女性患者肾移植前后性相关激素、微量元素以及生育能力的研究

Study on sexual hormones, trace elements and fertility in female recipients of hemodialysis and renal transplantation

目的探讨女性尿毒症患者在血液透析期间及肾移植术后性相关激素、微量元素和生育能力的变化。方法收集43例应有正常月经周期年龄段(18～45岁)的尿毒症患者血液透析期间及肾移植术后性相关激素、微量元素的资料,并调查肾移植前后的月经、性生活以及生育情况。另选20名健康女性作为对照。结果43例中,血液透析期间仅有4例月经规则,28例月经紊乱,11例停经;血清黄体生成激素(LH)、卵泡刺激素(FSH)、催乳激素(PRL)及雌二醇(E2)显著升高(P<0.01),孕酮显著降低(P<0.01),血清锌、镁及钙离子水平显著降低(P<0.05);肾移植后,随着肾功能的正常,升高的LH、FSH、PRL及E2开始下降(P<0.01),孕酮回升(P<0.01),至术后13个月以后,上述激素均恢复到正常范围,血清锌、镁及钙离子水平回升,但除了钙离子外,血清锌、镁离子的含量仍然低于正常值(P<0.05);术后有8例妊娠,6例在妊娠5～11周时终止,2例在妊娠至37周、35周时行剖腹产终止妊娠。结论血液透析不能明显改善尿毒症患者性相关激素、微量元素和生育能力的异常,而肾移植多能改善,尤其是在恢复月经周期和生育能力方面有显著的效果。

Objective To investigate the changes of sexual hormones, trace elements and fertility in female uremia patients and their relations during hemodialysis or after renal transplantation.Methods Data of 43 cases of uremia during hemodialysis or after renal transplantation from March 1999 to December 2002 were retrospectively analyzed. The conditions of menses, sexuality and fertility before and after renal transplantation were also studied. Twenty healthy women served as controls. Results During the hemodialysis, 4 patients had regular menstrual cycle, 28 irregular menstrual cycle, and 11 menolipsis. Some sexual hormones, such as LH, FSH, PRL and E_2 were significantly increased (P<~0.01 ), while P was significantly decreased (P<~0.01 ) and serum Zn, Mg and Ca were significantly decreased (P<~0.05 ). After transplantation, with the normalization of the renal function, the increased sexual hormones restored to normal until 13 months post-transplantation. Ca was in normal level after operation. Eight patients had the pregnancy. Six of them stopped the pregnancy during the 5-11 gestational weeks. Two patients had their babies in 37 weeks and 35 weeks respectively.Conclusion Hemodialysis can’t ameliorate the condition of sexual hormones, trace elements and fertility of uremia patients. But renal transplantation can do it, especially in the menstrual cycle and fertility.