本文選題：脫氫表雄酮 + 卵巢功能低下��； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：背景和目的 脫氫表雄酮(Dehydro-epiandrosterone, DHEA)應(yīng)用于卵巢功能低下患者的治療已有10余年時(shí)間,其在改善卵巢功能、調(diào)節(jié)免疫、改善代謝及保護(hù)心血管等方面的作用明顯,使得DHEA成為近年來婦科內(nèi)分泌的研究熱點(diǎn)。國內(nèi)外多數(shù)關(guān)于DHEA的研究提示其有效性,故其在改善生育功能和圍絕經(jīng)期癥狀方面得到廣泛應(yīng)用,但尚缺乏關(guān)于DHEA的作用機(jī)制及安全性,及DHEA對中國人有效性和耐受性的研究資料,需要開展更多大樣本量、隨機(jī)對照的基礎(chǔ)、臨床試驗(yàn)。 本研究通過分析卵巢功能低下患者服用DHEA前后卵巢功能指標(biāo)及肝功能變化,觀察DHEA是否能改善卵巢功能,是否對肝功能產(chǎn)生影響,為卵巢功能低下患者應(yīng)用DHEA治療提供有效性及安全性的證據(jù)。 方法 本研究以診斷為卵巢功能低下的患者為研究對象,共54名符合入選標(biāo)準(zhǔn),根據(jù)就診順序編號,隨機(jī)分為治療組和對照組,治療組(n=32)口服DHEA膠囊(每日3次,每次25mg),連續(xù)服用3個月；對照組(n=22)口服維生素E(每日1次,每次100mg),連續(xù)服用3個月。記錄所有患者服藥前和服藥3個月后的促卵泡激素(follicle-stimulating hormone,FSH)、黃體生成激素(luteotrophic hormone, LH)、雌二醇(estradiol, E2)、睪酮(testosteroneT)、硫酸脫氫表雄酮(dehydroepiandrosterone sulphate, DHEAS)及胰島素樣生長因子-1(insulin-like growth factor-1, IGF-1),門冬氨酸氨基轉(zhuǎn)移酶(alanine aminotransferase, AST)、丙氨酸氨基轉(zhuǎn)移酶(alanine aminotransferase, ALT),基礎(chǔ)竇卵泡數(shù)(antral follicle count, AFC),記錄身高和體重并計(jì)算體重指數(shù)(body mass index, BMI)。運(yùn)用SPSS20.0中文版軟件包對所統(tǒng)計(jì)數(shù)據(jù)進(jìn)行分析。 結(jié)果 本研究共收集54例患者,服藥前治療組、對照組患者一般資料、內(nèi)分泌水平、AFC和肝功能對比,兩組沒有統(tǒng)計(jì)學(xué)差異(P0.05)。治療組應(yīng)用DHEA后,FSH水平和FSH/LH較治療前顯著降低(P0.05)：血清LH、E2無明顯變化；AFC數(shù)目較治療前有所增加,但不具備統(tǒng)計(jì)學(xué)差異(P0.05)；治療組用藥后血清T、DHEAS及IGF-1水平較前均有所升高,其中IGF-1升高不具備統(tǒng)計(jì)學(xué)差異(P0.05),血清T及DHEAS水平治療后均明顯升高(P0.05)；AST、ALT及BMI的變化均無統(tǒng)計(jì)學(xué)差異(P0.05)；不良反應(yīng)：1例患者因卵巢多囊樣改變而停藥；完成試驗(yàn)者中2例出現(xiàn)面部痤瘡,4例訴面部油膩感。治療后與對照組比較,治療組血清FSH水平、FSH/LH比值顯著降低(P0.05),血清DHEAS、T水平顯著升高(P0.05)；兩組間其他觀察項(xiàng)目(AFC、血清LH、E2、IGF-1水平、AST、ALT及BMI)無明顯變化(P0.05)；對照組未發(fā)現(xiàn)不良反應(yīng)。 結(jié)論 1.DHEA可降低血清FSH水平、FSH/LH比值,說明其能改善卵巢功能。 2.DHEA可提高血清DHEAS、T水平,同時(shí)可能因雄激素的增高引起不良反應(yīng)。 3.本研究不支持DHEA可提高竇卵泡數(shù)、血清IGF-1水平。 4.本研究DHEA應(yīng)用方案并未導(dǎo)致肝功能及體重指數(shù)變化。
[Abstract]:Background and purpose Dehydroepiandrosterone (DHEA) has been used in the treatment of patients with ovarian dysfunction for more than 10 years. It plays an important role in improving ovarian function, regulating immunity, improving metabolism and protecting cardiovascular system. DHEA has become the focus of gynecological endocrine research in recent years. Most studies on DHEA at home and abroad suggest that it is effective, so it is widely used in improving reproductive function and peri-menopausal symptoms, but it lacks the mechanism and safety of DHEA. And DHEA for Chinese effectiveness and tolerance research data, need to carry out more large sample size, randomized controlled basis, clinical trials. In this study, we analyzed the changes of ovarian function and liver function in patients with hypofunctional ovary before and after taking DHEA, and observed whether DHEA could improve ovarian function and influence liver function. To provide evidence of efficacy and safety for patients with ovarian dysfunction treated with DHEA. Method In this study, 54 patients with ovarian dysfunction were randomly divided into treatment group (n = 54) and control group (n = 32) by oral administration of DHEA capsule (3 times a day). The control group was given vitamin E once a day, 100 mg / time for 3 months. The follicle-stimulating hormone follicle stimulating hormone FSHS, luteotrophic hormone, LHN, estradiol, E2, testosterone, dehydroepiandrosterone sulphate (DHEAS-1), insulin-like growth factor-1 (IGF-1), aspartate aminotroponin were recorded in all patients before and 3 months after administration. Alanine aminotransferase, alt, basic antral follicle count, AFCU, body height and weight were recorded and body mass index (BMI) was calculated. Using the Chinese version of SPSS20.0 software package to analyze the statistical data. Result In this study, 54 patients, before treatment group and control group, general data, endocrine level of AFC and liver function were compared. There was no statistical difference between the two groups (P 0.05). The levels of DHEA and FSH/LH in the treatment group were significantly lower than those before the treatment. The number of serum DHEA E2 was not significantly changed, but there was no statistical difference between the two groups, and the serum levels of THEAS and IGF-1 in the treatment group were higher than those before treatment, and the levels of THEAS and IGF-1 in the treatment group were higher than those before the treatment. The level of serum T and DHEAS were significantly increased after treatment. There was no significant difference in the changes of alt and BMI between the two groups. Of the 2 patients who completed the trial, 4 had facial acne and complained of facial greasy feeling. After treatment, compared with the control group, the serum FSH level and FSH / LH ratio in the treatment group were significantly lower than those in the control group (P 0.05), and the serum DHEASA T level was significantly higher than that in the control group (P 0.05), while other observation items such as AFC, serum LHH E2IGF-1 level, alt and BMIs were not significantly changed in the two groups, while no adverse reactions were found in the control group. Conclusion 1.DHEA can decrease serum FSH level and FSH / LH ratio, indicating that 1.DHEA can improve ovarian function. 2.DHEA can increase the serum DHEAST level and may cause adverse reactions due to the increase of androgen. 3. This study does not support that DHEA can increase the number of antral follicles and the level of serum IGF-1. 4. The application of DHEA in this study did not result in changes in liver function and body mass index (BMI).
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.75

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