男性性激素测定.ppt

单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Company Logo,*,单击此处编辑母版标题样式,看山是山，看水是水,看山不是山，看水不是水,Company Logo,+DHT,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 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 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,DHT,T,Company Logo,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,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 Practice Guideline.J Clin Endocrinol Metab 95:25362559,2010,雄激素缺乏的常见症状,/,体征,特异性较高的症状,/,体征,特异性较低症状,/,体征,性发育迟缓或不全,乏力、精力减退、缺少自信,性欲减退,抑郁,勃起功能障碍,注意力以及记忆力下降,不育,睡眠障碍,小睾丸（,5ml,）,轻度贫血,毛发减少,肌肉容量及肌力下降,乳腺不适，男子女性型乳房,脂肪增多,骨质疏松,体重指数增加,面色潮红、多汗,体格下降及工作效率下降,LOH,各国指南及诊断标准,指南,发表时间,LOH,诊断标准,男性迟发性性腺功能减退症的观察、治疗和检测,2008,症状、体征,TT8nmol/L,如,TT,在,8-12nmol/L,之间，则需重新测定或计算,FT,，,FT225pmol/L,男性性腺功能减退症诊疗手册,2009,用,AMS,或,ADAM,量表评估症状,根据出现症状提示，结合,TT11.5nmol/L,成年男性睾酮缺乏综合征的睾酮治疗,2010,症状、体征,TT8nmol/L,如,TT,在,8-12nmol/L,之间，则需重新测定或计算,FT,，,FT225pg/mL,男性迟发性性腺功能减退症指南,2012,症状、体征,TT8nmol/L,如,TT,在,8-11nmol/L,之间，,FT220pg/mL,男科学,-,睾酮治疗,2012,症状、体征,TT8nmol/L,如,TT,在,8-12nmol/L,之间，,FT21).,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.ch,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,31,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 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 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,Table,LUTS,睾酮,T,5-Rs,Company Logo,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%,and 12%95%confidence interval 2.1%to21.7%in the lower,middle,and upper testosterone tertiles,respectively;Fig.1).,Company Logo,Thank You!,Add your company slogan,