本文選題：低促性素性腺功能減退癥　切入點(diǎn)：hCG/FSH聯(lián)合治療　出處：《上海交通大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：【目的】 觀察hCG/FSH聯(lián)合治療和戈那瑞林脈沖治療是否能有效促進(jìn)男性低促性素性腺功能減退癥（idiopathic hypogonadotropic hypogonadism, IHH）患者精子生成、第二性征發(fā)育。探究戈那瑞林脈沖治療和hCG/FSH聯(lián)合治療相比，對(duì)誘導(dǎo)男性患者精子生成、第二性征發(fā)育是否具有優(yōu)勢(shì)性。 【方法】 納入上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院內(nèi)分泌代謝科收治的16例男性IHH患者，使用hCG/FSH聯(lián)合治療（hCG2000IU，biw，im6個(gè)月后，加用FSH75IU，tiw，im）。同期納入90例男性IHH患者，使用戈那瑞林脈沖治療，劑量為10μg-15μg/90min皮下注射。觀察治療后患者激素水平、第二性征發(fā)育、精子生成和配偶自然受孕情況。 48例確診為IHH男性患者，按1:2人數(shù)入組。雙促治療組16人，使用hCG/FSH聯(lián)合治療；脈沖治療組32人，使用戈那瑞林脈沖治療。比較兩組患者治療18個(gè)月后在激素水平、第二性征發(fā)育、精子生成、配偶自然受孕等方面是否具有差異。 【結(jié)果】 hCG/FSH聯(lián)合治療后患者T上升至正常范圍，第二性征發(fā)育，治療18個(gè)月后14名患者中11名有精子生成，精子密度中位數(shù)為3.03×106/ml。戈那瑞林脈沖治療后患者LH、FSH出現(xiàn)脈沖式波動(dòng)，T水平上升，第二性征發(fā)育。治療1年時(shí)生精率為60.61%，精子密度中位數(shù)為2.75×106/ml；2年時(shí)生精率達(dá)76.47%，精子密度中位數(shù)為14.04×106/ml�；颊呤状尉由蓵r(shí)間、首次精子密度達(dá)到20×106/ml時(shí)間均與睪丸初始體積有關(guān)（r=-0.448，P=0.001；r=-0.600，P=0.001）。治療12、18個(gè)月時(shí)有精子生成和無精子生成患者的初始睪丸體積有統(tǒng)計(jì)學(xué)差異。9名已婚患者中8名配偶自然受孕，已婚懷孕率為88.89%，平均誘導(dǎo)懷孕時(shí)間為（15.38±1.92）月。 hCG/FSH聯(lián)合治療與脈沖治療的療效比較研究顯示，患者的睪酮水平、第二性征發(fā)育、精子密度和誘導(dǎo)精子生成所需時(shí)間兩組無統(tǒng)計(jì)學(xué)差異。治療18個(gè)月后78.6%雙促組和77.0%脈沖組患者精子最大密度1×106/ml。脈沖組患者精子密度較雙促組增高(21.57×106/ml vs3.03×106/ml, P=0.11)。雙促組中1名患者已婚，其配偶成功自然受孕；脈沖組中8名患者已婚，其中7名患者配偶自然受孕，已婚懷孕率為87.5%。 【結(jié)論】 hCG/FSH聯(lián)合治療和戈那瑞林脈沖治療均能誘導(dǎo)男性IHH患者第二性征發(fā)育、精子生成，使配偶自然受孕，是安全、有效促進(jìn)生育能力的治療方法。戈那瑞林脈沖治療誘導(dǎo)男性IHH患者精子生成所需時(shí)間與初始睪丸體積有關(guān)，睪丸體積越大，誘導(dǎo)精子生成所需時(shí)間越短。 兩種治療方法對(duì)誘導(dǎo)男性IHH患者精子生成速度、最終精子密度以及第二性征發(fā)育無明顯差別，可根據(jù)患者自身需求選擇治療方案。脈沖治療因治療后精子密度相對(duì)更高，對(duì)部分促性腺激素治療效果不佳患者有效，且耐受性、依從性更好，與hCG/FSH聯(lián)合治療相比仍具有優(yōu)勢(shì)性。
[Abstract]:[purpose]. To observe whether the combination of hCG/FSH and gonadotropin pulse therapy can effectively promote the spermatogenesis and the development of secondary sexual characteristics in patients with idiopathic hypogonadotropic hypogonadism (IHHH), and to explore the comparison between gonarelin pulse therapy and hCG/FSH combined therapy. Whether secondary sexual development is dominant in inducing spermatogenesis in male patients. [methods]. Sixteen male IHH patients admitted to the Department of Endocrinology and Metabolism of Ruijin Hospital affiliated to Shanghai Jiaotong University were treated with hCG/FSH combined with hCG/FSH for 6 months. 10 渭 g-15 渭 g / 90 min subcutaneous injection was used to observe the hormone level, secondary sexual development, spermatogenesis and natural conception of the spouse after treatment. 48 male patients diagnosed as IHH were enrolled in the group according to 1: 2, 16 patients in the double promoting treatment group were treated with hCG/FSH combined therapy, and 32 patients in the pulse treatment group were treated with gonarelin pulse therapy. The hormone levels in the two groups were compared after 18 months of treatment. There are differences in secondary sexual development, spermatogenesis, and natural conception of spouses. [results]. After 18 months of treatment, 11 of the 14 patients had spermatogenesis, the median sperm density was 3.03 脳 10 ~ 6 / ml 路L ~ (3) 3 脳 10 ~ (-6) ml. The spermatogenesis rate was 60.61%, the median sperm density was 2.75 脳 10 6 / ml, the spermatogenic rate was 76.47% and the median sperm density was 14.04 脳 10 6 / ml at 2 years after treatment. The initial sperm density of 20 脳 10 6 / ml was related to the initial testicular volume. The initial testicular volume was significantly different between the patients with spermatogenesis and azoospermia at 12,18 months after treatment. The average pregnancy induction time was 15.38 鹵1.92 months. A comparative study of the effects of hCG/FSH combination therapy and pulse therapy showed that testosterone levels, secondary sexual development, There was no significant difference between the two groups in sperm density and the time required to induce spermatogenesis. After 18 months of treatment, the maximum sperm density of the 78.6% and 77.0% pulse groups was 1 脳 10 6 / ml. The sperm density of the pulse group was increased by 21.57 脳 10 6 / ml vs3.03 脳 10 6 / ml, P < 0. 11%. In the pulse group, 8 patients were married, 7 of them were naturally pregnant, and the married pregnancy rate was 87.5%. [conclusion]. The combination of hCG/FSH therapy and ganarelin pulse therapy can induce secondary sexual development and spermatogenesis in male patients with IHH. It is safe for spouses to conceive naturally. The duration of sperm production in male patients with IHH is related to the initial testicular volume. The larger the testis volume, the shorter the time required to induce spermatogenesis. There was no significant difference in the rate of sperm production, the final sperm density and the development of secondary sexual characteristics in male patients with IHH, but they could be selected according to the needs of the patients. It is effective in some patients with poor gonadotropin treatment and has better tolerance and compliance. It is still superior to hCG/FSH combined therapy.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.6

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