GnRH脉冲治疗男性先天性低促性腺激素性性腺功能减退症的有效性和安全性分析  

Effect and safety of pulsatile GnRH therapy for male congenital hypogonadotropic hypogonadism

作　　者：牛永华 徐浩[2] 陈胤伟 蓝儒竹[2] 王涛[2] 王少刚[2] 刘继红[2] NIU Yong-hua;XU Hao;CHEN Yin-wei;LAN Ru-zhu;WANG Tao;WANG SHAO-gang;LIU Ji-hong(Department of Pediatric Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China;Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China;Center of Reproductive Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院泌尿外科,湖北武汉430030 [3]华中科技大学同济医学院附属同济医院生殖医学中心,湖北武汉430030

出　　处：《中华男科学杂志》2024年第5期404-409,共6页National Journal of Andrology

基　　金：国家自然科学基金(82201758)。

摘　　要：目的:探究GnRH脉冲治疗男性先天性低促性腺激素性性腺功能减退症(CHH)的有效性和安全性。方法:回顾性分析了2013年1月至2023年3月在我中心应用GnRH脉冲治疗的45例男性CHH患者。治疗方法:戈那瑞林7~15μg,脉冲/90 min。患者前3个月,每个月随访1次,之后每3~6个月随访1次。每次随访记录身高、体重、Tanner分期、阴茎长度及睾丸体积,测量卵泡刺激素(FSH)、黄体生成素(LH)及睾酮(T),并记录不良反应。按照WHO第5版的标准进行精液常规分析。结果:45例患者随访时间(19.1±4.3)个月,治疗后FSH、LH、T相比治疗前均明显提高。6例隐睾患者在整个随访期间(18.2±8.6)个月内,睾酮水平均未达到正常。治疗后,所有患者的生殖器官和第二性征均得以改善。73.3%(33/45)的患者精液中出现精子,精子浓度为(18.2±6.2)×10~6/ml,前向运动精子百分率为(19.7±6.5)%,精液量为(1.8±0.6)ml。目前,有8例患者自然生育,3例患者通过辅助生殖技术生育。8例患者出现轻至中度乳房发育,6例患者出现注射部位皮下硬结,3例患者出现过敏反应,表现为全身红疹或局部荨麻疹,未出现其他不良反应。结论:GnRH脉冲治疗是治疗男性CHH有效且安全的方法,但在实际诊疗过程中,应根据患者的实际情况选择恰当的治疗方法。Objective:To investigate the efficiency and safety of the pulsatile GnRH therapy in the treatment of male congenital hypogonadotropic hypogonadism(CHH).Methods:We retrospectively analyzed the clinical data on 45 CHH males treated by pulsatile GnRH therapy in our hospital from January 2013 to March 2023.We treated the patients with gonadorelin at 7-15μg,one pulse/90 min,and followed them up every month in the first 3 months and then every 3 to 6 months after treatment,for an average of 19.1±4.3 months,during which we recorded the height,body weight,penile length,testis volume,Tanner stages,levels of FSH,LH and T,semen parameters and adverse reactions of the patients,followed by comparison of the data obtained with the baseline.Results:The levels of FSH,LH and T of the patients were dramatically elevated after treatment(P<0.01).The T level of the6 cases of cryptorchidism,however,failed to reach the normal value within 18.2±8.6 months of follow-up.Significant improvement was seen in the external genitalia and secondary sexual characteristics of all the patients,and spermatogenesis was observed in the semen in 33 cases(73.3%),with a mean sperm concentration of(18.2±6.2)106/ml,sperm progressive motility of(19.7±6.5)%,and semen volume of(1.8±0.6)ml.Eight of the cases achieved natural fertility,and another 3 achieved childbirth by assisted reproductive technology.As for adverse events,gynecomastia was observed in 8,subcutaneous induration in 6,and allergic reaction to therapeutic agent in 3 cases.Conclusion:Pulsatile GnRH therapy is an effective and safe strategy for male CHH.However,clinicians should choose appropriate approaches to different individual cases.

关 键 词：GnRH脉冲治疗 先天性低促性腺激素性性腺功能减退症 精子发生 

分 类 号：R453[医药卫生—治疗学]