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目的探讨造血干细胞移植对卵巢功能的影响。方法观察2002年10月至2003年10月间在昆明陆军总医院,昆明医学院附属第一、二医院以及云南省肿瘤医院中45例因急性非淋巴细胞白血病分别接受同种异体造血干细胞移植(Allo-SCT)和自体造血干细胞移植(Auto-SCT)患者的月经恢复情况和性激素变化以及卵巢的形态学改变,同时抽取45例同年龄段健康妇女作为对照。结果Allo-SCT中有2例月经恢复,Auto-SCT中有4例恢复,移植时年龄越小,卵巢功能越易恢复。Allo-SCT和Auto-SCT后促性腺激素较对照组显著升高,而雌激素显著降低,Allo-SCT的雄激素也显著降低。此外,移植组的子宫和卵巢体积均小于正常对照组(P<0.01),而Allo-SCT组的子宫和卵巢体积则更小。结论造血干细胞移植后引起的卵巢功能降低主要是因为移植前化疗对卵巢的损害,但Allo-SCT引起的免疫调节障碍可进一步使卵巢功能减退。
Objective To investigate the effect of hematopoietic stem cell transplantation on ovarian function. Methods From October 2002 to October 2003 in Kunming Army General Hospital, Kunming Medical College Affiliated First and Second Hospital and Yunnan Cancer Hospital, 45 cases of acute non-lymphocytic leukemia were received allogeneic hematopoietic stem cell transplantation Allo-SCT) and autologous hematopoietic stem cell transplantation (Auto-SCT) in patients with menstrual recovery and sex hormone changes and ovarian morphological changes, while taking 45 same age healthy women as a control. Results Allo-SCT in 2 cases of menstruation recovery, Auto-SCT in 4 cases recovered, the younger the age of transplantation, the more likely to restore ovarian function. Gonadotropin increased significantly after Allo-SCT and Auto-SCT compared with the control group, while estrogen decreased significantly and Ando-SCT also decreased significantly. In addition, the volume of uterus and ovary in the transplantation group was smaller than that of the normal control group (P <0.01), while the volume of the uterus and ovary in the Allo-SCT group was smaller. Conclusions The reduction of ovarian function after hematopoietic stem cell transplantation is mainly due to the damage to the ovary caused by chemotherapy before transplantation. However, the immunomodulatory disorder caused by Allo-SCT can further reduce ovarian function.