育龄女性应用促性腺激素释放激素类似物与促性腺激素释放激素激发试验的对比研究

Gonadotropin-releasing hormone analogue versus gonadotropin-releasing hormone in stimulation test among women of child-bearing age

目的探讨皮下注射促性腺激素释放激素类似物（GnRHa）激发试验与传统的静脉推注促性腺激素释放激素（GnRH）激发试验对育龄女性下丘脑一垂体一性腺轴功能的评价是否具有一致性。方法以2010年5月至7月在新疆自治区人民医院进行健康体检的20名20—30岁女性为研究对象，采用配对设计对20名女性先后进行GnRH和GnRHa激发试验，两试验均在用药前及用药后120min之内的7个时间点采血留取标本，应用化学发光法测定黄体生成素（LH）和卵泡刺激素（FSH）。对检测结果进行比较和分析。结果在GnRH和GnRHa激发试验中，7个时间点之间LH的差异均有统计学意义（U=154．0，P〈0．01），FSH的差异也均有统计学意义（U=5．598，P〈0．01）。两激发试验得到的相应的7个时点的LH进行比较后可以发现，仅在90min（P=0．037）及120min（P=0．013）两个时间点差异有统计学意义；FSH仅在120min时差异有统计学意义（P=0．017）。结论在育龄女性，GnRHa对LH的影响在0—60min与GnRH一致，对FSH的影响在0-90min与GnRH一致。因此，在一定程度上可以替代GnRH用于激发试验，并且可以简化为60min一次采血激发试验来对受试者下丘脑一垂体一性腺轴功能进行评价。

Objective To explore the potential consistency in evaluation of hypothalamus-pituitary-gonadal axis function among women of child-bearing age with stimulation test using subcutaneous gonadotropin-releasing hormone analogue （GnRHa） versus traditional intravenous GnRH. Methods Between May 2010 and July 2010, 20 females aged 20 - 30 undergoing routine checkup in Xinjiang People＇s Hospital were recruited and subjected to GnRH stimulation test first and then GnRHa stimulation test by matched pair design. Blood samples were collected from each patient at 7 time spots before and within 120 rain after drug use. Chemiluminescence （CLIA） was used to determine the levels of luteinizing hormone （LH） and follicle-stimulating hormone （FSH）. Results The level of LH varied significantly across 7 designated time spots in either GnRH or GnRHa stimulation test （ U = 154. 0, P 〈 0. 01 ）, so did the level of FSH （ U = 5. 598, P 〈 0. 01 ）. Comparison of values at 7 time spots between two stimulation tests demonstrated that LH levels showed remarkable differences only at 90 min （ P = 0. 037 ） and 120 min （P =0. 013 ）, while FSH levels only at 120 rain （P = 0. 017 ）. Conclusion Among women of child-beating age, GnRHa may show GnRH-consistent effects on LH level from 0 min to 60 mins and on FSH level from 0 min to 90 min, and therefore can be used as an alternative to GnRH in stimulation test within a certain range of time. Moreover, the stimulation test for evaluating the function of hypothalamus-pituitary-gonadal axis using GnRHa may be simplified by a one-stop blood collection at 60 min.