Aisaka K, Yoshida K, Mori H
Department of Obstetrics and Gynecology, San-ikukai Hospital, Tokyo, Japan.
Horm Res. 1992;37 Suppl 1:41-7. doi: 10.1159/000182347.
To elucidate the clinical background of the luteal-phase defect (LPD), 201 LPD cycles were studied in 753 infertile women. One hundred and twenty-one cases (62.2%) of LPD showed transient hyperprolactinemia. In transient hyperprolactinemia, there was a significant inverse correlation between serum prolactin (PRL) 30 min after the 500-micrograms intravenous loading of thyrotropin-releasing hormone TRH (PRL30) and progesterone (P4) in the luteal phase (r = -0.67, p less than 0.005). Mature follicles (diameter greater than 20 mm as determined by ultrasonography) were observed in 74 cases (61.2% of the transient hyperprolactinemia cases). On the contrary, in 25 (12.4%) of the 121 LPD cases who showed the hyper-luteinizing hormone (LH) syndrome (LH/FSH ratio greater than 1), only 9 (36%) had mature follicles. Of the remaining 55 cases who showed neither transient hyperprolactinemia nor the hyper-LH syndrome, 27 cases (49.1%) had mature follicles. Five of these patients indicated a significantly higher LH pulse amplitude despite depressed P4 secretion in the luteal phase. From these results, it was concluded that the most common cause of LPD was transient hyperprolactinemia. The second cause of LPD was suspected to be disturbed follicle development due to the inappropriate ratio of LH/FSH in the hyper-LH syndrome. Another cause was speculated to be the primary failure of a response from the corpus luteum to LH. Treatments based on the conclusions mentioned above resulted in a 48.3% pregnancy success rate.
为阐明黄体期缺陷（LPD）的临床背景，对753例不孕妇女的201个LPD周期进行了研究。121例（62.2%）LPD患者出现短暂性高催乳素血症。在短暂性高催乳素血症中，静脉注射500微克促甲状腺激素释放激素（TRH）后30分钟血清催乳素（PRL）（PRL30）与黄体期孕酮（P4）之间存在显著负相关（r = -0.67，p < 0.005）。74例（占短暂性高催乳素血症病例的61.2%）观察到成熟卵泡（经超声检查直径大于20毫米）。相反，在121例出现黄体生成素（LH）综合征（LH/FSH比值大于1）的LPD病例中，25例（12.4%）仅有9例（36%）有成熟卵泡。其余55例既未出现短暂性高催乳素血症也未出现LH综合征的患者中，27例（49.1%）有成熟卵泡。其中5例患者尽管黄体期P4分泌降低，但LH脉冲幅度显著升高。从这些结果得出结论，LPD最常见的原因是短暂性高催乳素血症。LPD的第二个原因被怀疑是LH综合征中LH/FSH比例不当导致卵泡发育受阻。另一个原因推测是黄体对LH反应的原发性失败。基于上述结论的治疗导致妊娠成功率为48.3%。
