CSE 2015:窦京涛教授谈国内外性腺疾病研究领域年度新进展

2015-08-31 MedSci MedSci原创

2015年中华医学会第十四次全国内分泌学学术会在南京召开,在8月27日下午“性腺研究年度进展报告及性功能减退”专场上,来自解放军总医院的窦京涛教授作了题为“国内外性腺疾病研究领域年度新进展”的精彩报告。影像学技术、生化检测技术以及基因分子生物技术在不断进步,内分泌疾病领域也发生了翻天覆地的变化,关于性腺疾病发病机制以及诊断和治疗研究有大量文献发表, 从不同角度探讨了性腺疾病的发病机制、基因诊断、临

2015年中华医学会第十四次全国内分泌学学术会在南京召开,在8月27日下午“性腺研究年度进展报告及性功能减退”专场上,来自解放军总医院的窦京涛教授作了题为“国内外性腺疾病研究领域年度新进展”的精彩报告。

影像学技术、生化检测技术以及基因分子生物技术在不断进步,内分泌疾病领域也发生了翻天覆地的变化,关于性腺疾病发病机制以及诊断和治疗研究有大量文献发表, 从不同角度探讨了性腺疾病的发病机制、基因诊断、临床诊断以及干预方法。现就其中对临床工作有更多借鉴意义的部分经典病种文献进行汇总分析, 以供临床医师参考。

一、国际性腺疾病研究领域新进展:

1. 46,XY性发育障碍(46,XY-DSD):46,XY-DSD包含一系列疾病。基因缺陷导致性腺发育障碍或雄激素合成/作用障碍导致内外生殖器发育不良。国外Werner教授通过对一家系两46,XY姐妹进行外显子测序,发现了DHH基因上一个新的突变位点R124Q,该学者认为DHH基因突变可能与46,XY患者精原细胞瘤形成密切相关,可能影响Leydig细胞和Sertoli细胞之间的相互作用进而影响性腺发育。

2. Klinefelter 综合征(KS)是男性最常见的染色体异常性疾病。德国学者发现超数X染色体在KS的病理过程具有重要作用,不同的基因表达模式其临床表现也各不相同。3. 21-羟化酶缺陷症:17-羟孕酮(17-OHP)升高是经典型21-羟化酶缺陷症的主要特征,多年来也一直被作为诊断及检测治疗效果的指标,但是其具有一定的局限性。国外学者对21-碳类固醇进行详细分析,试图找出新的21-羟化酶缺陷症生化标志物,结果发现采用液相质谱法在检测17-OHP的同时测定11-OHP和16-OHP可以提高诊断的准确度。4. Turner综合征:大多数的Turner综合征患者在病程中都会出现始基卵泡的进行性丧失,Stine学者研究发现AMH是Turner综合征卵巢功能早衰的一项预测因子。

二、国内性腺疾病研究领域新进展 

1. 性腺学组在窦京涛组长的带领下,编写了国内特发性低促性腺激素性性腺功能减退症诊治专家共识并于第四届成都性腺疾病学术会议期间进行发布,该共识发布有助于增加国内医师对该疾病了解,规范临床诊治。

2. 多囊卵巢综合征(PCOS):台湾一项最新研究发现,肌肉因子irisin水平和葡萄糖依赖性促胰岛素分泌多肽(GIP)可能在多囊卵巢综合征(PCOS)的发生发展中发挥作用,在PCOS早期irisin代谢存在异常,呈现Irisin抵抗状态,这一发现可为提高PCOS检出率提供新的生物标志物。重庆医科大学附属第二医学院学者也证实irisin可作为PCOS妇女胰岛素抵抗的一个生物标志物。在PCOS治疗方面,国内瑞金医院首次报道一例采用GnRH脉冲输注治疗非肥胖PCOS不孕症患者,治疗16天时月经来潮,8个月自然受孕,提示GnRH脉冲输注可以恢复非肥胖PCOS患者下丘脑GnRH脉冲分泌节律,恢复规律月经及自然排卵。

3. 特发性低促性腺激素性性腺功能减退症(IHH):HHIS研究组对9个三级医院67例IHH患者进行18个月治疗随访,比较FSH/hCG连续治疗和序贯治疗的疗效,结果提示在精子生成率方面,FSH/hCG序贯治疗并无明确优势。国内协和医院伍学焱教授还对GnRH脉冲输注与HCG/HMG联合肌注对男性IHH患者生精治疗效果进行比较,结果提示GnRH脉冲输注组在精子数量以及精子初现时间方面均优于HCG/HMG联合肌注。

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    2016-10-09 忠诚向上

    好好看下

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    2016-05-08 sjzlzc015
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