HCG/HMG联合治疗IHH与CCPHD患者的生精相关因素分析  

Spermatogenesis of combined HCG and HMG in patients with idiopathic hypogonadotropic hypogonadism and congenital combined pituitary hormone deficiency

作　　者：王玮杰 邵明玮[1] 陈远思 樊亚亚 连梦青 王姗姗 王小桐 秦贵军[1] Wang Weijie;Shao Mingwei;Chen Yuansi;Fan Yaya;Lian Mengqing;Wang Shanshan;Wang Xiaotong;Qin Guijun(Department of Endocrinology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院内分泌科,450052

出　　处：《中华内分泌代谢杂志》2022年第7期601-607,共7页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的比较人绒毛膜促性腺激素/人绝经后尿促性腺激素(HCG/HMG)联合治疗特发性低促性腺激素性性腺功能减退症(IHH)患者与先天性联合性垂体激素缺乏症(CCPHD)患者的生精疗效, 并探索其生精的相关因素。方法回顾性收集2014年1月至2018年11月就诊的90例IHH患者与61例CCPHD患者的临床资料。比较HCG/HMG联合治疗IHH患者与CCPHD患者的生精疗效。并将患者分为生精组与未生精组, 探索影响IHH患者与CCPHD患者治疗后生精疗效的相关因素。结果 HCG/HMG联合治疗后3个月、6个月、9个月, CCPHD患者睾丸体积小于IHH患者, 差异有统计学意义(P分别为0.004、0.021、0.032)。治疗2年后, 与IHH患者相比, CCPHD患者的睾丸体积增量较大(P<0.001)、生精率较高(P=0.048)、精子初现所需时间较短(P<0.001)。多因素logistic回归分析显示, 总胆固醇(TC)偏低(IHH组:OR=5.508, 95%CI 1.110~27.326, P=0.037;CCPHD组:OR=4.068, 95%CI 1.077~15.371, P=0.039)是IHH与CCPHD患者经HCG/HMG联合治疗后生精疗效较差的独立危险因素。结论 HCG/HMG联合治疗对CCPHD患者的生精疗效优于IHH患者。TC偏低是HCG/HMG联合治疗IHH与CCPHD患者生精疗效较差的独立危险因素。Objective To compare the spermatogenes response of human chorionic gonadotropin(HCG)combined with human menopausal gonadotropin(HMG)in patients with idiopathic hypogonadotropic hypogonadism(IHH)and congenital combined pituitary hormone deficiency(CCPHD),and to explore related factors.Methods Clinical data of 90 IHH patients and 61 CCPHD patients from January,2014 to November,2018 were retrospectively analyzed.Spermatogenesis was compared between the two groups receiving combined gonadotropin therapy.The patients were then divided into two subgroups:spermatogenesis subgroup and nonspermatogenesis subgroup.Related factors of spermatogenesis after the combined gonadotropin therapy were investigated.Results After the combined treatment of HCG/HMG for 3,6,and 9 months,the patients with CCPHD revealed lower testicular sizes than those with IHH(P=0.004,0.021 and 0.032,respectively).Compared with IHH patients,CCPHD patients had larger testicular volume increments(P<0.001),higher spermatogenesis rates(P=0.048),and shorter initial time for sperm appearance(P<0.001)after 24-month treatment.Multivariate logistic regression analysis showed that lower total cholesterol(TC)(IHH group:OR=5.508,95%CI 1.110-27.326,P=0.037;CCPHD group:OR=4.068,95%CI 1.077-15.371,P=0.039)was an independent risk factor of poorer spermatogenesis in patients with IHH and CCPHD.Conclusions The patients with CCPHD demonstrate a better response to combined gonadotropin treatment than those with IHH.Lower TC is an independent risk factor for poor spermatogenesis of combined HCG/HMG therapy in patients with IHH or CCPHD.

关 键 词：低促性腺激素性性腺功能减退症 精子生成 人绒毛膜促性腺激素 人绝经后尿促性腺激素 

分 类 号：R584[医药卫生—内分泌]