Szilágyi A, Hole R, Keckstein J, Rossmanith W G
Department of Obstetrics and Gynecology, University of Pécs, Hungary.
Gynecol Endocrinol. 1993 Sep;7(3):159-66. doi: 10.3109/09513599309152497.
Ovarian surgery has been demonstrated as an effective means to establish regular menstrual cycles and resumption of ovulation in patients with polycystic ovarian disease (PCO). We questioned whether such reinstitution of menstrual cyclicity may be associated with changes in the opioidergic and dopaminergic activity known to be aberrant in these women. Opioidergic and dopaminergic tone was therefore assessed in patients with PCO before and after ovarian laser vaporization (n = 4) or classical ovarian wedge resection (n = 4). Blood samples for the determination of luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin were frequently obtained following opioidergic and/or dopaminergic antagonism affected by naloxone (4 mg i.v.) or metoclopramide (10 mg i.v.). In response to either surgical approach, circulating LH levels decreased (p < 0.01), while FSH concentrations remained unaltered. Further, LH and FSH concentrations did not noticeably change following challenges with naloxone or metoclopramide: this applied to conditions before and after ovarian surgery. Prolactin release in response to metoclopramide was markedly (p < 0.01) higher following ovarian surgery than before. Thus, both ovarian laser surgery and classical wedge resection can effectively restore normal menstrual cyclicity in PCO patients, although they failed to alter opioidergic and dopaminergic activity. Dopaminergic inhibition of prolactin secretion was further enhanced after ovarian surgery. These observations suggest that different modes of ovarian surgery are effective in influencing central gonadal control, but that the central opioidergic and dopaminergic control of gonadotropin and prolactin secretion remains unaffected by ovarian surgery in PCO women, even when menstrual cyclicity is resumed.
卵巢手术已被证明是使多囊卵巢疾病（PCO）患者建立规律月经周期并恢复排卵的有效手段。我们质疑这种月经周期的恢复是否可能与这些女性已知异常的阿片能和多巴胺能活性变化有关。因此，我们对4例接受卵巢激光汽化术和4例接受经典卵巢楔形切除术的PCO患者在手术前后的阿片能和多巴胺能张力进行了评估。在静脉注射纳洛酮（4毫克）或甲氧氯普胺（10毫克）产生阿片能和/或多巴胺能拮抗作用后，频繁采集血样以测定黄体生成素（LH）、卵泡刺激素（FSH）和催乳素。无论采用哪种手术方式，循环中的LH水平均下降（p<0.01），而FSH浓度保持不变。此外，在使用纳洛酮或甲氧氯普胺激发后，LH和FSH浓度没有明显变化：这适用于卵巢手术前后的情况。卵巢手术后，甲氧氯普胺刺激引起的催乳素释放明显高于术前（p<0.01）。因此，卵巢激光手术和经典楔形切除术都能有效恢复PCO患者的正常月经周期，尽管它们未能改变阿片能和多巴胺能活性。卵巢手术后，多巴胺对催乳素分泌的抑制作用进一步增强。这些观察结果表明，不同的卵巢手术方式对影响中枢性腺控制有效，但即使恢复了月经周期，PCO女性的卵巢手术对促性腺激素和催乳素分泌的中枢阿片能和多巴胺能控制仍无影响。
