Blumenfeld Z, Amit T
Department of Obstetrics and Gynecology, Rambam Medical Center, Technion-Isreal Institute of Technology, Haifa.
Ann Med. 1994 Aug;26(4):249-54. doi: 10.3109/07853899409147899.
During the last few years the potential importance of intraovarian regulators of follicular development has been recognized, and the effects of various growth factors on granulosa cell responses to gonadotrophins have been extensively investigated. Ovarian responses to exogenous gonadotrophins were improved by adjuvant growth hormone (GH) treatment of GH-deficient patients, and responses to hMG were apparently predicted by estimated GH reserve. However, the results of different studies of GH/hMG cotreatment were equivocal. Therefore, a randomized, prospective, cross-over study protocol between GH/hMG/hCG versus hMG/hCG was undertaken. Whereas 16 pregnancies were achieved in the 26 Clonidine-negative patients (61.5%) either in the GH/hMG cycle (11) or in the succeeding one (5), no benefit was detected in 8 Clonidine-positive patients from the GH/hMG combination. The recently described GH-binding protein (BP) may reflect the GH-receptor. GH-BP levels were evaluated in the sera and follicular fluids (FF) of patients undergoing ovulation induction with either hMG/hCG or GH/hMG/hCG. GH-BP increase in serum correlated with E2, and progesterone (P4) concentrations. The FF GH-BP correlated with serum GH-BP levels. Lower FF GH-BP levels were measured in older compared to younger women, while increased values were obtained both in patients with elevated E2 concentrations in serum and in FF, or when more than five oocytes were retrieved. Primary increased GH-BP in unexplained infertility may suggest a new mechanism whereby excessive GH-BP levels may deprive GH from its receptor and thus decrease the introavarian IGF-I production.(ABSTRACT TRUNCATED AT 250 WORDS)
在过去几年中，卵巢内卵泡发育调节因子的潜在重要性已得到认可，并且对各种生长因子对颗粒细胞对促性腺激素反应的影响进行了广泛研究。生长激素（GH）缺乏患者接受辅助生长激素治疗可改善卵巢对外源性促性腺激素的反应，而对人绝经期促性腺激素（hMG）的反应显然可通过估计的生长激素储备来预测。然而，不同的生长激素/人绝经期促性腺激素联合治疗研究结果并不明确。因此，开展了一项生长激素/人绝经期促性腺激素/人绒毛膜促性腺激素（hCG）与 人绝经期促性腺激素/人绒毛膜促性腺激素之间的随机、前瞻性、交叉研究方案。在 26 例可乐定阴性患者中，16 例（61.5%）在生长激素/人绝经期促性腺激素周期（11 例）或随后的周期（5 例）中成功妊娠，而 8 例可乐定阳性患者未从生长激素/人绝经期促性腺激素联合治疗中获益。最近描述的生长激素结合蛋白（BP）可能反映生长激素受体。对接受人绝经期促性腺激素/人绒毛膜促性腺激素或生长激素/人绝经期促性腺激素/人绒毛膜促性腺激素促排卵的患者的血清和卵泡液（FF）中的生长激素结合蛋白水平进行了评估。血清中生长激素结合蛋白的增加与雌二醇（E2）和孕酮（P4）浓度相关。卵泡液生长激素结合蛋白与血清生长激素结合蛋白水平相关。与年轻女性相比，老年女性的卵泡液生长激素结合蛋白水平较低，而血清和卵泡液中雌二醇浓度升高的患者或回收超过 5 个卵母细胞的患者，其生长激素结合蛋白水平升高。不明原因不孕症患者生长激素结合蛋白原发性升高可能提示一种新机制，即过高的生长激素结合蛋白水平可能使生长激素与其受体分离，从而降低卵巢内胰岛素样生长因子-I 的产生。（摘要截短于 250 字）
