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Hypothalamus-pituitary-gonad Axis Function in Polycystic Ovary Syndrome Women Following Triptorelin Stimulation Test
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摘要:
目的 利用促性腺激素释放激素类似物(曲普瑞林)兴奋试验评价多囊卵巢综合征(polycystic ovary syndrome, PCOS)患者的下丘脑-垂体-性腺轴功能并探讨其变化特点。 方法 对PCOS患者(n=20)和健康对照者(n=30)进行曲普瑞林兴奋试验, 在0、15、30、45、60和90 min测定血黄体生成素(luteinizing hormone, LH)和卵泡刺激素(follicular stimulating hormone, FSH)的水平。比较PCOS组和健康对照组在基线状态以及兴奋试验后LH、FSH水平的变化以及LH/FSH比值的差异。 结果 对照组和PCOS组患者的睾酮分别为(1.9±0.5)nmol/L和(3.5±1.4)nmol/L(P=0.012)。PCOS患者的基线LH水平高于对照组[(11.3±6.6)U/L比(3.7±2.7)U/L, P=0.028];在曲普瑞林兴奋试验中, PCOS组LH的升高幅度明显大于对照组; 在第15分钟, PCOS组和对照组的LH分别为(41.4±28.0)和(24.7±19.0)U/L(P=0.036);在第60分钟, PCOS组和对照组的LH分别为(64.0±34.8)和(44.8±22.5)U/L(P=0.060)。PCOS组和对照组的基线FSH水平分别为(4.6±2.0)和(4.9±1.6)U/L(P=0.467);在曲普瑞林兴奋试验中, PCOS组FSH水平升高幅度小于对照组; 在第60分钟, 两组FSH水平分别为(9.9±4.0)和(17.3±5.6)U/L(P=0.041)。基线状态PCOS组和对照组的LH/FSH比值分别为2.9±1.1和0.8±0.2(P=0.023);此比值在曲普瑞林兴奋试验中进一步升高, 在第60分钟时两组分别为6.5±1.3和3.1±0.9(P=0.038)。 结论 PCOS患者基础状态LH和LH/FSH比值明显升高, 在曲普瑞林兴奋试验中, LH和FSH曲线之间的差距进一步增加, LH/FSH比值进一步升高, 提示PCOS患者存在特征性的下丘脑-垂体-卵巢轴功能异常。 Abstract:Objective To evaluate the function of hypothalamus-pituitary-gonad axis (HPGA) in patients with polycystic ovary syndrome (PCOS) using gonadotropin-releasing hormone (GnRH) analogue (triptorelin) stimulation test and to investigate the changes of HPGA following triptorelin stimulation test. Methods Triptorelin stimulation test was conducted in PCOS patients (n=20) and healthy controls (n=30). Serum levels of luteinizing hormone (LH) and follicular stimulating hormone (FSH) were measured at 0, 15, 30, 45, 60 and 90 minutes after intramuscular injection of triptorelin 100 μg in the test. LH and FSH levels and LH/FSH at baseline and after stimulation test were compared between the two groups. Results The control group had a higher level of testosterone than the PCOS group[(1.9±0.5)nmol/L vs. (3.5±1.4)nmol/L, P=0.012]. Baseline LH in the PCOS group was higher than that in the control group[(11.3±6.6)U/L vs. (3.7±2.7)U/L, P=0.028]. After triptorelin stimulation test, LH in the PCOS group increased with a larger magnitude than the control group[at 15 min, (41.4±28.0)U/L vs. (24.7±19.0)U/L, P=0.036; at 60 min, (64.0±34.8)U/L vs. (44.8±22.5)U/L, P=0.060]. Baseline FSH in the PCOS group and the control group were (4.6±2.0) and (4.9±1.6)U/L(P=0.467), respectively.FSH increased less in the PCOS group than in the control group[at 60 min, (9.9±4.0)U/L vs. (17.3±5.6)U/L, P=0.041]. Baseline LH/FSH ratios in the PCOS group and the control group were 2.9±1.1 and 0.8±0.2 (P=0.023), respectively, which both increased after triptorelin stimulation test (6.5±1.3 vs. 3.1±0.9, P=0.038). Conclusions PCOS patients demonstrate higher baseline LH and LH/FSH ratio, growing difference between LH and FSH levels and increasing LH/FSH ratio after triptorelin stimulation test, which indicate dysfunction of HPGA in PCOS patients. -
Key words:
- polycystic ovary syndrome /
- triptorelin stimulation test /
- gonadotropin
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表 1 PCOS组和对照组患者一般资料$\left( {\overline x \pm s} \right)$
组别 年龄(岁) 身高(cm) 体重(kg) 体重指数
(kg/m2)空腹血糖
(mmol/L)空腹胰岛素
(mU/L)睾酮
(nmol/L)对照组(n=30) 22.6±3.6 162.1±1.9 61.3±3.9 24.1±2.3 5.1±0.3 12.6±1.6 1.9±0.5 PCOS组(n=20) 24.8±2.8 161.8±1.7 76.2±5.2 29.3±2.5 5.3±0.4 27.7±3.1 3.5±1.4 P值 0.641 0.783 0.024 0.001 0.074 0.001 0.012 PCOS：多囊卵巢综合征 
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表 2 曲普瑞林兴奋试验中PCOS组和对照组LH、FSH和LH/FSH比值随时间的变化$\left( {\overline x \pm s} \right)$
指标 组别 0 min 15 min 30 min 45 min 60 min 90 min LH(U/L) 对照组 3.7±2.7 24.7±19.0 37.0±21.0 41.0±23.7 44.8±22.5 47.4±23.1 PCOS组 11.3±6.6 41.4±28.0 58.6±38.0 62.0±35.5 64.0±34.8 65.0±35.7 P值 0.028 0.036 0.045 0.067 0.060 0.083 FSH(U/L) 对照组 4.9±1.6 8.2±1.9 11.3±2.9 12.9±2.9 14.7±4.2 17.3±5.6 PCOS组 4.6±2.0 6.7±2.8 8.3±3.2 8.8±3.5 9.3±4.0 9.9±4.0 P值 0.854 0.471 0.256 0.198 0.064 0.046 LH/FSH比值 对照组 0.8±0.2 2.9±0.7 3.3±1.1 3.2±0.8 3.1±0.9 2.7±0.9 PCOS组 2.9±1.1 6.5±1.2 7.1±1.6 7.0±1.6 6.5±1.3 6.4±1.3 P值 0.023 0.019 0.035 0.032 0.038 0.041 PCOS：同表 1；LH：黄体生成素；FSH：卵泡刺激素
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