Tondolo V, Citterio F, Panocchia N, Nanni G, Favi E, Brescia A, Castagneto M
Division of Organ Transplantation, Department of Surgery, Catholic University of Sacred Heart, Rome, Italy.
Transplant Proc. 2005 May;37(4):1915-7. doi: 10.1016/j.transproceed.2005.04.004.
End-stage renal disease is associated with disorders in hypothalamic-pituitary-gonadal function. Immunosuppressive therapies may influence the restoration of normal levels of gonadal hormones after renal transplantation. The aim of the present study was to evaluate the hormonal status of successful renal transplant recipients who were treated with different immunosuppressive agents.
Testosterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) were measured in 59 male renal transplant recipients with stable graft function with serum creatinine <2.5 mg/dL. Patients were treated with three different immunosuppressive regimens: group I, calcineurin inhibitors (CI; n = 15), group II, sirolimus without calcineurin inhibitors (SRL; n = 15), group III, sirolimus in combination with calcineurin inhibitors (SRL * CI; n = 29).
Testosterone was significantly lower in group II versus group I (3.12 +/- 1.23 versus 4.39 +/- 1.53 ng/mL; P < .0197). Group III had higher testosterone values than group II, but lower than group I. FSH and LH were also higher in the SRL group, but the differences were not statistically significant, perhaps because of the small number of patients. No relationship was found between testosterone blood levels and age, posttransplant follow-up, renal function, time on dialysis, body mass index, steroid use, or posttransplant diabetes.
Sirolimus seems to impair the improvement of gonadal function after renal transplantation. Further prospective studies are needed to confirm these data before patients are advised of this potential side effect.
终末期肾病与下丘脑 - 垂体 - 性腺功能紊乱有关。免疫抑制疗法可能会影响肾移植后性腺激素恢复到正常水平。本研究的目的是评估接受不同免疫抑制药物治疗的成功肾移植受者的激素状态。
对59名移植肾功能稳定且血清肌酐<2.5mg/dL的男性肾移植受者测量睾酮、促黄体生成素（LH）和促卵泡生成素（FSH）。患者接受三种不同的免疫抑制方案治疗：第一组，钙调神经磷酸酶抑制剂（CI；n = 15），第二组，无钙调神经磷酸酶抑制剂的西罗莫司（SRL；n = 15），第三组，西罗莫司与钙调神经磷酸酶抑制剂联合使用（SRL*CI；n = 29）。
第二组的睾酮水平显著低于第一组（3.12±1.23对4.39±1.53ng/mL；P<.0197）。第三组的睾酮值高于第二组，但低于第一组。SRL组的FSH和LH也较高，但差异无统计学意义，可能是因为患者数量较少。未发现睾酮血水平与年龄、移植后随访、肾功能、透析时间、体重指数、类固醇使用或移植后糖尿病之间存在关联。
西罗莫司似乎会损害肾移植后性腺功能的改善。在向患者告知这种潜在副作用之前，需要进一步的前瞻性研究来证实这些数据。
