41例男性特发性低促性腺激素性性腺功能减退症的临床分析

目的：探讨男性特发性低促性腺激素性性腺功能减退症（IHH）的临床特征和治疗。方法：2011年3月—2013年3月在南京医科大学第一附属医院生殖医学科男科就诊的IHH导致的41例男性不育患者中，13例为kallmann综合征，7例有隐睾病史。41例患者中，35例接受人绒毛膜促性腺激素（hCG）联合人绝经促性腺素（HMG）治疗，给予hCG、HMG治疗3～24个月；6例拒绝接受此研究方案。结果：治疗后，35例患者均感觉体力改善，性欲增强，同时第二性征得到不同程度的发育。27例患者疗程超过6个月，且双侧睾丸总体积、卵泡刺激素和睾酮水平均较治疗前显著上升，差异有统计学意义（7.1±2.9）mL vs. （9.1±3.9）mL，（1.2±0.8）IU/L vs. （2.0±0.8）IU/L，（1.1±0.8）nmol/L vs. （12.5±2.7）nmol/L，均P＜0.05]。35例接受治疗的患者中分别有4，7，5例在治疗第3，6，9个月出现精子，共16例，其中11例患者的配偶在治疗过程中自然妊娠。 结论：男性IHH的临床特征为睾丸功能低下， hCG联合HMG是有效的治疗方法，可明显改善患者临床症状并恢复部分生育能力。

Clinical Analysis on 41 Cases of Male Idiopathic Hypogonadotropic Hypogonadism

Objective：To analyze the clinical characteristics of male idiopathic hypogonadotropic hypogonadism（IHH）, and to evaluate treatment outcome. Methods：41 infertile men diagnosed as IHH were recruited in this study, including 13 patients with kallmann syndrome and 7 patients with maldescended testes. 35 patients were treated with hCG 2 000 IU plus HMG 150 IU intramuscularly twice a week，for 3 to 24 months. 6 patients rejected treatment. Results：After treatment，all patients felt improved physical strength and increased sex drive，with the secondary sexual development in different degrees. In the 27 patients with treatment over 6 months，the testis volume（7.1±2.9）mL vs.（9.1±3.9）mL]，FSH level（1.2±0.8）IU/L vs.（2.0±0.8)IU/L] and testosterone level（1.1±0.8）nmol/L vs.（12.5±2.7）nmol/L）]were higher significantly than those before treatment（P＜0.05）. 16 patients after treatment were found to have sperm in semen, and 11 patients achieved preganacy. Conclusions：The clinical characteristics of male patients with IHH was testicular dysfunction and infertility. Therapy with hCG plus HMG is efficiency，which can improve the development of second sexual characteristics, and help some patients to achieve eventually fertility.