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    卵巢早衰30例臨床研究
    關鍵字:研究,臨床,EF,IJ,CD,AB,wx,yz,KL,MN, 發布時間:2011-08-21

    論著?臨床論壇 CHINFsFcoMM¨NJ"fitOoCTORS 王月明 743400甘肅靜寧縣中醫院婦產科 摘要目的:分析卵巢早衰患者的診治 方法及臨床特征。方法:回顧性分析卵巢 早衰患者30例臨床資料。結果:經過3 —6個月的治療后,總有效率93.33%。 治療前后(月經第5天)空腹的血清性激 素水平發生變化。治療前后的E2、FSH、 LH激素相比差異有顯著性(P<0.05)。 結論:多數卵巢早衰的發病原因不明。應 進行長期的激素替代治療。 關鍵詞卵巢早衰性激素 doi:10.3969/j.issn.1007—614x.2010. 25.()58 回顧性分析2006年2月一2010年3 月診治的卵巢早衰患者30例臨床資料, 報告如下。. 資料與方法 本組患者30例,年齡17~39歲,< 20歲3例,23~30歲13例。>30歲14 例。月經稀少漸至閉經者21例,紊亂閉 經5例,突然閉經者4例。低雌激素血癥 表現17例。 實驗竄檢查:空腹狀態于清晨9:00 左右通過抽靜脈血的方式對血清E2、 FSH、LH、PRI進行測量,次數為2次,檢 測次數每月1次;利用電化學發光的方式 進行,型號為Elecsys2010。測定結果得 出FsH>40U/I。LH>40U/L。E2<40rig/ L,PRL表明患者處于正常狀態。 治療方法:均采取人工周期治療的方 式。一般情況下采用口服倍美力,劑饋為 0.625—1.25rag/日;持續使用22—25天, 同時配合安宮黃體酮,劑最為4—6mg/ 日;使用lO一12天,藥物停用后所有患者 均出現月經來潮,且在月經5天后持續使 用。在3個周期后對血清性激素檢查。 保留生育功能要求患者7例,其中6 例倍美力降至半量(0.625mg),接受治療 時間為3個月,1例子官內膜異位癥患者 在進行雙側卵巢囊腫腹腔鏡術后將藥物 改用媽富隆l片/日,規定2l天為l療 程,持續治療時間在3個月,藥物停止后 患者的月經正常,在B超檢查中發現卵 泡完成發育,但不夠徹底,通過促排卵治 療出現成熟卵泡,但受孕情況未發生。 卵巢早衰30例臨床研究 保留生育功能的患者要持續治療3個月, 這樣町促進患者的性激素保持正常狀態,3 例患者至藥物停止過程中,其月經處于正 常,2例月經苗顯著降低。在B超檢查下觀 察到卵泡正常發育,但不夠徹底,促排卵治 療后4例可檢杏到成熟卵泡,但受孕情況較 差。l例患者的卵泡發育不夠成熟。 18例沒有提出保留牛育功能的要 求,15例在治療3~6個月后以媽富隆l 片/日,持續用藥時間達21天為1療程, 患者接受3療程的治療后,共5例接受血 清性激素觀察后發現恢復正常,且月經量 顯著降低。剩余13例,共10例m清性激 素顯示正常;停藥后1例月經恢復,7例 月經量變少,5例依舊會發牛斷閉經。對 2例甲減患者及4例免疫性疾病患者采 取適當的治療方式。 療效判斷標準:①完全恢復:血清性 激素處于標準狀態,用藥后癥狀消失,規 律行經,隨訪3個月中未出現復發者,圍 絕經期患者的癥狀消除,在夫性生活及生 殖道萎縮方面有所緩解;②效果顯著:血 清性激素呈現良好狀態,藥物停止后能夠 保持正常的停月經持續3個周期,而月經 減少,圍絕經期為出現相關癥狀,但在夫 妻性生活或乍殖萎縮方面有所緩解;③療 效較差:對血清性激素進行檢測發現 FSH、LH出現降低,E2顯著提升,但藥物 停止后出現復發,且存在間斷性閉經。圍 絕經期癥狀逐漸緩解,在性生活及生殖道 萎縮方面逐漸恢復…。 結果 臨床療效:治療3-6個月后治愈15例 (50.O%),有效13例(43.33%),無效2例 (&67%)。總有效率93.33%(28/30)。 治療前后i血L清性激素水平:治療前后 (月經第5天)空腹的疵清性激素水平發 生變化。3種激素在治療前后比較差異 均有顯著性(P<0.05),見表l。 討論 該病的因素與遺傳、代謝異常、免疫 性損害、醫源性、感染等方面存在聯 系‘21。檢測激素水平結果和臨床癥狀是 當前卵巢早衰的診斷的主要依據。生殖 器官分泌性激素的作用以及血清中性激 素的水平常常會被下丘腦一垂體性腺軸 所影響,但是當生殖器官分泌激素功能出 現異常情況時就存在引發機體內分泌功 能失調的狀況,甚至出現病癥變化,從而 降低了卵巢內卵泡的數目,使得卵母細胞 閉鎖過程加速導致卵泡消耗過早。造成 卵細胞耗竭速度變化的原因較為復雜,一 般都與卵巢腫瘤手術存在著必然的聯系, 這是因為放、化療、免疫能力下降會引起 卵泡數日降低,這樣就會使得卵巢分泌 雌、孕激素量追殲降低,使得抑制垂體 FSH、LH的效果降低,增加了血清FSH、 LH的水平pj。而FSH增加會導致卵巢 功能變弱,從而引起r激素的轉化,在臨 床治療過程中將FSH值大于40IU/L時 視為卵泡濾泡耗竭。若高FSH與高LH 同時存在,說明卵巢功能衰竭。 卵巢功能衰退的治療:這一時期的患 者主要癥狀為規律的月經、月經稀發、規 則出血等等。而規律月經患者尤需治療。 對規則出血的患者應該給予子宮器質性 病變的改善,同時結合患者的周期性孕激 素做出相應的協調。 雌激素水平低落的治療:根據患者無 保留生育功能的要求,實施雌、孕激素的 有效診斷,在必要時應該結合雌孕激素的 補允治療1=作,例如:可通過媽富隆周期 性治療來維護患者的發育及身體狀況,實 現月經正常、癥狀去除、性生活正常,身體 素質的恢復。而需保留生育功能的患者 采取輔助生育的治療。 心理治療:應注意患者精神和婚姻問 題,進行必要的婚姻、心理方面的治療,如 及時改善和減輕患者的情緒及癥狀、指導 夫妻性生活、改善夫妻關系和生活質量、 促進夫妻感情溝通及表達、改善人際關系 等綜合治療。 參考文獻 l張富青.卵巢早衰40例臨床治療分析[J]. 中國婦幼保健,2003,18:173. 2莫中福.卵巢早衰病因及診治的研究進展 [J].河北醫科大學學報,2006,27:231. 3譚貝加。馬紅.卵巢早衰研究進展[J].天津 中醫藥,2007,24:260—261. 裹1治療前后血清性教素水平變化情況§ 5例性激素患者難以恢復正常,而需。 64中國杜區醫師?醫學專業2010年第25期(第12卷總第250期) 萬方數據 換頁

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