继发性高促性腺激素闭经的病因与临床表现的异质性——附245例病历分析

Heterogeneity of clinical feature and etiology of secondary hypergonadotropic amenorrhea with clinical analysis of 245 cases

目的探讨继发性高促性腺激素闭经(SHA)的病因与表现的异质性(多样性)以及治疗对策。方法回顾性分析245例SHA病历,电话或通信随访到71例,描述其病史、症状、体格检查、实验室、影像学、腹腔镜及骨密度检查指标、治疗和随诊情况。结果病因可能涉及遗传、免疫、手术、放疗、化疗、免疫抑制治疗等医源性因素以及受感染、环境和心理等影响。闭经之前月经形式多种多样,闭经之后7例患者一度恢复自然月经,甚至妊娠。72.7%的患者呈低骨量。结论SHA从病因、病程到临床表现都有明显的多样性,对SHA不要放弃促生育的努力,还应关注其低骨量等健康问题。

Objective： To investigate the heterogeneity of clinical feature and etiology in patients with secondary hypergonadotropic amenorrhea （SHA） . Methods： 245 cases of SHA were retrospectively analyzed and 71 cases have been followed by phone or letter to describe the history, symptoms, medical examination, laboratory and imaging examination, laparoscopy, bone mineral density, treatment and follow- up. Results： The etiological factors involved hereditary, immunologic, iatrogenic （including operation, chemotherapy, radiotherapy, immunosuppressive therapy）, infection, toxicant and psychological factors. The type of menstruation before amenorrhea was multiform. Seven cases have resumed menstruation for some time, even pregnancy after the diagnosis of SHA. About 72.7% of patients with SHA have low bone density. Conclusion： The obvious diversity of SHA is observed in etiology, course and clinical manifestation. It is possible for the patients with SHA to get pregnancy. The low bone density and other health problems of SHA patients should be paid attention to.