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为了解女性尿毒症患者卵巢功能障碍的发病情况,明确发病部位,探索其发病机理。方法 应用酶免疫法(EIA)检测了25例更年期前尿毒症透析患者的泌乳素(PRL)、促卵泡素(FSH)、促黄体素(LH)、雌二醇(E_2)及孕酮(P)的基础水平,并观察了部分患者服用克罗米酚(CC)及溴隐停后以上激素的变化。结果 与近龄健康妇女相比RPL明显升高,FSH、LH亦升高,而孕酮值显著下降。闭经者服用CC后,血LH、FSH和E_2水平上升,谓之CC试验结果阳性。虽PRL广泛升高,用嗅隐停可使之暂时下降,但效果很不稳定,排卵率亦很低。结论 (1)尿毒症女性普遍的月经无周期和缺乏E_2、LH峰,以及孕酮值低下,证实了存在下丘脑-垂体-卵巢轴损害;(2)尿毒症女性CC刺激试验阳性,说明垂体-卵巢轴是正常的,损伤部位在下丘脑;(3)尿毒症女性PRL显著升高,主要是垂体泌乳细胞分泌增加,溴隐停治疗,效果不稳定;(4)尿毒症女性月经紊乱应给对症处理,但无需促排卵治疗,而成功肾移植是最好的治疗方法。
To understand the incidence of ovarian dysfunction in female patients with uremia, a clear location and explore its pathogenesis. Methods Serum prolactin (PRL), follicle stimulating hormone (LH), progesterone (LH), estradiol (E2) and progesterone (P) in 25 patients with premenopausal uremia were measured by enzyme immunoassay (EIA) Basal level, and observed in some patients taking clomiphene citrate (CC) and bromocristine above the hormone changes. Results Compared with healthy women in recent years, RPL was significantly higher, FSH, LH also increased, while the progesterone value decreased significantly. Amenorrhea after taking CC, blood LH, FSH and E 2 levels, that the CC test results were positive. Although PRL is widely increased, with sniffing can make a temporary decline, but the effect is very unstable, ovulation rate is also very low. Conclusions (1) Uremic women generally have no menstrual period, lack of E_2, LH peak and low progesterone value, which confirms the hypothalamus-pituitary-ovarian axis damage. (2) The positive CC test in uremic women indicates that pituitary - the ovarian axis is normal, the lesion in the hypothalamus; (3) uremic female PRL was significantly increased, mainly pituitary lactation cells increased secretion of bromocriptine treatment, the effect is unstable; (4) uremic menstrual disorders should give Symptomatic treatment, but without ovulation induction therapy, and successful kidney transplantation is the best treatment.