功能低减男子促红细胞生成素 (EPO)的影响 ,探讨雄激素促进红细胞和血红蛋白生成增加的机制。　方法 :8例原发性性腺功能低减 (Klinefelter综合征 )病人 ,接受初次 5 0 0mg或10 0 0mg十一酸睾酮 (TU)肌肉注射 ,间隔 3个月后交叉剂量第二次注射。注射前后观察血清性激素水平的变化 (放免法 ) ;在注射前和后的第 4、8周分别查血常规和红细胞比容 ,酶免疫法测定血清EPO。　结果 :注射TU后 ,第二性征发育情况改善 ,血睾酮水平显著升高 ,注射后 1周达峰值 ,维持有效治疗的雄激素水平 (>10nmol/L)超过 6周。血红细胞计数、红细胞比容和血红蛋白含量的均数均有不同程度的增加趋势 ,但统计学上差异不显著 (P >0 .0 5 )。与治疗前相比 ,注射TU后EPO水平显著升高 ,并维持 8周以上 (P <0 .0 1～ 0 .0 5 ) ;第 2次注射TU仍然使EPO水平升高。　结论 :雄激素替代治疗使性腺功能低减男子EPO水平升高 ,是红细胞生成增加的机制之一。

Effect of Androgen on Erythropoientin in Patients with Hypogonadism

Objectives: To observe the change of erythropoienth (EPO) in patients of hypogonadism who received androgen replacement treatment and explore the mechanism of androgen-induced increase of red blood cells and haemoglobin. Methods:Eight patients with Klinefelter's syndrome, divided into two groups, received TU intramuscular injections of 500 mg or 1000 mg dose, respectively. After three months, seven patients received the second injection of crossover dose. Testosterone levels in serum were measured with RIA before and after the injections treatment. RBC count, impacted volume of blood cells and haemoglobin concentration were measured before treatment and 4, 8 weeks after treatment. At the same interval, EPO levels were measured with ELISA method. Results: Development of the secondary sex characters was improved in all patients after the TU injection. Serum testosterone levels raised significantly and reached the peak one week after the injections. Effective level of testosterone lasted for over 6 weeks. RBC count, impacted volume of blood cells and haemoglobin increased at different degrees after TU injections, but these changes were not significant in statistic(P< 0.05). The increased levels remained for 8 weeks. EPO levels were elevated significantly (P< 0.01 or 0.05) after the TU injection(Pbat > 0.05). The second injection could still make the EPO level go up. Conclusions: Androgen replacement treatment can increase the EPO levels in patients of hypogonadism, which is one of the mechanism of RBC production increase.