Hovi L, Tapanainen P, Saarinen-Pihkala U M, Siimes M A
Children's Hospital, University of Helsinki, Finland.
Bone Marrow Transplant. 1997 Oct;20(7):561-5. doi: 10.1038/sj.bmt.1700927.
Pubertal development and androgen production were evaluated 1-10 years after bone marrow transplantation (BMT) in 15 females aged 14-23 (mean 17) years. Before BMT, these patients had received combination chemotherapy for hematologic malignancy, and all had had a transplant program including total body irradiation (TBI). Of the nine patients who were pre-menarcheal at BMT, two had subsequently experienced spontaneous menarche at 11.5 and 13.3 years of age. Six were post-menarcheal, but became amenorrheic after BMT. Menstruation subsequently started spontaneously in one of them 6 years after BMT. At the time of the study, three patients were early to mid-pubertal and 12 late pubertal or post-pubertal. Twelve patients were receiving sex steroid substitution therapy. Serum concentrations of testosterone, androstenedione, dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS) were determined. Androgen levels of late pubertal and post-pubertal transplanted patients were compared with 19 post-menarcheal patients aged 14-21 (mean 17) years who had been treated for hematologic malignancy with conventional chemotherapy. Testosterone levels of 52 healthy post-menarcheal females aged 14-29 (mean 19) years were measured as controls. Androgen levels of the BMT patients were lower than those of the conventionally treated patients. Differences in testosterone, androstenedione and DHEA levels were significant. Three spontaneously menstruating BMT patients had normal androgen levels. Testosterone levels of the conventionally treated patients and healthy controls were similar. Subnormal androgen production might be one factor behind the problems in pubertal development and sex life experienced by females after BMT. The use of these hormone levels for follow-up purposes and the potential value of androgen replacement therapy in females after TBI merit further study.
对15名年龄在14 - 23岁（平均17岁）的女性进行了研究，评估她们在骨髓移植（BMT）后1 - 10年的青春期发育和雄激素生成情况。在进行BMT之前，这些患者因血液系统恶性肿瘤接受了联合化疗，并且所有人都接受了包括全身照射（TBI）在内的移植方案。在BMT时处于月经初潮前的9名患者中，有2名随后分别在11.5岁和13.3岁时自然月经初潮。6名患者在BMT前已月经初潮，但在BMT后闭经。其中1名患者在BMT后6年月经又自然恢复。在研究时，3名患者处于青春期早期至中期，12名处于青春期晚期或青春期后。12名患者正在接受性类固醇替代治疗。测定了血清睾酮、雄烯二酮、脱氢表雄酮（DHEA）和硫酸脱氢表雄酮（DHEAS）的浓度。将青春期晚期和青春期后接受移植患者的雄激素水平与19名年龄在14 - 21岁（平均17岁）、因血液系统恶性肿瘤接受传统化疗的月经初潮后患者进行比较。测量了52名年龄在14 - 29岁（平均19岁）健康月经初潮后女性的睾酮水平作为对照。BMT患者的雄激素水平低于传统治疗患者。睾酮、雄烯二酮和DHEA水平的差异具有显著性。3名自然月经恢复的BMT患者雄激素水平正常。传统治疗患者和健康对照的睾酮水平相似。雄激素生成不足可能是BMT后女性青春期发育和性生活问题的一个原因。利用这些激素水平进行随访以及TBI后女性雄激素替代治疗的潜在价值值得进一步研究。
