抗苗氏管激素与生长激素缺乏伴低促性腺激素睾丸发育不良症的关系  

Relationship of anti-Müllerian hormone with growth hormone deficiency and hypogonadotropic hypogonadism

作　　者：王伟[1] 王德芬[1] 倪继红[1] 崔贻芬[1] 奚容平[1] 付红梅[1] 王秀民[1] 

机构地区：[1]上海第二医科大学附属瑞金医院儿内科,200025

出　　处：《中华内分泌代谢杂志》2002年第1期39-41,共3页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的　探讨雄激素对抗苗氏管激素 (AMH)的作用机制及血清AMH的临床检测意义。方法　正常青春发育各期男童 48例 ,其中选取 10例为对照组 ;10例原发性生长激素缺乏伴低促性腺激素睾丸发育不良男童患者均单独给予重组人生长激素 (rhGH)治疗一年 ,第二年rhGH联合性激素 (HCG或长效庚酸睾酮 ) ,总疗程二年。于治前及治疗后采血检测AMH、睾酮、FSH及LH。结果(1)正常儿童在青春发育前血清AMH水平较高 ,进入青春发育后AMH渐趋下降 ,至TannerG4～ 5期最低 ;与血睾酮呈负相关。 (2 )患者组在治前血清AMH为 (318.0± 34 .7) pmol/L ,明显高于正常对照组 (4 1.6± 6 .7) pmol/L(P <0 .0 0 1)。患者经第一年单纯GH治疗后 ,血清AMH明显下降 (195 .4± 6 1.2 ) pmol/L ,第二年采用 (rhGH)联合性激素治疗 ,血清AMH进一步下降 ,而血清睾酮值则逐步增高。结论　 (1)正常男童进入青春发育后血清AMH呈递减趋势 ,血睾酮逐步升高 ,两者呈负相关 ;(2 )生长激素缺乏伴低促性腺激素睾丸发育不良患者血清AMH持续高值 ,经GH及GH联合性激素治疗后血清AMH水平随血睾酮升高而下降 ;(3)临床检测血清AMH有助于全面评估男性睾丸的发育及其功能状况。Objective To explore the effect of androgen on antimüllerian hormone (AMH) and to evaluate clinical significance of AMH assay. Methods Ten boys aged 12～20 years old with primary growth hormone deficiency (GHD) and hypogonadotropic hypogonadism (patient group) and 48 healthy adolescent boys in various Tanner stages from G 1～G 4～5 (control group) were assayed for serum AMH, testosterone. All patients received recombinant human GH (0.1 U·kg -1·d -1) for 2 years with combined human chorionic gonadotrophin (1000 U b.i.w) or testosterone enanthate (50～100 mg/month) treatment during the second year. Blood samples were collected at the start and then every 6 months. Results (1) In control group, serum AMH level was highest before puberty and declined subsequently as pubertal stage advanced, and the lowest level occurred at stage G 4～5, and serum AMH level was negatively correlated with the testosterone level. (2) The serum AMH of patient group was (318.0±34.7)pmol/L before treatment, significantly higher than the controls 〔(41.6±6.7)pmol/L (P<0.001)〕. After the first year of GH therapy, serum AMH declined to (195.4±61.2)pmol/L (P<0.01). A further decrease in serum AMH levels was observed at the end of the 2nd year after combined treatment for 1 year (P<0.001). Serum testosterone level was elevated in contrast to the decreased AMH concentration. Conclusion (1) Serum AMH level shows a negative correlation with serum testosterone concentration in healthy adolescent boys. (2) Serum AMH level in GHD patients with hypogonadotropic hypogonadism shows higher value, and declines with the treatment of GH and sex hormone, with concomitant elevation of serum testosterone level. (3) Serum AMH assay may provide an additional information of testicular functions.

关 键 词：抗苗勒管激素 性腺功能减退症 绒毛膜促性腺素类 睾酮 睾丸发育不良症 

分 类 号：R725.8[医药卫生—儿科]