Ovarian and uterine characteristics after total body irradiation in childhood and adolescence: Response to sex steroid replacement
Ovarian and uterine characteristics after total body irradiation in childhood and adolescence: Response to sex steroid replacement
复制标题
DOI：
10.1111/j.1471-0528.1999.tb08180.x
复制
发表时间：
1999-12-01
期刊：
影响因子：
--
通讯作者：
Wallace, WHB
中科院分区：
文献类型：
--
作者：
Bath, LE;Critchley, HOD;Wallace, WHB
目的探讨儿童和青少年期全身照射（14.4 Gray）对卵巢和子宫特征的影响，并探讨其对生理性类固醇血清浓度的反应。设计确定了所有在苏格兰儿科中心接受过全身照射治疗的青春期后女性幸存者。对其卵巢和子宫特征进行了研究。招募人员来自随访的肿瘤诊所。确定了9名妇女，其中8人进行了评估，5人进行了详细调查。12名接受急性白血病治疗但未接受全身照射治疗的妇女作为对照，5名没有儿童期恶性肿瘤病史的健康妇女作为对照。方法采用血清促性腺激素和性类固醇测定卵巢功能。通过超声扫描研究卵巢功能衰竭女性对生理性类固醇替代的子宫反应，以及卵巢功能正常女性对内源性性类固醇产生的反应。生理性类固醇替代是通过透皮雌二醇贴片和自我给药阴道孕酮子宫托来实现的。主要观察指标测定卵巢功能和子宫对生理性类固醇血清浓度的反应。结果全身照射治疗的8例女性中有6例卵巢功能衰竭；保存功能在两个女孩治疗青春期前谁有早期卵巢功能衰竭的生化证据。4名卵巢功能衰竭的妇女在基线评估时子宫体积缩小，血液供应检测不到，子宫内膜缺失；生理性类固醇替代治疗3个月后，子宫血供和子宫内膜反应与对照组无显著差异；子宫体积有所改善，但仍明显小于对照组，并与全身照射时的年龄相关。结论全身照射后卵巢功能衰竭较为常见，风险与治疗年龄有关。生理性类固醇替代改善了子宫措施，这些妇女可能受益于辅助生殖技术。
Objective To study the effect of total body irradiation (14.4 Gray) in childhood and adolescence on ovarian and uterine characteristics, and to investigate the response to physiological sex steroid serum concentrations.Design All long term post-pubertal female survivors of total body irradiation who had been treated in paediatric centres in Scotland were identified. Their ovarian and uterine characteristics were studied.Setting Recruitment was from follow up oncology clinics.Sample Nine women were identified, eight of whom were assessed and five progressed to detailed investigation. A control population of 12 women treated for acute leukaemia, but not treated with total body irradiation, and five healthy women with no history of childhood malignancy were recruited as controls.Methods Ovarian function was determined by measurement of serum gonadotrophins and sex steroids. Uterine response to physiological sex steroid replacement was investigated in women with ovarian failure, and to endogenous sex steroid production in women with ovarian function by ultrasound scan. The physiological sex steroid replacement was achieved with transdermal oestradiol patches and self administered vaginal progesterone pessaries.Main outcome measures Determination of ovarian function and uterine response to physiological sex steroid serum concentrations.Results Six of eight women treated with total body irradiation had ovarian failure; preservation of function was seen in two girls treated pre-pubertally who had biochemical evidence of incipient ovarian failure. Four women with ovarian failure had reduced uterine volume, undetectable blood supply and absent endometrium at baseline assessment; after three months of physiological sex steroid replacement treatment uterine blood supply and endometrial response were not significantly different from controls; uterine volume improved but remained significantly smaller than controls and correlated with age at total body irradiation.Conclusions Ovarian failure after total body irradiation is common and risk relates to age at treatment. Physiological sex steroid replacement improved uterine measures and these women may benefit from assisted reproductive technology.