造血干细胞移植对卵巢功能的影响45例分析

The study on ovarian function in reproductive age woman after haematopoietic stem cell transplantation for haematological malignancies

目的探讨造血干细胞移植对卵巢功能的影响。方法观察2002年10月至2003年10月间在昆明陆军总医院,昆明医学院附属第一、二医院以及云南省肿瘤医院中45例因急性非淋巴细胞白血病分别接受同种异体造血干细胞移植(Allo-SCT)和自体造血干细胞移植(Auto-SCT)患者的月经恢复情况和性激素变化以及卵巢的形态学改变,同时抽取45例同年龄段健康妇女作为对照。结果Allo-SCT中有2例月经恢复,Auto-SCT中有4例恢复,移植时年龄越小,卵巢功能越易恢复。Allo-SCT和Auto-SCT后促性腺激素较对照组显著升高,而雌激素显著降低,Allo-SCT的雄激素也显著降低。此外,移植组的子宫和卵巢体积均小于正常对照组(P<0.01),而Allo-SCT组的子宫和卵巢体积则更小。结论造血干细胞移植后引起的卵巢功能降低主要是因为移植前化疗对卵巢的损害,但Allo-SCT引起的免疫调节障碍可进一步使卵巢功能减退。

Objective To study the influence on the ovarian function and the positive predictor of cycle recovery. Methods The positive predictors of menstrual cycles recovery , the alteration of hormone and the ovarian morphology were studied in reproductive age woman after Allo - SCT（ n = 22） or Auto - SCT（ n = 23 ）, and compared with hormone of 45 normal reproductive age woman. Results Menstrual cycles recovered in two and four women in the Allo - SCT and Auto - SCT groups respectively, being associated with younger age. Significantly higher gonadotrophin levels and lower estradM were seen in the patients than in controls. In Allo - transplanted women, androgens were also significantly lower than in controls. Ovarian and uterine volumes were lower in patients than in controls, and in the Allo - than in the Auto - transplanted women. Within the Allo - Sct group, endocrine function and ovarian and uterine volumes were significantly lower in the patients suffering from cGVHD. Conclusion Ovarian failure in SCT recipients is likely to be caused principally by myelo - ablative treatments, but the ovarian function can be worsened by an altered immunomodulation in Allo - SCT.