Holdsworth S, Atkins R C, de Kretser D M
N Engl J Med. 1977 Jun 2;296(22):1245-9. doi: 10.1056/NEJM197706022962201.
We studied the effects of uremia on the pituitary-testicular axis in 35 men with creatinine clearances less than 4 ml per minute per 1.7m(2). We found significant elevation (p less than 0.001) of plasma luteinizing hormone and follicle-stimulating hormone (p less than 0.005) and subnormal levels of testosterone (p less than 0.005). Testicular histology revealed severe spermatogenic damage. Human chorionic gonadotropin produced a subnormal testosterone response. The initial response of plasma luteinizing hormone and follicle-stimulating hormone to luteinizing-hormone-releasing hormone was normal, but their subsequent decline was prolonged. The suppression of plasma luteinizing hormone levels by testosterone propionate was normal, but the nadir occurred late; the elevated plasma luteinizing hormone level was due to reduced metabolic clearnace and increased production. Chronic renal failure interferes with testicular steroid production and spermatogenesis.
我们研究了35名肌酐清除率低于每分钟4毫升/1.7平方米的男性患者中尿毒症对垂体-睾丸轴的影响。我们发现血浆黄体生成素和促卵泡激素显著升高（p<0.001）（p<0.005），睾酮水平低于正常（p<0.005）。睾丸组织学显示严重的生精损害。人绒毛膜促性腺激素产生的睾酮反应低于正常。血浆黄体生成素和促卵泡激素对促黄体生成素释放激素的初始反应正常，但随后的下降延长。丙酸睾酮对血浆黄体生成素水平的抑制正常，但最低点出现较晚；血浆黄体生成素水平升高是由于代谢清除率降低和生成增加。慢性肾功能衰竭会干扰睾丸类固醇生成和精子发生。
