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目的 探讨雄激素对抗苗氏管激素 (AMH)的作用机制及血清AMH的临床检测意义。方法 正常青春发育各期男童 48例 ,其中选取 10例为对照组 ;10例原发性生长激素缺乏伴低促性腺激素睾丸发育不良男童患者均单独给予重组人生长激素 (rhGH)治疗一年 ,第二年rhGH联合性激素 (HCG或长效庚酸睾酮 ) ,总疗程二年。于治前及治疗后采血检测AMH、睾酮、FSH及LH。结果(1)正常儿童在青春发育前血清AMH水平较高 ,进入青春发育后AMH渐趋下降 ,至TannerG4～ 5期最低 ;与血睾酮呈负相关。 (2 )患者组在治前血清AMH为 (318.0± 34 .7) pmol/L ,明显高于正常对照组 (4 1.6± 6 .7) pmol/L(P <0 .0 0 1)。患者经第一年单纯GH治疗后 ,血清AMH明显下降 (195 .4± 6 1.2 ) pmol/L ,第二年采用 (rhGH)联合性激素治疗 ,血清AMH进一步下降 ,而血清睾酮值则逐步增高。结论 (1)正常男童进入青春发育后血清AMH呈递减趋势 ,血睾酮逐步升高 ,两者呈负相关 ;(2 )生长激素缺乏伴低促性腺激素睾丸发育不良患者血清AMH持续高值 ,经GH及GH联合性激素治疗后血清AMH水平随血睾酮升高而下降 ;(3)临床检测血清AMH有助于全面评估男性睾丸的发育及其功能状况。
Objective To investigate the mechanism of action of androgens against muscarinic hormone (AMH) and the clinical significance of serum AMH. Methods Forty-eight boys were enrolled in this study. Ten of them were selected as control group. Ten patients with dysplastic primary hypo-hypo-gonadotropin testis were randomly assigned to receive recombinant human growth hormone (rhGH) Year, the second year rhGH combined sex hormone (HCG or long-acting testosterone), the total course of treatment for two years. AMI, testosterone, FSH and LH were collected before and after treatment. Results (1) The level of AMH in normal children before adolescence was higher than that in normal children. AMH gradually decreased after entering adolescence, and reached the lowest in Tanner G4 ~ 5, but negatively correlated with serum testosterone. (2) The pretreatment serum AMH was (318.0 ± 34.7) pmol / L in the patient group, which was significantly higher than that in the normal control group (41.6 ± 6.7) pmol / L (P <0.01). Serum AMH decreased significantly (195.4 ± 6.2 1.2 pmol / L) after the first year of GH treatment, and combined with rhGH for the second year, serum AMH decreased further and serum testosterone level gradually increased. Conclusions (1) The serum AMH of normal boys entering the youth development decreased gradually, and the level of serum testosterone increased gradually. There was a negative correlation between them. (2) The serum AMH of patients with growth hormone deficient and hypogonadotropin testicular dysplasia persisted high, The level of serum AMH decreased with the increase of serum testosterone after GH and GH combined hormones treatment. (3) Clinical detection of serum AMH helps to evaluate the development and functional status of male testis.