青春期功血性激素治疗后继发HA8例分析

下丘脑性闭经(hypothalamic amenorrhea,HA)是指垂体水平以上疾病所引起的闭经.可由中枢神经系统的器质性病变引起,也可为精神因素、营养不良等因素造成的下丘脑功能性改变所致,还可由某些药物的应用所致,而由青春期功血性激素治疗后所致的HA未见报道.本文就8例此类病例分析如下.

青春期功能失调性子宫出血合并重度贫血性激素止血治疗分析

青春期功能失调性子宫出血（简称青春期功血）是妇科常见的出血性疾病之一。功能性子宫出血临床分为无排卵性功能失调性子宫出血和排卵性子宫异常出血，青春期功能失调性子宫出血多属于无排卵性功能失调性子宫出血．是青春期少女的一种常见病，但若治疗不及时不恰当，可致重度贫血甚至休克而严重危害少女的身心健康。

不孕症卵泡发育不良患者B超监测卵泡联合血性激素检查结果分析与对策

目的：分析不孕症卵泡发育不良患者B超检测卵泡联合血性激素检查结果，探究临床治疗方法。方法：在我院选择不孕症卵泡发育不良患者50例，为观察组；正常排卵但不孕患者50例，为对照组，观察两组患者的B超检测与血性激素检查结果。结果：两组患者月经周期、卵泡期、黄体期、窦卵泡数及基础血清卵泡刺激素、黄体生成素、雌二醇水平无明显变化；而观察组卵泡中、晚期最大卵泡平均直径、生长速度以及血清卵泡刺激素、雌二醇水平低于对照组。结论：不孕症卵泡发育不良患者其卵泡中、晚期生长缓慢，卵泡晚期及黄体中期激素水平降低，卵泡发育趋于停滞、闭锁或是未成熟卵泡排卵病多伴有黄体功能发育不全。

阴道B超联合血激素监测排卵在不孕症患者中的应用

目的探讨阴道B超联合血性激素监测排卵在不孕症治疗中的应用效果。方法选取100例不孕症患者,按照监测排卵方法不同分为对照组(30例)和研究组(70例)。对照组采用阴道B超监测卵泡发育及排卵,研究组采用阴道B超联合血促黄体生成素、雌二醇监测排卵,比较两组的排卵期前卵泡直径和子宫内膜厚度、子宫内膜形态、排卵率和妊娠率情况。结果两组排卵期前的子宫内膜厚度、卵泡直径、子宫内膜形态、排卵率比较,差异无统计学意义(P>0.05);研究组的妊娠率为28.57%,高于对照组的10.00%,差异有统计学意义(P<0.05)。结论采用阴道B超联合血性激素监测排卵,适时指导性生活,及时药物干预,可提高妊娠率,在不孕症治疗中的应用效果显著。

中药内服外洗治疗迟发型痤疮伴高雄激素血症相关分析

目的:观察中药内服外洗治疗多囊卵巢综合征(PCOS)患者中伴高雄激素血症及迟发性痤疮者临床疗效。方法:将入选患者采用中医辨证分型后随机分为治疗组和对照组,治疗组采用本院中药协定处方张氏枇杷清肺方内服外洗患处,连续治疗3个月;对照组采用达英-35,自然月经或孕激素撤退出血后第1天开始口服,每日1片,连服21d后停药,撤退性出血后第1天开始服用下一周期,重复3个周期。观察患者治疗前、治疗后1个月、治疗后3个月、治疗停药后3个月、治疗停药后6个月的临床皮损情况、黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)及卵巢变化、子宫大小和内膜厚度各项指标情况变化。结果:(1)在改善痤疮临床症状方面,治疗组在治疗后1个月效果明显优于对照组(P<0.05);治疗后3个月两组无显著性差异(P>0.05);在停药后复诊过程中,治疗组症状反复情况明显低于对照组(P均<0.05),有统计学差异。(2)在患者激素水平对比方面,入选患者治疗前血清雄激素水平均明显升高,但在治疗后1个月治疗组能显著降低雄激素水平,起效时间快于对照组(P<0.05),治疗后3个月两组无差异(P>0.05),停药后治疗组血清雄激素水平升高慢于对照组,有统计学差异(P<0.05)。(3)超声检查双侧卵巢多囊、子宫大小及内膜改变情况方面,两组对比均无显著性差异(P>0.05)。结论:通过疗效观察,张氏枇杷清肺方与达英-35都具有改善痤疮皮损及降低雄性激素水平功效,但张氏枇杷清肺方症状缓解起效时间更快、复发率更低、激素水平反弹更少,且无不良反应,值得临床推广。

米非司酮用于围绝经期功能性子宫出血的疗效探讨

目的探讨米非司酮用于围绝经期功能性子宫出血的疗效。方法分别采用小剂量米非司酮6个月及3个月各治疗30例围绝经期功血,对其治疗效果进行对照。结果应用米非司酮治疗后血性激素FSH、LH、E2、P均有下降,且口服米非司酮6个月组性激素水平下降尤为显著,差异有统计学意义(P<0.05);用药期间患者均暂时性闭经,贫血明显缓解,口服米非司酮6个月组有效率高于口服米非司酮3个月组,差异无统计学意义(P>0.05),口服米非司酮6个月组复发率低于口服米非司酮3个月组,差异有统计学意义(P<0.05)。结论口服小剂量米非司酮6个月治疗围绝经期功血安全有效,且复发率低,值得临床使用。

多囊卵巢综合征胰岛素抵抗患者的临床特征

目的 :探讨多囊卵巢综合征 (polycystic ovary syndrome PCOS)胰岛素抵抗患者的临床表现特征。方法 :选择诊断为 PCOS、及糖负荷后 6 0 min或 12 0 min血胰岛素≥ 16 0 m IU/ L的患者 37例为胰岛素抵抗 PCOS 组。随机选择胰岛素及糖负荷 6 0 min、12 0 m in血胰岛素正常的 PCOS患者 37例为对照组 PCOS 组。对比两组 PCOS患者早卵泡期或闭经状态下各项性激素、卵巢体积、体重指数 (body mass index BMI)。结果 :1PCOS 组的平均睾酮 (testosteroneT)值、雄烯二酮 (androstenedione A)值、BMI均显著高于 PCOS 组 (P<0 .0 5 )。 2 PCOS 组中高水平睾酮、特别是高水平雄烯二酮及肥胖患者的构成比显著高于 PCOS 组 (P<0 .0 5 ) ;而高 L H患者则显著低于 PCOS 组 (P<0 .0 5 )。结论 :在胰岛素抵抗的 PCOS患者中 ,几乎全部伴有雄烯二酮的异常升高 ,高雄激素血症是其特有的临床特征。胰岛素抵抗并非 PCOS共同表现特征 ,它在一定程度上与体重有一定的依存关系 ,提示对

Effect of Buyang Huanwu Decoction on Platelet Activating Factor Content in Arterial Blood Preand Post-Arterial Thrombosis in Rats

To explore the effect of Buyang Huanwu Decoction (BHD) on platelet activating factor (PAF) content in arterial blood pre- and post-arterial thrombosis in rats, male Wistar rats were randomly divided into 3 groups, the medicine group treated with BHD, the control group with dexamethasone liquid, and the blank group with distilled water. Oral administration was given for 14 consecutive days, once daily. Model of arterial thrombosis was established in the animals 2 hours after final medication, the blood content of PAF, dry weight (DW) and occlusion time (OT) of thrombus, and dry weight of thrombus/body weight (TW/BW) ratio were observed. Results indicated that BHD could markedly lower the arterial blood content of PAF after thrombosis, increase the OT of thrombus, reduce the dry weight of thrombus and the TW/BW ratio (P

Study of serum level of sex hormones and expression of their receptors in patients with bronchogenic carcinoma

Objective: To study the serum level of estradiol, progesterone and testosterone (SEL, SPL and STL) and the expression of the receptors of estradiol and progesterone (ER and PR) in 53 cases of bronchogenic carcinoma. Methods: ER and PR in the tissue of the carcinoma were determined with enzyme-linked affinity histochemical method. SEL, SPL and STL were measured with double antibody radioimmunoassay. Results: Most of ER and PR were present in the cytoplasm of the malignant cells (58.2%) and the positive rates of ER and PR were 49.1% and 54.7% respectively. SEL and SPL were significantly higher in the patients with lung cancer than in the subjects of the control groups (P<0.05), no matter whether ER and PR were positive or negative. SEL and SPL were lower in the ER positive, PR positive and both ER and PR positive groups than in the ER negative, PR negative and both ER and PR negative groups. Conclusion: The existence of ER and PR in the patients with bronchogenic carcinoma indicates that the pathogenesis of bronchogenic carcinoma is sex hormone dependent to some extent. ER and SEL are negatively correlated with a correlative coefficient of -1.

Octreotide reverses shock due to vasoactive intestinal peptide-secreting adrenal pheochromocytoma: A case report and review of literature

Vasoactive intestinal peptide-producing tumors （VIP-oma） usually originate in the pancreas and are chara-cterized by diarrhea, hypokalemia, and achlorhydria （WDHA syndrome）. In adults, nonpancreatic VIPoma is very rare. Herein, we report an unusual case of VIP-producing pheochromocytoma marked by persistent shock, fushing, and watery diarrhea and high sensitivity to octreotide. A 53-year-old woman was hospitalized for sudden-onset hypertension with convulsions, which then rapidly evolved to persistent shock, fushing, and watery diarrhea. Abdominal computed tomography indicated a left adrenal mass, accompanied by bleeding;and marked elevations of both plasma catecholamine and VIP concentrations were documented via laboratory testing. Surprisingly, all clinical symptoms responded swiftly to octreotide treatment. Once surgically treated, hormonal levels normalized in this patient, and the clinical symptoms dissipated. Postoperative pathological and immunohistopathological studies confrmed a VIP-secreting pheochromocytoma with strong, diffuse positivity for somatostatin receptor type 2. During a 6-mo follow-up period, she seemed in good health andwas symptom-free.

Androgen deficiency in elderly men with systolic chronic heart failure

Objective Several previous studies have shown androgens deficiency in men with CHF, and 2 studies on the prognostic significance of serum levels of androgens in CHF patients have yielded conflicting results. The aim of this study was to examine the relationship between serum concentration of testosterone and mortality in men with systolic CHE Methods A total of 175 elderly （age ≥ 60 years） men with CHF were recruited. Total testosterone fiT） and sex hormone binding globulin （SHBG） were measured, and free serum testosterone （eFT） was calculated. The median follow-up time was 1262 days. Results During follow-up 54 （30.9%） patients died. TT and eFF deficiency was found in 21.7% （38/175） and 27.4% （48/175） patients, respectively. Both TT and eFT were inversely associated with LVEF and NT-proBNP （all P〈0.01）. Kaplan-Meier curves for patients in low, medium and high tertiles according to TF and eFT level showed significantly different cumulative survival rate （both P〈0.01 by log-rank test）. However, after adjustment for clinical variables, there were no significant associations between either Tr or eFT levels or survival time （OR=0.97, 95% CI, 0.84-1.12, P--0.28; and OR=0.92, 95% CI, 0.82-1.06,/＇=0.14, respectively）. Conclusion Our study showed that although levels of TT and eFT are commonly decreased in elderly patients with systolic CHF and related to disease severity, they are not independent predictors for mortality

Andropause and the development of cardiovascular disease presentationmore than an epi-phenomenon

Andropause refers to a generalized decline of male hormones, including testosterone and dehydroepiandrosterone in middle-aged and aging men. This decline in hormones has been associated with changes such as depression, loss of libido, sexual dysfunction, and changes in body composition. Aging has been associated with an abundance of concomitant diseases, in particular cardiovascular diseases, and although andropause is correlated to aging, a causal relationship between reduction of androgens and the development of chronic diseases such as atherosclerosis and heart failure has not been convincingly established yet. On the other hand, increasing data has emerged that revealed the effects of low levels of androgens on cardiovascular disease progression. As an example, low levels of testosterone have been linked to a higher incidence of coronary artery disease. Whether hormone replacement therapy that is used for andropausal men to alleviate symptoms of ＂male menopause＂ can halt progression of cardiovascular disease, remains controversially discussed, primarily due to the lack of well-designed, randomized controlled trials. At least for symptom improvement, the use of androgen replacement therapy in andropausal men may be clinically indicated, and with the appropriate supervision and follow up may prove to be beneficial with regard to preservation of the integrity of cardiovascular health at higher ages.

Drug-induced liver injury in hospitalized patients with notably elevated alanine aminotransferase

AIM： To identify the proportion, causes and the nature of drug-induced liver injury （DILI） in patients with no- tably elevated alanine aminotransferase （ALT）. METHODS： All the inpatients with ALT levels above 10 times upper limit of normal range （ULN） were ret- rospectively identified from a computerized clinical laboratory database at our hospital covering a 12-mo period. Relevant clinical information was obtained from medical records. Alternative causes of ALT eleva- tions were examined for each patient, including bili- ary abnormality, viral hepatitis, hemodynamic injury, malignancy, DILI or undetermined and other causes. All suspected DILI cases were causality assessed usingthe Council for International Organizations of Medical Sciences scale, and only the cases classified as highly probable, probable, or possible were diagnosed as DILI. Comments related to the diagnosis of DILI in the medical record and in the discharge letter for each case were also examined to evaluate DILI detection by the treating doctors. RESULTS： A total of 129 cases with ALT 〉 i0 ULN were identified. Hemodynamic injury （n = 46, 35.7%）, DILl （n = 25, 19.4%） and malignancy （n = 21, 16.3%） were the top three causes of liver injury. Peak ALT val- ues were lower in DILI patients than in patients with hemodynamic injury （14.5 5.6 ULN vs 32.5 ：I： 30.7 ULN, P = 0.001）. Among DILI patients, one （4%） case was classified as definite, 19 （76%） cases were clas- sified as probable and 5 （20%） as possible according to the ClOMS scale. A hepatocellular pattern was ob- served in 23 （92%） cases and mixed in 2 （8%）. The extent of severity of liver injury was mild in 21 （84%） patients and moderate in 4 （16%）. Before discharge, 10 （40%） patients were recovered and the other 15 （60%） were improved. The improved patients tended to have a higher peak ALT （808 ＋ 348 U/L vs 623 ＋ 118 U/L, P = 0.016） and shorter treatment duration before discharge （8 ＋ 6 d vs 28 ~ 12 d, P = 0.008） compared with the recovered patients. Twenty-two drugs and 6 herbs were found associated with DILl. Antibacterials were the most common agents causing DILI in 8 （32%） cases, followed by glucocorticoids in 6 （24%） cases. Twenty-four （96%） cases received treatment of DILl with at least one adjunctive drug. Agents for treatment of DILI included anti-inflammatory drugs （e.g., glycyr- rhizinate）, antioxidants （e.g., glutathione, ademetionine 1,4-butanedisulfonate and tiopronin）, polyene phospha- tidyl choline and herbal extracts （e.g., protoporphyrin disodium and silymarin）. Diagnosis of DILl was not mentioned in the discharge letter in 60% of the cases. Relative to prevalent cases and cases from wards of internal medicine, incident cases and cases from surgi- cal wards had a higher risk of missed diagnosis in dis- charge letter [odds ratio （OR） 32.7, 95%CI （2.8-374.1）,CONCLUSION： DILI is mostly caused by use of anti- bacterials and glucocorticoids, and constitutes about one fifth of hospitalized patients with ALT 〉 10 ULN. DILI is underdiagnosed frequently.

Problems associated with glucose toxicity:Role of hyperglycemia-induced oxidative stress

Glucose homeostasis deficiency leads to a chronic increase in blood glucose concentration. In contrast to physiological glucose concentration, chronic super-physiological glucose concentration negatively affects a large number of organs and tissues. Glucose toxicity means a decrease in insulin secretion and an increase in insulin resistance due to chronic hyperglycemia. It is now generally accepted that glucose toxicity is involved in the worsening of diabetes by affecting the secretion of B-cells. Several mechanisms have been proposed to explain the adverse effects of hyperglycemia. It was found that persistent hyperglycemia caused the functional decline of neutrophils. Infection is thus the main problem resulting from glucose toxicity in the acute phase. In other words, continued hyperglycemia is a life-threatening risk factor, not only in the chronic but also the acute phase, and it becomes a risk factor for infection, particularly in the perioperative period.

Second-trimester maternal β-human chorionic gonadotropin level associated with subsequent development of pregnancy-induced hypertension

Objective:To determine whether maternal β-human chorionic gonadotropin(β-hCG) level in second-trimester may be associated with subsequent development of pregnancy-induced hypertension(PIH).Methods:Seven hundred and sixty-two women in mid-trimester were to have maternal urine β-hCG standardized concentrations and maternal serum β-hCG measurements.Their case histories were recorded and reviewed from mid-trimester to delivery.The relation was observed between maternal urine,serum markers and subsequent development of PIH.Results:Among 762 women,504 cases were normal pregnancies,42 cases had PIH,94 cases had premature rupture of membrane (PROM),69 cases had preterm delivery (PD),53 other cases were excluded by various reasons.The levels of maternal urine,serum β-hCG in PIH were (61.75±9.78) IU/L and (304.56±54.17) ng/mg respectively,which were higher significantly than normal pregnancy group ([20.65±7.61] IU/L and [146.34±47.81] ng/mg,P<0.05).When maternal serum,urine β-hCG levels ≥2 MOM(multiple of mean),the incidences of developing PIH were increased significantly as compared with those of β-hCG <2 MOM women.The incidence of PIH increased from 5.1% in pregnancies with urine β-hCG ≥2 MOM to 11.7% in cases with urine β-hCG ≥4 MOM.Conclusion:The elevation of maternal mid-trimester urine,serum β-hCG levels is not only an early signal for dysfunction of placenta but also a dangerous signal for development of PIH.Second-trimester maternal urine β-hCG measurement proves to be superior to serum marker in clinical prediction.

Suppression of angiotensin Ⅱ stimulated responses in aortic vascular smooth muscle cells of experimental cirrhotic rats

Functional responses to angiotensin Ⅱ (AT-Ⅱ) were determined in aortic vascular smooth muscle cells (VSMCs) from experimental cirrhotic rats. Our data showed that AT-Ⅱ-stimulated extracellular acidification rate (ECAR), which was measured by Cytosensor microphysiometry, was significantly reduced in the aortic VSMCs from the cirrhotic rats as compared to those from the control animals. The ability of AT-Ⅱ to promote formation of inositol phosphates, the second messenger produced by the activation of Gq-coupled receptors, was also considerably suppressed in the cirrhotic VSMCs. Furthermore, the maximal p42/44 MAPK phosphorylation stimulated by AT-Ⅱ was significantly reduced in the cirrhotic VSMCs in contrast to that in the normal VSMCs. Taken together, our data clearly demonstrated that the functional responses to AT-Ⅱ was severely suppressed in aortic VSMCs in cirrhosis, indicating the impairment of general Gq-coupled receptor signaling and subsequent biological function in the cirrhotic VSMCs.

氟他胺和二甲双胍在难治性多囊卵巢综合征中的临床应用

目的:探讨氟他胺和二甲双胍在难治性多囊卵巢综合征(PCOS)中的临床应用。方法:30例难治性PCOS的不孕患者,观察口服氟他胺和二甲双胍12周前后的临床症状及检测指标,比较生殖内分泌指标及糖代谢指标的变化。结果:治疗前后体重指数(BMI)、臀围比值(WHR)、多毛评分(F-G评分)、黄体生成素(LH)、黄体生成素/卵泡刺激素(LH/FSH)、总睾酮(T)、游离睾酮(FT)、雄烯二酮(A2)、硫酸脱氢表雄酮(DHEAS),空腹胰岛素(FINS)较治疗前明显下降,差异均有显著性(P<0.01～0.05),性激素结合球蛋白(SHBG)较治疗前明显升高(P<0.05),其余指标治疗前后无明显差异。用药后有21例(70%)患者恢复排卵性月经。结论:①氟他胺、二甲双胍治疗使大部分患者排卵异常得到很大改善,同时多毛、肥胖也得到一定控制。②氟他胺、二甲双胍能使难治性PCOS患者的卵巢-垂体生殖轴激素水平得到有效的改善。③对无生育要求的PCOS患者提供一种新的治疗手段;对有生育要求的患者,由于胎儿安全性问题不明,尚须做进一步深入研究。

多囊卵巢综合征与复发性流产

多囊卵巢综合征是常见的内分泌失调疾病,尽管很多研究表明与复发性流产相关,但原因仍然不明。可能的影响因素有:高雄性激素血症、高胰岛素血症等。减轻体重和卵巢打孔以及应用二甲双胍可降低流产的发生率。

Effects of sex hormones on apoptosis in peripheral blood mononuclear cells from patients with systemic lupus erythematosus

Objective To study the effects of dehydroepiandrosterone (DHEA) and/or estradiol (E 2) on apoptosis in peripheral blood mononuclear cells (PBMCs) from patients with systemic lupus erythematosus (SLE) Methods The percentage of apoptosis of PBMCs from SLE patients and healthy blood donors were examined by means of AO staining 48?h after culture with DHEA and/or E 2 at physiologic or pathologic concentrations Results The percentage apoptosis of PBMCs from SLE patients is higher than that of healthy blood donors ( P <0 01) E 2, whether at physiological or at pathological concentrations, had no effects on apoptosis of PBMCs from both SLE patients and healthy donors ( P >0 05) Both DHEA and DHEA plus E 2 at physiologic concentrations, had no effect on apoptosis of PBMCs from healthy donors ( P >0 05), but significantly inhibited that of SLE patients ( P <0 05); at pathologic concentrations,they promoted apoptosis of PBMCs from SLE patients as well as healthy blood donors ( P <0 05) There were no significant differences between the effects of DHEA and that of DHEA plus E 2 ( P >0 05) Conclusion DHEA plays an important role in the apoptosis of PBMCs from SLE patients; low serum levels of DHEA may cause accelerated apoptosis