男性性激素测定ppt课件

1、男性性激素测定,从保列治的应用开始,看山是山，看水是水 看山不是山，看水不是水,Company Logo,Company Logo,DHT,Company Logo,Company Logo,Company Logo,5-ARIs,Company Logo,5-ARIs,serum DHT 70% with finasteride . 95% with dutasteride. prostate DHT concentration is reduced to a similar level (85-90%) by both 5-ARIs,Company Logo,5-ARIs,leading

2、to prostate 18-28% PSA 50% after 6-12 months of treatment,Company Logo,5-ARIs,improve IPSS 15-30%, Qmax 1.5-2.0 mL/s,Company Logo,5-ARIs ED,Company Logo,5-ARIs,Contributes to high Gleason grade PCa,Company Logo,Company Logo,5-ARIs,serum T 23%-24% during the 4-year study period Placebo with a slight

3、increase of 1% to 6% in the,Company Logo,前列腺内,Company Logo,性功能,Company Logo,性功能,Company Logo,Company Logo,DHT T,potential negativecardiovascular events, and depression,Company Logo,Morales a Wang C, et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU,

4、 EAA and ASA Recommendations. Eur Urol 2009; 55:121-130,迟发性性腺功能减退症定义,迟发性性腺功能减退症（Late-onset hypogonadism, LOH）：一种与年龄增长相关的临床和生物化学综合征。 其特征为： 具有一定临床症状； 血清睾酮水平降低； 对机体多种器官、系统功能有不利影响； 严重影响生活质量,Shalender Bhasin,. Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical P

5、ractice Guideline. J Clin Endocrinol Metab 95: 25362559, 2010,雄激素缺乏的常见症状/体征,LOH各国指南及诊断标准,雄激素,Company Logo,游离睾酮,与白蛋白 结合的睾酮,与性激素 结合球蛋白 结合的睾酮,生物活性睾酮,无生物活性睾酮,总睾酮正常值：12-35nmol/L,睾酮的存在形式,Company Logo,F+T,Finasteride+oral testosterone undecanoate 7天 对T和DHT没明显变化,Company Logo,T luts,studies have demonstrated

6、 that the prostate can increase involume by approximately with the addition of testosterone,which is thought may be enough to decompensate a signifiantlyobstructed bladder,Company Logo,Th European Association of Urology guidelines warnthat androgen deprivation therapy(ADT) is contraindicated in men

7、with severe LUTS (IPSS21,Company Logo,激素的测定,血液中甾体激素的测定可采用 光谱分析法 (包括紫外分光光度法和荧光分析法 ) 色谱法 （包括高效液相色谱分析法、气相色谱与质谱联用分析法、胶束电动毛细管色谱法）、 免疫学分析方法（包括放射免疫测定法、化学发光免疫测定法 ） 磁分离酶联免疫测定法,Company Logo,FT测定,在纯度和温度严格控制下 平衡透析法测定 是生理学上评估血清 FT最经典的方法,Company Logo,Vermeulen公式计算,www.issam.ch FT或Bio-T计算器,Company Logo,www.issam.c

8、h 游离睾酮或生物活性睾酮计算器,游离睾酮或生物活性睾酮,检测方法 平衡透析法 过于复杂 临床推广难 类同方法 不准确 故不推荐,Bio-T测定,硫酸铵盐沉淀SHBG-T，再测定Bio-T从而评估FT,Company Logo,酶免法,酶免法测得FT仅占0.23% 相差8-9倍,Company Logo,Summery,设想 ，评估一男性的激素情况应该 多维度（T、DHT、DHEA等） 细分解（TT、FT、Bio-T等,Company Logo,mans LUTSis appropriately treated there is no longer a contraindication to

9、TRT,Company Logo,However, about 25%30% of patients do not experience any improvement in theirurinary symptoms and another 5%7% developed worsening symptoms and may ultimately require surgery 8. It should be noted that resistance to therapy with finasteridemay occur through silencing of the 5-R type

10、2 gene by DNAmethylation, leading to a state in which approximately 30% of patients do not express 5-R type 2 in the prostate,Company Logo,Company Logo,Table,Higher levels of serum free testosterone are associated with an increased risk ofaggressive prostate cancer among older men,Company Logo,5-ARIs,Thismay explain some of the noted symptoms such as anxiety,depression and suicide in patients who have been treatedwith finasteride,Company Logo,5-Rs,was 23% 95% confidence interval 11.1% to35.6%, 25% 95% confidence interval 14.6% to 34.7