[脉冲式促性腺激素释放激素输注与促性腺激素治疗男性特发性低促性腺激素性性腺功能减退的精子发生]

[Spermatogenesis of pulsatile gonadotropin-releasing hormone infusion versus gonadotropin therapy in male idiopathic hypogonadotropic hypogonadism].

作者信息

Huang Bingkun, Mao Jiangfeng, Xu Hongli, Wang Xi, Liu Zhaoxiang, Nie Min, Wu Xueyan

机构信息

Department of Endocrinology/Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences, Beijing 100730, China.

Department of Endocrinology/Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences, Beijing 100730, China; Email:

出版信息

Zhonghua Yi Xue Za Zhi. 2015 May 26;95(20):1568-71.

PMID:26463603

Abstract

OBJECTIVE

To compare the efficacies of pulsatile gonadotropin-releasing hormone (GnRH) versus human chorionic gonadotropin/human menopausal gonadotropin (HCG/HMG) for spermatogenesis in male idiopathic hypogonadotropic hypogonadism (IHH).

METHODS

For this retrospective study, a total of 92 male IHH outpatients from May 2010 to October 2014 were recruited and categorized into GnRH (n = 40) and HCG/HMG (n = 52) groups. Each subject selected one specific therapy voluntarily. The gonadotropin levels were measured in the first week and monthly post-treatment in GnRH group. And serum total testosterone (TT), testicular volume (TV) and rate of spermatogenesis were observed monthly post-treatment in two groups. Spermatogenesis, TT and TV were compared between two groups.

RESULTS

All IHH patients were treated for over 3 months. The median follow-up periods in GnRH and HCG/HMG groups was 8.2 (3.0-18.4) and 9.2 (3.0-18.6) months respectively (P = 0.413). In GnRH group, LH ((0.5 ± 0.6) vs (3.4 ± 2.4) U/L, P < 0.01) and FSH ((1.3 ± 1.1) vs (5.8 ± 3.8) U/L, P < 0.01) increased after 1-week treatment. In GnRH group, at the end of follow-up, TT ((1.0 ± 1.0) vs (7.4 ± 5.2) nmol/L, P < 0.01) and TV ((2.3 ± 1.5) vs (8.1 ± 4.0) ml, P < 0.01) significantly increased compared to baseline. In HCG/HMG group, TT ((0.8 ± 0.6) vs (14.4 ± 8.0) nmol/L, P < 0.01) and TV ((2.3 ± 2.1) vs (7.6 ± 4.2) ml, P < 0.01) significantly increased after therapy. The success rate of spermatogenesis was 50.0% (20/40) in GnRH group versus 28.8% (15/52) in HCG/HMG group (P = 0.038). GnRH group required a shorter treatment time for initial sperm appearance than HCG/HMG group ((6.5 ± 3.1) vs (10.8 ± 3.7) months, P = 0.001).

CONCLUSION

Pulsatile GnRH requires a shorter time for initiation of spermatogenesis than gonadotropin therapy in IHH male patients.

摘要

目的

比较脉冲式促性腺激素释放激素（GnRH）与人绒毛膜促性腺激素/人绝经期促性腺激素（HCG/HMG）对男性特发性低促性腺激素性性腺功能减退症（IHH）患者精子发生的疗效。

方法

本回顾性研究纳入了2010年5月至2014年10月期间共92例男性IHH门诊患者，并将其分为GnRH组（n = 40）和HCG/HMG组（n = 52）。每位受试者自愿选择一种特定治疗方法。GnRH组在治疗第1周及之后每月测量促性腺激素水平。两组在治疗后每月观察血清总睾酮（TT）、睾丸体积（TV）和精子发生率。比较两组之间的精子发生情况、TT和TV。

结果

所有IHH患者均接受了超过3个月的治疗。GnRH组和HCG/HMG组的中位随访期分别为8.2（3.0 - 18.4）个月和9.2（3.0 - 18.6）个月（P = 0.413）。在GnRH组，治疗1周后促黄体生成素（LH）（（0.5 ± 0.6） vs （3.4 ± 2.4）U/L，P < 0.01）和促卵泡生成素（FSH）（（1.3 ± 1.1） vs （5.8 ± 3.8）U/L，P < 0.01）升高。在GnRH组，随访结束时，与基线相比，TT（（1.0 ± 1.0） vs （7.4 ± 5.2）nmol/L，P < 0.01）和TV（（2.3 ± 1.5） vs （8.1 ± 4.0）ml，P < 0.01）显著增加。在HCG/HMG组，治疗后TT（（0.8 ± 0.6） vs （14.4 ± 8.0）nmol/L，P < 0.01）和TV（（2.3 ± 2.1） vs （7.6 ± 4.2）ml，P < 0.01）显著增加。GnRH组精子发生成功率为50.0%（20/40），而HCG/HMG组为28.8%（15/52）（P = 0.038）。GnRH组初始出现精子所需的治疗时间比HCG/HMG组短（（6.5 ± 3.1） vs （10.8 ± 3.7）个月，P = 0.001）。