高促性腺激素继发闭经的临床研究  

HypergonadotropicSecondaryAmenorhea:ClinicalAnalysisof126Cases

作　　者：林金芳[1] 于传鑫[1] 

机构地区：[1]上海医科大学妇产科医院

出　　处：《中华妇产科杂志》1996年第5期278-282,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的：探讨高促性腺激素继发闭经的病因，早期诊断和治疗措施。方法：对１２６例高促卵泡激素（ＦＳＨ≥４０ＩＵ／Ｌ）继发闭经患者的临床资料进行分析。结果：６例有卵巢破坏的物理因素，１２０例无明显诱因。１８例≤２５岁发病者中，１６例（８８．９％）为单侧或双侧性腺发育不全，２例（１１．１％）为无反应卵巢，８例（４４．４％）核型异常，１３例（７２．２％）性征发育不全；１０２例＞２５岁发病者中，６８例行卵巢形态和组织学检查，卵巢为萎缩型，其中２１例（３０．９％）一侧性腺发育不全，１例核型异常，无性征发育不全，８２例（８０．４％）有烘热症状；闭经前的月经紊乱期血ＦＳＨ正常或升高＞１０ＩＵ／Ｌ，用克罗米酚后的ＦＳＨ药物峰一致升高＞２０ＩＵ／Ｌ。１０２例不孕症患者采用雌激素治疗的排卵率和妊娠率，闭经＜１年者明显高于闭经＞１年者（Ｐ＜０．０１，Ｐ＜０．０２５）。结论：高促性腺激素继发闭经患者中，＜２５岁发病者性腺发育不全为主要病因，＞２５岁发病者病因尚不能确定。烘热症状为早期征象，克罗米酚功能试验可用于卵巢功能衰退的早期诊断；早期雌激素治疗有助于挽救生育机能。Objective:Tostudytheetiologyandearlydiagnosisofhypergonadotropicamenorrheaandtoexploretheappropriatetreatmentforpreservingtheirreproductivefunction.Methods:126casesofsecondaryamenorrheawithserumfolicularstimulatinghormone(FSH)levels≥40IU/Lwereana-lysed.Theirclinicalmanifestations,karyotypes,ovarianmorphologyandhistology,repro-ductivehormoneassays,andresponsestoestrogentherapyandovulationinductionwerestudied.Re-sults:6casespresentedwithhistoriesofovariansurgery,radiotherapyorchemotherapy.Amongtheother120cases,18manifestedamenorheabeforeorat25yearsofage,102developedamenorrheaafterage25.Intheformergroup,16(88.9%)showedunilateralorbilateralgonadaldysgenesis,andtheother2(11.1%)weredefinedasresistantovaries.Abnormalitiesofsexchromosomekary-otypeoccuredin44.4%(8/18).Inthelatergroup,68underwentlaparotomyorlaparoscopyexam-ination.Morphologicalandhistologicalexaminationsofbothovariesshowedatrophicovariesinalcasesacompaniedby30.9%(21/68)unilateralgonadaldysgenesis;sexchromosomalabnormalitywasfoundinonlyonewithnosexualimmaturation.Theeficacyofestrogentreatmentwassignifi-cantlybeteramongcaseswithamenorhealessthan1yearascomparedwiththoselongerthan1year.Clomiphenechalengetestgivento8casesduringtheirirregularmenstrualstagesproducedanelevationofFSHlevelsto>20IU/Lwithoutanyresponseofestradiolsecretion.Conclusions:Theearlierestrogentherapyisinitiated,thegreaterpossibilityofpregnancywilbeachievedincasessuf-feringfromhypergonadotropicamenorrhea.Theclomiphenechalengetestmayprovideevidenceofwaningovarianfunctionforearlydiagnosis.

关 键 词：促性腺素炎 闭经 氯米芬 药物疗法 激素疗法 

分 类 号：R711.510.5[医药卫生—妇产科学]