促性腺激素释放激素皮下微量脉冲输注治疗中枢性继发性闭经一例临床研究

Clinical research of impulse GnRH infusion treatment to a patient with central secondary amenorrhea

目的皮下持续脉冲输注促性腺激素释放激素（GnRH）诱导中枢性继发性闭经患者自发排卵、自然受孕的临床研究。方法采用垂体激素泵以90min的脉冲频率皮下输注戈那瑞林（LHRH），试验性治疗1例中枢性继发性闭经患者，于第3天、4周、8周、16周进行访视，监测血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇、孕酮水平；子宫内膜和卵巢的变化，以自然受孕为观察终点。结果经过治疗，血清LH、FSH、雌二醇水平明显升高、子宫内膜逐渐增厚。8周恢复自然月经，16周后自然受孕。足月妊娠，分娩1个健康女婴。结论GnRH脉冲治疗在国内首次应用于中枢性继发性闭经患者，可模拟下丘脑GnRH生理分泌模式、恢复卵巢功能，重建生理周期，修复生育功能，为该类疾病最理想、最符合下丘脑-垂体-性腺轴生理调节机制的治疗方法。有更多的病例正在参与这项研究，以进一步验证其有效性，为人工辅助生殖技术新的治疗方法。

Objective To apply continuous subcutaneous pulse infusion of gonadotropin-releasing hormone （GnRH） to treat patients with central secondary amenorrhea, and to observe the induction of spontaneous ovulation and natural fertilization. Methods Using micro-pulse infusion pumps with each 90-minute infusion of LHRH 10 μg daily, the serum LH, FSH, estrogen, and progesterone levels ; and change in endometrium and ovarian size before and after treatment were monitored. The end point is natural pregnancy. Results The levels of serum LH, FSH, and estrogen were obviously increased after 4 weeks of treatment. The natural menstrual cycle was rebuilt after 8 weeks of treatment. The patient was pregnant and the treatment was stopped by 16 weeks. The experience of pregnancy was favourable. 40 weeks later, the patient delivered a healthy female infant via caesarean section. Conclusions It was the first time in China that the technology of micro GnRH pump was applied in patients with secondary central amenorrhea. The result demonstrates that this technology can perfectly simulate the physiology of hypothalamic GnRH secretion. At present, more patients are included in this research to confirm the effectiveness.