lancet diabetes endo:染色体核型为46,XY的女性可采用睾酮替代治疗性腺切除术后的雄激素不敏感综合征

2018-08-01 MedSci MedSci原创

性腺切除术后出现完全性雄激素不敏感综合征(CAIS)的女性抱怨心理健康和性生活满意度下降。Wiebke Birnbaum等人在德国的3个大学医学中心和3个专业化治疗机构开展一国家级的多中心的双盲随机交叉试验,对比采用雄激素或雌激素的激素替代疗法用于染色体核型为46,XY的性腺切除术后罹患CAIS的女性的效果。2011年11月7日-2016年1月23日期间,研究人员招募了26位18-54岁的染色体核

性腺切除术后出现完全性雄激素不敏感综合征(CAIS)的女性抱怨心理健康和性生活满意度下降。Wiebke Birnbaum等人在德国的3个大学医学中心和3个专业化治疗机构开展一国家级的多中心的双盲随机交叉试验,对比采用雄激素或雌激素的激素替代疗法用于染色体核型为46,XY的性腺切除术后罹患CAIS的女性的效果。

2011年11月7日-2016年1月23日期间,研究人员招募了26位18-54岁的染色体核型为46,XY的、遗传学确诊为CAIS的性腺切除术后的女性,将其随机分至A组(雌二醇1.5mg/日 持续6个月,改为睾酮50mg/日 持续6个月)14人和B组12人(用药顺序恰与A组相反)。受试者同时服用雌二醇或睾酮假体,以防识别活性物质。所有受试者在2个月的磨合期每天服用1.5mg雌二醇。主要结点是心理健康相关的生活质量(以德国标准化SF-36调查问卷评估);次要结点有心理健康(以BSI评估)、性功能(女性性功能评估[FSFI])和身体效应。

26位患者中有10位患者退出研究,其中2位随访满5次,因此仍被纳入主要分析。两个治疗组之间的心理健康相关的生活质量无明显差别(p=0.794),心理健康的BSI评分也无差别。对于FSFI,睾酮仅在改善性欲方面优于雌二醇(p=0.018)。两组均未见病毒增生,促性腺激素浓度保持稳定。研究期间,两组的雌二醇和睾酮浓度都发生明显变化。患者接受雌二醇治疗时共发生28例副反应事件(23例1级、5例2级)、接受睾酮治疗期间共发生38例副反应事件(34例1级、3例2级、1例3级)。在磨合期发生了1例严重副反应(纤维性乳腺病)和20例副反应(16例1级和4例2级),随访期间发生12例副反应事件(9例1级、3例3级)。

睾酮耐受性良好,与雌二醇用于激素替代疗法一样安全。睾酮或可作为CAIS患者的备选激素,特别是对于性功能减退的女性。

原始出处:

Wiebke Birnbaum,et al. Oestrogen versus androgen in hormone-replacement therapy for complete androgen insensitivity syndrome: a multicentre, randomised, double-dummy, double-blind crossover trial. The Lancet Diabetes&Endocrinology. July 31,2018.https://doi.org/10.1016/S2213-8587(18)30197-9

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    2018-08-08 howi
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