Sexually Transmitted Disease Statistics
Sexually Transmitted Disease Statistics
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性传播疾病统计
DOI：
10.1177/014107688207500103
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发表时间：
1982
影响因子：
17.3
通讯作者：
M. Adler
中科院分区：
文献类型：
--
作者：
M. Adler
详细介绍了这些检测的重要性（Scammell、McGarrick、Chamberlain 和 Jeffcoate，正在准备中），并得出结论：高催乳素血症是内分泌学中最被过度诊断的病症！另外 25% 是雄激素检测的请求。这些要求可能反映了我们医院对雄激素相关问题的特殊兴趣。在实践中，我们的经验是，雄激素测定虽然通常具有相关性和兴趣，但在个体患者的管理中通常不具有直接的临床价值。我们约 20% 的常规请求是血浆黄体酮，以确认或排除不孕症患者、月经规律的患者以及诱导排卵后的排卵。这些检测仅在黄体中期有价值，并且在月经稀发患者中难以解释。它们对于闭经和周期的卵泡期没有用处。虽然上述内容是不言而喻的，但滥用我们服务的情况仍然存在。识别所谓的“黄体期缺陷”需要重复测量黄体酮，以确定分泌量或持续时间减少的模式。这种情况（如果存在）不能仅根据一两次黄体酮测定来诊断。尽管黄体生成素 (LH) 和卵泡刺激素 (FSH) 检测的值有些不同，但垂体促性腺激素检测（约占请求的 15%）几乎总是一起进行。无论发生在什么年龄，原发性卵巢功能衰竭患者的两者都会升高，但 FSH 在这方面是一个更好的判别因素。多囊卵巢综合征的一个重要生化特征是 LH: FSH 比率升高。促性腺激素测定对于月经规律的患者几乎没有价值，除非在预期的周期中期点附近频繁采集样本。我们医院使用两种不同的雌二醇检测方法：其中一种是有用的，而且确实是必要的；另一种是有用的，实际上是必要的；另一种是有用的，而且是必需的。另一个，几乎没用。快速（2 小时）血浆雌二醇测定用于监测排卵诱导，并且由于当天即可获得结果，因此可以适当调整剂量。一种长期的、分析更准确的雌二醇测定法也在使用中。对于有卵巢功能衰竭证据的患者，尤其是围绝经期患者，通常会要求进行此检查。在我看来，通过仔细询问病史、检查患者及其阴道细胞学以及进行简单的生物测定（例如孕激素戒断试验），妇科医生可以更快、更准确地了解患者的雌激素状态。准确预测内分泌学在妇科中的应用的未来发展是不可能的。可以看出两种趋势可能会变得突出。首先，许多人现在认识到外周血浆中激素浓度的估计并不一定反映激素的生物学意义。组织结合和终末器官反应的测试很可能会被设计出来并应用于临床。其次，随着分析方法变得更加强大，它们也变得更简单、更便宜（就像计算机一样）。使用简单技术（例如使用“量油棒”）的床边病理学正在取得进展，这将逐渐缩小实验室和临床医生之间的差距，并将激素分析带到离患者最有效的地方。伦敦切尔西妇女医院生化内分泌学 S L Jeffcoate 教授
significance of these assays in detail (Scammell, McGarrick, Chamberlain & Jeffcoate, in preparation) and concluded that hyperprolactinaemia is the most over-diagnosed condition in endocrinology! A further 25% are requests for androgen assays. These requests may reflect the special interest of our hospital in androgen-related problems. In practice, our experience is that androgen assays, whilst often of relevance and interest, are not often of direct clinical value in the management of the individual patient. About 20% of our routine requests are for plasma progesterone to confirm or exclude ovulation in patients with infertility and regular menstruation and after induction of ovulation. The assays are of value only in the mid-luteal phase and are difficult to interpret in patients with oligomenorrhoea. They are useless in amenorrhoea and in the follicular phase of the cycle. Whilst the foregoing should be self-evident, abuses of our service still do occur. Identification of the so-called 'defective luteal phase' requires repeated progesterone measurements to establish a secretion pattern reduced either in amount or duration. This condition, if it exists, cannot be diagnosed on the basis of only one or two progesterone assays. The pituitary gonadotrophin assays (about 15% of requests) are nearly always done together, although the value of luteinising hormone (LH) and follicle-stimulating hormone (FSH) assays are somewhat different. Both will be elevated in patients with primary ovarian failure at whatever age this occurs, but FSH is a better discriminant in this respect. An important biochemical feature of the polycystic ovary syndrome is an increase in the LH: FSH ratio. Gonadotrophin assays are rarely of value in patients with regular menstruation unless frequent samples are taken around the expected mid-cycle point. Two distinct oestradiol assays are in use in our hospital: one of them is useful, indeed essential; the other, almost useless. A quick (2 hour) plasma oestradiol assay is used to monitor induction of ovulation and as the results are available the same day this allows appropriate adjustment of the dosage. A long, analytically more accurate, oestradiol assay is also in use. This is often requested for patients with evidence of ovarian failure, especially those in the perimenopausal period. In my view the gynaecologist can obtain a quicker and biologically more accurate idea of the oestrogen status of the patient by taking a careful history, examining the patient and her vaginal cytology and by doing a simple bioassay such as a progestogen-withdrawal test. It is impossible to predict precisely any future developments in the application of endocrinology to gynaecology. Two trends may be discerned which may become prominent. First, many now recognize that the estimation of hormone concentrations in peripheral plasma does not necessarily reflect the biological significance of the hormone. It is likely that tests of tissue binding and end-organ response will be devised and applied clinically. Secondly, as analytical methods become more powerful they also become simpler and cheaper (like computers). There is a development towards bedside pathology using simple techniques (e.g. with 'dip-sticks') which will progressively erode the gap between the laboratory and the clinician and bring hormone analyses to the place where they are most effective close to the patient. S L Jeffcoate Professor of Biochemical Endocrinology Chelsea Hospital for Women, London