女性尿毒症患者血液透析前后月经变化及其临床意义探讨

Menstruation changes of female uremia patients before and after dialysis and clinical significance

目的 探讨女性尿毒症患者透析前后月经变化情况及其临床意义.方法 把本透析中心47例女性患者按照规律血液透析前后月经变化情况进行分组：A组行规律血液透析前已闭经29例,B组行规律血液透析后闭经13例,C组行规律血液透析后仍有月经3例,D组行规律血液透析前已闭经、平均透析（9.7＆#177;1.4）个月后月经复潮2例,分析各组所致原因;应用酶免疫法（EIA）测定18例育龄期女性尿毒症患者及20例适龄健康女性中促卵泡生成素（FSH）、泌乳素（PRL）、促黄体素（LH）、雌二醇（E2）及孕酮（P）水平.结果 4组女性尿毒症患者月经变化情况原因各不相同：A组原因考虑服用雷公藤之际时间长及就医不及时等原因所致;B组原因考虑自然绝经及血液透析治疗不能改善卵巢功能障碍,月经难以复潮所致;C组原因考虑患者为年轻女性,病史短,透析开始时机及时所致;D组原因考虑口服雷公藤致性腺抑制,后因病情需要,及时停服雷公藤,改为血透治疗,雷公藤服药时间短所致.而18例育龄期女性尿毒症患者的PRL、FSH、LH均较健康对照组升高,孕酮值则显著降低.结论 血液透析不能改善女性尿毒症患者的卵巢功能障碍,临床上应根据患者不同月经变化情况进行不同指导.

Objective To investigate the changes of menses in female uremia patients before and after dialysis. To analyze the clinical significance. Methods The 47 female uremia patients were grouped according to the situation oi menstruation changes he[ore and alter dialysis. Because there were four cases, so we divided into four groups. Group A 29 cases were amenorrhea before treated with regular dialysis. Group B 13 cases were amenorrhea after treated with regular dialysis. Group C 3 cases were menstruation after treated regular dialysis. Group D 2 cases were amenorrhea after treated with regular dialysis. But after average dialysis（9. 7 ＋ 1.4）months they were menstruation again. To analysis the reasons. Blood from 18 cases female dialysed patients with uremia and 20 normal controls were tested {or sex hormones（FSH,PRL,LH,E2 and P）. Results The reasons of menstruation chan- ges in four group are different. Group A reasons to consider taking lei gong teng a long time and had the medical treatment not timely. Group B reasons to consider natural menopause and the dialysis ther- apy can＇t improve ovarian dysfunction. The female patient can＇t have menstruation again. Group C rea- sons to consider the patients were young women,had the short treatment history and had the medical treatment timely. Group D reasons to consider the patients took lei gong teng shortly , due to the ill- ness needed , they had the blood dialysis treatment instead. FSH, PRL, LH, E2 in all female uremia were increased, while the progesterone was decreased. Conclusions Dialysis can not improve the o- varian function. We must give the different guidances according to the actual situation of menstruation changes.