摘要
目的 了解应用环磷酰胺 (CTX)治疗原发性肾病综合征 (INS)患儿的远期性腺损害及对子代的影响。方法 对 196 5～ 1984年间用CTX治疗的INS中 2 2例 (男 14例 ,女 8例 )在停药 10～31年时进行了远期随访。对男性检查精液 ,对女性观察月经和第二性征等。随访年龄 18～ 35岁。结果 (1)男性组 14例中 ,11例作精液检查 ,3例正常 ,8例异常 (2例精子数正常 ,但活动差 ,6例精子数减少 ) ;8例精液异常者中 ,5例有第二性征的改变 ,其中 2例无胡须 ,1例声音变细小 ,2例睾丸较正常小。CTX用药情况 :用药年龄 3～ 14岁。 6例精液异常者 ,CTX剂量 3～ 4.5mg/ (kg·d) ,平均累积总量 5 49mg/kg,总疗程 92～ 15 2d ;3例精液正常者 ,CTX剂量 2～ 2 .5mg/ (kg·d) ,平均累积总量 2 49.8mg/kg ,总疗程 10 5～ 12 0d。 (2 )女性组 8例 ,月经和第二性征均无明显异常改变。CTX剂量 2～ 5mg/(kg·d) ,平均日用量 4.7mg/kg ,累积总量 2 81～ 6 89mg/kg ,平均累积总量 5 87.5mg/kg ,总疗程 98～15 1d ;1例出现习惯性流产 ,余 7例无明显性腺损害。子代共 7人 (3男 ,4女 ) ,生长发育及体格检查均正常。结论 CTX对性腺的远期损害与累积总量及用药时间长短相关 ;卵巢较睾丸对CTX耐受力较强 ;CTX累积总量 <30 0mg/kg ,疗程 <12
Objective To investigate the long-term influences of cyclophosphamide on sexual glands and the effect on offsprings of idiopathic nephrotic syndrome (INS) patients who had received cyclophosphamide treatment. Methods Twenty-two cases with INS, 14 males and 8 females, aged 6.8 years in average, who received cyclophosphamide treatment from 1965 to 1984, were followed up. The sperm routine examination, assessment on menstruation and secondary sexual characters of all the patients were analyzed after discontinuation of cyclophosphamide for 10-31 years, and the other relavant items were examined at the same time. The sperm was obtained by manustupration about five days after the last sperm excretion, then the sperm was put into a small clean vial and checked within twenty minutes. The voice, laryngeal protuberance, and beard were observed and the size of external genital organ also was measured in male group; menstruation and breast development were observed in female group. The above examinations were done by special physicians. The patients, age was 18-35 years during following up. The patients had some clinical symptoms during the period of receiving cyclophosphamide, such as vomiting, nausea, hair loss, granulocytopenia and so on. Results Sperm count was done in 11 of 14 male cases with INS, in whom 3 cases had normal number and normal activity of sperm, 2 had normal number but less activity, and 6 had diminished sperm number. The secondary sexual characters were observed in above 8 cases with abnormal sperm routine test, of whom 3 cases had normal secondary sexual character, 5 cases had abnormal secondary sexual character, of whom 2 cases had no beard, one case had abnormal voice, and 2 cases had testes smaller than normal. No abnormality was found in menstruation and secondary sexual character in female group. Cyclophosphamide was administered at age of 3 to 14 years. Six cases with abnormal sperm had received cyclophosphamide 3-4 mg/ (kg·d) dosage, the mean total dose of cyclophosphamide was 549 mg/kg, total treatment course was 92-152 days; 3 cases with normal sperm had received cyclophosphamide 2-2.5 mg/(kg·d) dosage, the mean total dose of cyclophosphamide was 249.8 mg/kg, total treatment course was 105～ 120 days; 8 female cases received 2-5 mg/(kg·d) dosage, the mean total dose was 587.5 mg/kg, total treatment course was 98-151 days. Habitual abortion occurred in 1 case, others showed no sign of sexual gland damage in female group. Seven offsprings were observed (3 males, 4 females) and all of them had normal growth and development, physical examination were all in normal ranges. Conclusion The long-term sexual gland damage in patients treated with cyclophosphamide was related to its total dose and the course of administration. The function of testes was relatively more sensitive to cyclophosphamide than that of ovary. It was relatively safe when the cumulative dose of cyclophosphamide was less than 300 mg/kg and the course of administration was less than 120 days.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2000年第12期759-761,共3页
Chinese Journal of Pediatrics
关键词
环磷酰胺
儿童
肾病综合征
性腺损害
Nephrotic syndrome
*'Cyclophosphamide
*'Gonad
*'Reproduction
