發(fā)布時間：2018-06-04 04:38

  本文選題：多種垂體激素缺乏癥 + 促性腺激素��； 參考：《山東大學》2013年碩士論文

【摘要】：1.研究背景及目的 多種垂體激素缺乏癥(MPHD)是一類以生長激素(GH)缺乏伴一種或多種其他垂體激素缺乏為特征的疾病,其最常見的伴發(fā)缺乏激素是促性腺激素,但臨床對于性腺功能低下的治療無統(tǒng)一標準和指南。目前常用方法是青春期時給予性激素替代治療改善第二性征,在有生育需求時給予促性腺激素類似物如人絨毛膜促性腺激素(hCG)和人絕經(jīng)期促性腺激素(hMG)治療。但性激素對生育無改善,甚至會損害生育能力和終身高。本研究的目的為觀察早期,即青春期即給予促性腺激素替代治療對MPHD患兒性腺發(fā)育的影響。 2.對象與方法 對象 2007.2---2013.2山東大學附屬省立醫(yī)院兒科內(nèi)分泌門診收治的多種垂體激素缺乏癥患兒,其中伴有促性腺激素低下、男性年齡大于12歲、女性年齡大于11歲者作為研究對象。按開始治療年齡分為2組：①青春期組：男性年齡大于等于12歲且小于16歲,女性年齡大于等于11歲且小于14歲,共29例,男性26例,女性3例；②青春期后組：男性年齡大于等于16歲,女性年齡大于等于14歲,共31例,男性26例,女性5例。 方法 所有男性患兒均給予hCG及hMG肌注,所有女性患兒給予hMG肌注,每3天1次,每次hCG1000u～2000u、hMG75u,3個月為1療程。同時其他缺乏激素給予替代療法,使患兒相應激素水平和臨床表現(xiàn)維持正常。每3個月復查,至少隨訪6個月,其中43例觀察足9個月,8例觀察到36個月。 觀察指標 分別記錄用藥前和用藥后3個月、6個月時的血清性激素水平(促卵泡生成素FSH、黃體生成素LH、雌二醇E2、睪酮To)、體格檢查(身高H、乳房和陰毛發(fā)育Tanner分期、陰莖長度和周長、睪丸體積)、影像學檢查(子宮、卵巢和睪丸B型超聲,骨齡BA,下丘腦-垂體核磁共振成像掃描H-P MRI)和其他相關(guān)檢查結(jié)果(如精液分析)。 3.結(jié)果 (1)青春期組用藥前FSH0.52±0.53mIU/ml, LH0.14±0.27mIU/ml, E23.8±8.2pg/ml, To0.09±0.21ng/ml,用藥3個月FSH、E2、To較用藥前顯著升高(p分別0.01、0.001、0.01),用藥6個月FSH、LH、E2、To均顯著高于用藥前,FSH3.49±3.57mIU/ml(P0.01), LH2.11±3.2mIU/ml (P0.01), E221.77±13.44pg/ml (P0.001), To3.97±2.71ng/ml(P0.001)。用藥3個月FSH、LH、E2和To增高值與用藥6個月比較無顯著性差異(P均0.05)。用藥前Tanner分期均為Ⅰ期,用藥6個月有5人進入Ⅱ期,1人Ⅲ期。男性陰莖長度和周長均明顯增長(P0.001),睪丸容積由1.18±0.91m1增大至5.64±2.38ml(P0.001),有效率96.2%。女性B超顯示子宮體積增大、卵巢內(nèi)出現(xiàn)卵泡。 (2)青春期后組用藥前FSH0.95±0.82mIU/ml, LH0.21±0.37mIU/ml, E29.85±12.07pg/ml, To0.89±1.83ng/ml,用藥3個月E2、To明顯升高(p分別0.001、0.01),用藥6個月FSH、E2和To顯著高于用藥前,FSH2.11±1.85mIU/ml (P0.01), LH0.25±0.56mIU/ml (P0.5), E228.17±23.06pg/ml (P0.01), To3.28±3.38ng/ml (P0.01).用藥6個月LH、E2和To增高值與3個月比較無顯著性差異(P均0.5),FSH增高明顯(P0.05)。用藥前Tanner分期有22人Ⅰ期,9人Ⅱ期,用藥后Ⅱ期有13人,Ⅲ期7人。男性陰莖長度和周長均明顯增長(P0.001),睪丸容積從2.40±1.75m1增大到4.73±2.16ml(P0.001),有效率76.9%。。用藥6個月后有2例女性月經(jīng)初潮,男性中有9例出現(xiàn)遺精,1例已結(jié)婚育有一子。 (3)兩組比較：青春期組FSH和LH在用藥后3個月和6個月的增長值均明顯高于青春期后組(P均0.05)。E2和To增長值兩組間無顯著性差異(P0.1)。兩組間陰莖長度和周長增長值無明顯差異,青春期組睪丸體積較青春期后組增大明顯(P0.01)。 (4)不同垂體激素缺乏患者在兩組分布無差異(P0.1),其他激素水平維持正常時,缺乏不同垂體激素的MPHD患兒應用促性腺激素治療后激素水平升高和第二性征改變無明顯差異(P0.05)。 (5)青春期組治療前后身高、骨齡小于青春期后組,但預期成人身高(PAH)始終高于青春期后組(P0.05)。用藥后兩組骨齡變化無明顯差異(P0.1),但青春期組身高增長值更大(P0.01)。 (6)有無垂體柄阻斷綜合征患者的初始激素水平、第二性征和療效比較無顯著性差異(P0.05)。 (7)LH、睪丸容積變化值與開始治療年齡呈負相關(guān)(R分別0.3、0.4,P分別0.05、0.01)。 4.結(jié)論 (1)青春期和青春期后開始促性腺激素替代治療均可改善患兒第二性征和性激素水平,而青春期開始治療對患兒性腺功能的恢復更有利,且開始治療時間越晚,療效越差。 (2)青春期開始治療者對預期成人身高無損害,有利于終身高。 (3)其他激素水平維持正常時,缺乏不同垂體激素的MPHD患兒應用促性腺激素替代療法后性激素水平和第二性征發(fā)育變化無明顯差異。
[Abstract]:1. background and purpose of research
Multiple pituitary hormone deficiency (MPHD) is a class of diseases characterized by the lack of growth hormone (GH) with one or more other pituitary hormones. The most common associated deficiency of hormone is gonadotropin. However, there is no unified standard for the treatment of hypogonadism and the south. The common method is to give sex hormone replacement at puberty. Treatment improves secondary sex, and gives gonadotropin analogues such as human chorionic gonadotropin (hCG) and human menopause gonadotropin (hMG) at birth demand. However, sex hormone does not improve fertility and even damages fertility and final height. The aim of this study was to give gonadotropin in the early stages of adolescence. The effect of alternative therapy on the gonadal development of children with MPHD.
2. objects and methods
object
2007.2---2013.2 a variety of children with pituitary hormone deficiency treated in the Department of pediatric endocrinology, affiliated Provincial Hospital of Shandong University, with low gonadotropin, male age more than 12 years old and women older than 11 years of age as research subjects. The age of the beginning of treatment is divided into 2 groups: (1) the adolescent group: the male age is more than 12 years old and small. At the age of 16, women are more than 11 years old and less than 14 years old. There are 29 cases, 26 men and 3 women. 2. After puberty, male age is more than or equal to 16 years, female age is more than or equal to 14 years. There are 31 cases, 26 men and 5 women.
Method
All male children were given hCG and hMG intramuscular injection. All female children were given hMG intramuscular injection, 1 times every 3 days, each hCG1000u to 2000u, hMG75u, 3 months for 1 courses. At the same time, the other lack of hormone replacement therapy made the corresponding hormone level and clinical manifestation normal. Every 3 months reexamination, at least for 6 months, 43 cases were observed for 9 months. 8 cases were observed for 36 months.
Observation index
Serum sex hormone levels (follicle generating hormone FSH, luteinizing hormone LH, estradiol E2, testosterone To), physical examination (H, Tanner staging of breast and pubic hair, penis length and perimeter, testicular volume), and imaging examination (uterus, ovarian and testicular B ultrasound, bone age BA, hypothalamus - hypothalamus -) were recorded respectively at 3 months and 6 months after medication, respectively. Pituitary magnetic resonance imaging scanning H-P MRI) and other related examination results (such as semen analysis).
3. results
(1) the puberty group was FSH0.52 + 0.53mIU/ml, LH0.14 + 0.27mIU/ml, E23.8 + 8.2pg/ml, To0.09 + 0.21ng/ml, the medication was 3 months FSH, E2, To was significantly higher than before the medication (P respectively). .001), To3.97 + 2.71ng/ml (P0.001). There was no significant difference in the value of FSH, LH, E2 and To for 3 months (P 0.05). The Tanner staging of the drugs before medication was stage I, and 5 people entered stage II and 1 in 6 months. The male penis length and Zhou Changjun increased significantly (P0.001), and the volume of the testis increased from 1.18 + 0.91m1 to 5.64. 0.001) the effective rate was 96.2%. B ultrasound showed that the volume of uterus increased and ovarian follicles appeared.
(2) after adolescence, FSH0.95 + 0.82mIU/ml, LH0.21 + 0.37mIU/ml, E29.85 + 12.07pg/ml, To0.89 + 1.83ng/ml, 3 months E2, To significantly increased (P 0.001,0.01), 6 months of medication. Ng/ml (P0.01). There was no significant difference in the 6 month LH, E2 and To increased value compared with 3 months (P 0.5), FSH increased significantly (P0.05). Before medication, there were 22 people in stage I stage and 9 stage II stage, 13 in stage II and 7 in stage II. The male penis length and Zhou Changjun increased significantly (P0.001), and the volume of testis increased from 2.40 + 1.75m1 to 4.73 + 2.16ml. 01) the effective rate of 76.9%.. Was 2 months after menarche in 6 months, 9 of male cases had seminal emission, and 1 had married one child.
(3) the comparison between the two groups: the growth values of FSH and LH in the puberty group were significantly higher than those of the post puberty group (P 0.05) and the growth values of.E2 and To (P0.1). There was no significant difference in the penis length and perimeter growth between the two groups, and the volume of testosterone in puberty group was significantly higher than that in the post puberty group (P0.01).
(4) there was no difference in the distribution of the two groups in the patients with different pituitary hormone deficiency (P0.1), and when the other hormone levels were normal, there was no significant difference in the level of hormone level and the secondary sex change after the gonadotropin treatment (P0.05) in children with the lack of different pituitary hormones.
(5) the height of the puberty group was less than that of the post puberty group before and after the treatment, but the expected adult height (PAH) was always higher than that in the post puberty group (P0.05). There was no significant difference in bone age between the two groups after the treatment (P0.1), but the height growth of the puberty group was higher (P0.01).
(6) there was no significant difference in the initial hormone levels between patients with and without pituitary stalk interruption syndrome (P0.05).
(7) LH, the volume of testicular volume was negatively correlated with the age of onset (R 0.3,0.4, P 0.05,0.01, respectively).
4. conclusion
(1) gonadotropin replacement therapy at puberty and puberty can improve the secondary sex and sex hormone levels in children, and the onset of puberty is more favorable for the recovery of the sexual gland function of the children, and the later the treatment time is, the worse the curative effect is.
(2) the onset of puberty is not harmful to the expected adult height, and is beneficial to the final height.
(3) when other hormone levels are normal, there is no significant difference in the level of sex hormone and the development of secondary sex sex hormone levels in children with MPHD lacking different pituitary hormones.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R725.8

【參考文獻】

相關(guān)期刊論文 前10條

1 傅永倫;匡延平;;小劑量hCG聯(lián)合HMG對低促性腺激素性腺功能減退癥不育患者卵巢刺激的療效觀察[J];國際婦產(chǎn)科學雜志;2011年05期

2 楊念欽;王國民;;HCG、FSH聯(lián)合治療低促性腺激素性性腺功能減退癥29例報告[J];中國男科學雜志;2009年12期

3 李麗霞;李坤霞;孫春香;萬代紅;李堂;;2487名青少年性發(fā)育調(diào)查[J];臨床和實驗醫(yī)學雜志;2006年09期

4 狄福松,崔毓桂,賈悅,王曉東,張桂元;脈沖式皮下注射黃體生成素釋放激素治療男性促性腺激素缺乏癥(附14例報道)[J];生殖醫(yī)學雜志;2004年01期

5 劉戈力,葉大勛,馬咸成,王崇新,楊青巖;正常青少年青春期性征發(fā)育調(diào)查[J];天津醫(yī)科大學學報;1999年01期

6 何聯(lián);陳海濤;楊星海;鄭新民;;HCG對青春期前低促性腺激素性腺發(fā)育不良型小陰莖的療效觀察[J];中國婦幼保健;2011年20期

7 潘慧,史軼蘩,鄧潔英,伍學焱,盧雙玉;LHRH興奮試驗早期鑒別診斷青少年的體質(zhì)性青春發(fā)育延遲和男性低促性腺激素性功能低減的價值[J];中華內(nèi)分泌代謝雜志;2003年02期

8 趙明,王曉,張忠軍;垂體柄中斷綜合征一例[J];中華內(nèi)分泌代謝雜志;2005年03期

9 狄福松;崔毓桂;賈悅;;促性腺激素治療男性低促性腺激素性性腺功能減退癥的療效評估[J];中華內(nèi)科雜志;2005年11期

10 鄧汪東;蔣學武;;先天性小陰莖治療進展[J];中華小兒外科雜志;2006年08期

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