左炔诺孕酮(LNG)配伍十一酸睾酮(TU)对精子生成抑制差异的研究

Individual Difference Study on LNG Implant Plus TU Injection for Suppression of Spermatogenesis

目的:探讨左炔诺孕酮(LNG)埋植剂和十一酸睾酮(TU)针剂配伍应用对男性精子生成抑制作用所产生明显个体差异的原因。方法:征集自愿对象16名,前臂埋植两根型皮下埋植剂,每根含LNG 75mg,并于3周后每月肌注针剂TU 250mg,共3次。根据精子密度不同将完成研究的16位男性志愿者分为两组,反应组(简称R组)7人,无反应组(简称N组)9人。比较两组间的血清FSH、LH、T和LNG水平的变化趋势及差异。结果:皮埋后,R组的FSH水平显著低于N组,但其LH水平高于N组(P<0.05);两组间血清T水平无显著性差异(P>0.05);R组的血清LNG水平高于N组(P<0.05);R组的血清T/LH比值显著低于N组(P<0.05)。结论:在应用LNG埋植剂配伍TU过程中,体内血药浓度(LNG和T)的高低,促性激素FSH的抑制程度,精子生成的潜在能力以及Leydig细胞的功能状态是抑制精子生成差异的重要原因,也可能是影响男性激素避孕方法有效性的一个重要因素。

Objective: To research the cause resulting in significant difference from LNG implant plus TU in-jection for suppression of spermatogenesis. Methods: There were 16 Chinese male volunteers were operated two pieces of 75mg contraception implant on the forearm and were injected 25mg TU one time every month after the third week divided into 2 groups according to sperm density, 7 men in Respondent Group ( R Group) and 9 men in Nonrespondent Group (N Group). The differences and change of serum FSH, LH, T and LNG were studied between the two groups. Results: Serum levels of FSH in R Group were significantly lower than those in N Group ( P < 0. 05) ; Serum levels of LH in R Group were slightly higher than those in N Group (P < 0. 05). There was no significant difference in serum T between two groups. Serum levels of LNG in R Group were higher than those in N Group (P < 0. 05 ) and values of T/LH ratio in N Group were higher than those in R Group during treatment (P < 0. 05 ). Conclusion: The balance of LNG and T, the in-hibitive degree of FSH secretion, as well as individual spermatogenetic potential and the condition of Leydig cells are the important reasons, as caused individual differences form suppression of spermatogenesis and may be also the main factors influencing the efficacy of hormonal male contraception.