Ishiguro H, Yasuda Y, Tomita Y, Shinagawa T, Shimizu T, Morimoto T, Hattori K, Matsumoto M, Inoue H, Yabe H, Yabe M, Shinohara O, Kato S
Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan.
Bone Marrow Transplant. 2007 Apr;39(8):483-90. doi: 10.1038/sj.bmt.1705612. Epub 2007 Mar 5.
An increasing number of long-term surviving bone marrow transplantation (BMT) recipients have recovered from their primary disease but are at risk of developing failure of endocrine organs. We investigated 30 recipients who underwent allogeneic BMT during childhood or adolescence. Testicular growth and function were evaluated by serial measurement of testicular volume, basal luteinizing hormone (LH), basal follicle-stimulating hormone (FSH) and testosterone levels and by gonadotropin-releasing hormone (GnRH) provocative test. Puberty started spontaneously in all patients. However, all except four patients had normal testosterone levels with elevated LH, indicating partial Leydig cell dysfunction. Standard deviation scores of testicular volume at last evaluation were statistically lower in those who had received irradiation without gonadal shield compared to those with (-2.04+/-0.45 vs -0.30+/-1.17, respectively, P<0.005), suggesting damage of testicular germinal epithelium owing to gonadal irradiation. Serial measurement of testicular volume showed a tendency of growth to stop at 10 ml in those without gonadal shield. Among the 30 patients, only one patient has fathered a child after reaching spontaneous puberty. These results suggest that gonadal shield is effective to protect testicular growth and function, although the attainment of fertility is difficult to achieve.
越来越多长期存活的骨髓移植（BMT）受者已从原发性疾病中康复，但面临内分泌器官功能衰竭的风险。我们调查了30名在儿童期或青春期接受异基因BMT的受者。通过连续测量睾丸体积、基础促黄体生成素（LH）、基础促卵泡生成素（FSH）和睾酮水平以及促性腺激素释放激素（GnRH）激发试验来评估睾丸的生长和功能。所有患者均自发进入青春期。然而，除4名患者外，所有患者的睾酮水平正常但LH升高，提示部分睾丸间质细胞功能障碍。与接受性腺屏蔽照射的患者相比，未接受性腺屏蔽照射的患者在最后一次评估时睾丸体积的标准差得分在统计学上更低（分别为-2.04±0.45和-0.30±1.17，P<0.005），提示性腺照射对睾丸生精上皮造成了损伤。对未接受性腺屏蔽照射的患者连续测量睾丸体积显示，睾丸体积在达到10 ml后有停止生长的趋势。在这30名患者中，只有1名患者在自发进入青春期后生育了孩子。这些结果表明，性腺屏蔽对保护睾丸生长和功能有效，尽管生育难以实现。
