ENDOCRINES IN GYNAECOLOGY
ENDOCRINES IN GYNAECOLOGY
复制标题
DOI：
10.1136/bmj.1.4489.79
复制
发表时间：
1947-01-01
影响因子：
--
通讯作者：
BOURNE, A
中科院分区：
文献类型：
--
作者：
BOURNE, A
毫无疑问，性激素的发现给制药商带来了巨大的布恩，但我们不能对痛苦的病人的益处充满信心。在早期的实验证明了它们对实验室动物生殖系统的结构和功能的显著影响之后，我们对它们在用于治疗女性盆腔疾病时发挥类似的效果寄予厚望。但是，除了一些明确的例外，我们感到非常失望。为什么会这样，原因不难找到。这一医学分支是在1917年由Stockard和Papanicolaou观察到的，即注射Graafian卵泡的液体会引起阴道粘膜的发情变化。从这一基本发现中，我们积累了关于雌激素和孕激素分泌的知识，它们对生殖道发育和子宫内膜周期性变化的影响，以及垂体促性腺激素及其与卵巢的关系。30年来，这项工作的大部分是在小动物和猴子身上进行的实验工作。临床应用的困难这是临床上令人失望的第一个原因。人们希望并期望，通过将这种或那种激素注射到大鼠和兔子身上获得的精确结果将与人类患者获得的结果类似。但是内分泌系统的机制是无限复杂的，不仅在单个物种中，而且在不同物种甚至密切相关的物种中也存在差异。人们很快意识到，从观察一种动物中得出的推论不能安全地用于另一个物种，更不用说另一个物种是人类了。此外，实验工作已经在正常动物或那些遭受严重和完全毁损手术，如切除垂体的动物身上进行。我们的病人不是正常的动物，他们也没有受到严重的外科切除，除了，很少，通过切除两个卵巢。临床经验表明，根据动物对激素治疗的反应所作的推论不能应用于妇女盆腔疾病的平行治疗。另一个困难是人类受试者的足够剂量。合成雌激素现在可以以任何剂量给予，而替代的垂体激素（绒毛膜促性腺激素和马血清激素）可能只能以完全不符合女性体重比例的剂量给予。因为脑垂体的促性腺激素是
There is no doubt that the discovery of the sex hormones has conferred an enormous boon on the drug manufac-turers, but we cannot be so confident of the benefit to the suffering patient. After the early experiments which demonstrated their striking effects on the structure and function of the genital system of laboratory animals we had high hopes that they would exert comparable effects when used for the treatment of pelvic disorders in women. But with some well-defined exceptions we have been grievously disappointed. The reasons why this should be are not far to seek. This branch of medicine was initiated in 1917 by the observation by Stockard and Papanicolaou that injection of the liquor of the Graafian follicle produced oestral changes in the vaginal mucosa. From this fundamental discovery has been built up our knowledge of the secretions of oestrogen and progesterone; of their effect on the development of the genital tract, and on the cyclic changes of the endometrium; later, of the gonadotrophins of thepituitary and their relation to the ovary. The greater part of this work during thirty years has been done byexperimental work on smallanimals and monkeys.Difficulties in Clinical Use Herein lies the first reason for clinical disappointment. It was hoped and expected that the precise result obtained by injecting this or that hormone into rats and rabbits would be similarly obtained with the human patient. But the mechanism of the endocrine system is infinitely com-plex, not only in the individual species but also in its variations in different species even closely allied. It was soon realized that deductions made from observation of one animal could not safely be made for anotherspecies, and still less where the other species was human. Moreover, theexperimental work has been done on either normal animals or those which have suffered a severe and totally mutilating operation, such as ablation of the pituitary gland. Our patients are not normal animals nor have they been subjected to severe surgical mutilation, except, rarely, by removal of both ovaries. Clinical experience has shown that deductions made from tha reactions of animals to hormone treatment cannot be applied to parallel treatment of the pelvic disturbances of women. A further difficulty is adequate dosage for the human subject. Whereas the synthetic oestrogens can now be given inany amount itis probable that the substitute pituitary hormones (chorionic gonadotrophin and mare's serum hormone) can be given only in doses totally inadequate for the proportional weight of a woman. As the pituitary hormones-the gonadotrophins-are the prime