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1.
目的:探讨卵巢早衰(POF)患者血清抑制素B(INHB)、抗苗勒管激素(AMH)及性激素水平与子宫动脉血流参数的相关性。方法:选择2018年5月至2020年5月期间我院收治的126例POF患者(POF组)和同期于我院进行体检的85例健康女性志愿者(对照组)。检测所有研究对象血清INHB、AMH以及促黄体生成素(LH)、促卵泡激素(FSH)、雌二醇(E2)水平,经阴道多普勒超声检测子宫动脉血流参数[收缩期峰值流速(PSV)、舒张末期流速(EDV),血流阻力指数(RI)、搏动指数(PI)]。Pearson相关性分析POF患者血清INHB、AMH、LH、FSH、E2水平与PSV、EDV、RI、PI的相关性。结果:POF组血清INHB、AMH、E2水平、PSV、EDV低于对照组(P<0.05),LH、FSH水平、RI、PI高于对照组(P<0.05)。Pearson相关性分析结果显示POF患者血清INHB、AMH、E2水平与PSV、EDV呈正相关(P<0.05),与RI、PI呈负相关(P<0.05),LH、FSH与PSV、EDV呈负相关(P<0.05),与RI、PI呈正相关(P<0.05)。结论:POF患者血清INHB、AMH、E2水平降低,LH、FSH水平升高,血清INHB、AMH和性激素与子宫动脉血流受限有关。  相似文献   

2.
目的:探讨激素替代周期子宫内膜微创术治疗卵巢早衰患者的临床疗效及安全性。方法:选择2013年12月~2015年12月于我院进行治疗的卵巢早衰患者68例,随机分为实验组与对照组,每组34例,实验组患者采用激素替代周期子宫内膜微创术进行治疗,对照组患者服用中药抗衰复巢汤。比较治疗前后两组患者血清卵泡刺激素(FSH)、促黄体生成素(LH)及雌二醇(E2)水平,同时对两组患者的不良反应情况进行统计,治疗结束后比较两组患者的临床疗效。结果:与治疗前相比,两组患者血清FSH、LH水平均降低,E2水平均升高;治疗结束后,与对照组相比,实验组患者血清FSH、LH水平较低,E2水平较高(P0.05),不良反应发生率较低(P0.05),临床总有效率较高(P0.05)。结论:应用激素替代周期子宫内膜微创术可以减少卵巢早衰患者在治疗后的不良反应,提高临床疗效。  相似文献   

3.
Premature ovarian failure (POF) is characterized by amenorrhea and high serum levels of follicle-stimulating hormone (FSH). POF causes female infertility and represents a substantial women's health risk affecting 1% of women by age 40. Although ovarian autoimmunity has been associated with POF, the identity of ovarian Ags recognized is unknown. In this study, we show that autoimmune-targeted disruption of the pituitary-ovarian axis leads to POF. Immunization of SWXJ female mice with the p215-234 peptide derived from mouse inhibin-alpha activates CD4(+) T cells and induces experimental autoimmune oophoritis with a unique biphasic phenotype characterized by an early stage of enhanced fertility followed by a delayed stage of POF. Affected mice show high serum levels of inhibin-alpha-neutralizing Abs that prevent inhibin-mediated down-regulation of activin-induced pituitary FSH release. The loss of activin/FSH down-regulation leads to prolonged metestrus-diestrus, superovulation, increased numbers of mature follicles, increased offspring, accelerated depletion of primordial follicles, and ultimately premature infertility. Thus, inhibin-alpha-targeted experimental autoimmune oophoritis is initiated by CD4(+) Th1 T cells that stimulate B cells to produce inhibin-alpha-neutralizing Abs directly capable of mediating POF and transferring disease into naive recipients. Our inhibin-alpha autoimmune model of POF shows how premature infertility may develop in the context of elevated FSH levels thereby closely mimicking the hallmark features of human POF.  相似文献   

4.
BACKGROUND: We report a successful pregnancy in a woman with severe ovarian dysfunction and infertility associated with a variant beta-subunit of luteinizing hormone (LH). METHOD/OUTCOME: A 35-year-old woman consulted our unit for infertility. Laparoscopy and ultrasonography showed obstruction of the right tube and ovulation from the right ovary only. Human menopausal gonadotrophin (hMG) therapy was used for six subsequent cycles, but did not result in conception. Subsequently, marked elevation of follicle-stimulating hormone (FSH) and testosterone, together with polycystic ovary (PCO) were noted. The patient failed to respond to ovarian stimulation by hMG. Severe ovarian dysfunction such as premature ovarian failure (POF) was strongly suspected. Sequence analysis of the LH beta-subunit gene indicated heterozygosity for point mutations Trp(8) to Arg(8) and Ile(15) to Thr(15) in the coding sequence. LH hypersecretion resembling that seen in PCO syndrome was observed. Induction of ovulation by hMG was successful in the first cycle in which the basal LH and FSH were well controlled with gonadotrophin-releasing hormone analog following estrogen-progesterone replacement. She conceived and delivered a healthy male infant at term. CONCLUSION: Clinicians should be clinically aware of patients with immunologically anomalous LH variant who might be at risk of developing ovarian failure within a relatively short time span. Pertinent treatment should be applied without delay in such cases.  相似文献   

5.
Among the causes of premature ovarian failure (POF) two groups of factors are reported: factors which lead to decrease of follicular number and factors which stimulate follicular atresia. In the first group genetic factors are the most important whereas in the second: enzymatic autoimmunological, iatrogenic, toxins and infections are reported. In 1986 familiar POF on the background of long arm of chromosome X deletion was reported. Other chromosomes which are important for normal ovarian function are: chromosome 21 (AIRE gene), chromosome 11 (gene of beta FSH, ATM gene), chromosome 3 (gene responsible for BEPS syndrome) and chromosome 2 (genes of FSH and LH receptors). In this review the role of these genes and results of several epidemiological studies are reported.  相似文献   

6.
摘要 目的:分析脐带间充质干细胞对卵巢早衰家兔的治疗效果及机制研究。方法:经腹腔连续注射 2 d 环磷酰胺50 mg/(kg?d)建立卵巢早衰家兔模型。将建模成功的10只家兔随机分成模型组和治疗组,每组5只。建模一周后,治疗组家兔每天经耳缘静脉注射5×106/mL脐带间充质干细胞混悬液2 mL,连续注射3 d。模型组家兔经耳缘静脉注射等量无菌生理盐水。于治疗后 0 d、7 d、14 d和28 d,取家兔静脉血检查血清激素表达水平。于治疗后28 d,检测家兔卵巢中生长卵泡数、封闭卵泡数、黄体数、富半胱氨酸蛋白61(CYR61)和结缔组织生长因子(CTGF)mRNA及蛋白质相对表达量。结果:治疗前,模型组和治疗组家兔血清雌二醇(E2)、促卵泡生成素(FSH)、FSH/黄体生成素(LH)、抑制素B(INHB)和抗苗勒管激素(AMH)、均无显著差异(P>0.05)。与模型组相比,治疗后治疗组家兔血清E2和INHB水平显著上升(P<0.05),FSH水平显著下降(P<0.05),FSH/LH均无显著差异(P>0.05)。随着治疗时间延长,治疗组家兔血清E2和FSH水平周期性波动。治疗28 d后,与模型组相比,治疗组家兔血清AMH水平显著升高(P<0.05);卵巢组织中CYR61和CTGF mRNA及蛋白质相对表达量均显著升高(P<0.05);生长卵泡数显著升高(P<0.05);封闭卵泡数和黄体数均显著降低(P<0.05)。结论:静脉注射脐带间充质干细胞可通过上调CYR61和CTGF的表达,促进卵泡生成,恢复卵巢功能,达到治疗卵巢早衰的临床效应。  相似文献   

7.
王琰  杨瑛  刘兵  陈宥艺  陈冬波 《生物磁学》2011,(10):1844-1846,1850
目的:探讨小鼠骨髓间充质干细胞(MSCs)移植对去氧乙烯基环己烯(VCD)所致卵巢早衰治疗的可行性。方法:采用VCD(160mgkg^-l,day^-1)连续腹腔注射来诱导小鼠卵巢早衰。每侧卵巢注射转染了绿色荧光基因小鼠骨髓来源的MSCs,于移植后14、28天及45天,取各组血液标本及卵巢组织,同时观察小鼠动情周期的变化;酶联免疫法检测血清FSH、LH水平,显微镜下观察MSC在卵巢的分布。结果:MSCs移植后各组均可见绿色荧光,并且主要分布于卵巢间质区,卵巢泡膜细胞区也可见绿色荧光细胞。MSCs组动情周期较实验对照组缩短,FSH与LH水平较实验对照组低,差异具有显著性。结论:骨髓间充质干细胞可改善卵巢早衰小鼠的卵巢内分泌功能,并且长时间存在于卵巢组织。骨髓间充质干细胞可能成为卵巢早衰治疗的新方法。  相似文献   

8.
Previous studies have shown that the ovarian failure in autoimmune‐induced premature ovarian failure (POF) mice could be improved by the transplantation of human placenta‐derived mesenchymal stem cells (hPMSCs); however, the protective mechanism of hPMSCs transplantation on ovarian dysfunction remains unclear. Ovarian dysfunction is closely related to the apoptosis of granulosa cells (GCs). To determine the effects of hPMSCs transplantation on GCs apoptosis, an autoimmune POF mice model was established with zona pellucida glycoprotein 3 (ZP3) peptide. It is reported that the inositol‐requiring enzyme 1α (IRE1α) and its downstream molecules play a central role in the endoplasmic reticulum (ER) stress‐induced apoptosis pathway. So the aim of this study is to investigate whether hPMSCs transplantation attenuated GCs apoptosis via inhibiting ER stress IRE1α signaling pathway. The ovarian dysfunction, follicular dysplasia, and GCs apoptosis were observed in the POF mice. And the IRE1α pathway was activated in ovaries of POF mice, as demonstrated by, increased X‐box binding protein 1 (XBP1), up‐regulated 78 kDa glucose‐regulated protein (GRP78) and caspase‐12. Following transplantation of hPMSCs, the ovarian structure and function were significantly improved in POF mice. In addition, the GCs apoptosis was obviously attenuated and IRE1α pathway was significantly inhibited. Transplantation of hPMSCs suppressed GCs apoptosis‐induced by ER stress IRE1α signaling pathway in POF mice, which might contribute to the hPMSCs transplantation‐mediating ovarian function recovery.  相似文献   

9.
10.
目的:探讨蒙药乌力吉-18对大鼠下丘脑-垂体-卵巢轴相关激素及受体的影响。方法:选取40只健康雌性未孕SD大鼠,随机分为空白组、对照组、乌力吉-18高、低2个剂量组,每组10只。空白组灌胃等体积蒸馏水,对照组灌胃逍遥丸,高、低剂量组分别灌胃2.0 g·kg-1·d-1、1.0 g·kg-1·d-1乌力吉-18,连续给药31学艺术d。采用酶联免疫吸附法测定血清促性腺激素释放激素(GnRH)、促卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E2)及孕酮(PROG)的含量;免疫组化法检测下丘脑组织促性腺激素释放激素(GnRH)、垂体组织促性腺激素释放激素受体(GnRHR)的表达;以蛋白免疫印迹技术检测卵巢组织促卵泡生成素受体(FSHR)、黄体生成素受体(LHR)蛋白表达量。以实时荧光定量PCR检测卵巢组织中FSHR、LHR基因表达量。结果:与空白组比较,乌力吉-18低剂量组可明显升高血清LH含量(P<0.05),上调下丘脑组织GnRH、垂体组织GnRHR表达及卵巢组织FSHR、LHR蛋白表达(P<0.05);乌力吉-18高剂量组可显著升高血清FSH、LH、E2含量(P<0.05),上调下丘脑组织GnRH表达及卵巢组织FSHR表达量(P<0.05),并可显著升高卵巢组织中FSHR、LHR基因表达量(P<0.05);对照组可明显升高血清E2含量(P<0.05)。结论:蒙药乌力吉-18可明显升高血清FSH、LH及E2的含量,促进下丘脑组织GnRH、垂体组织GnRHR及卵巢组织中FSHR、LHR的表达,表明乌力吉-18能够对下丘脑-垂体-卵巢轴相关激素及受体表达产生影响。  相似文献   

11.
A luteinizing hormone/follicle-stimulating hormone-releasing hormone (LH/FSH-RH) test was performed in 70 women with amenorrhoea or anovulatory infertility, or both, and a clomiphene stimulation test was also performed in 24 of these patients. Most patients responded to LH/FSH-RH with significant increases in LH and FSH. In women with gonadal dysgenesis or premature ovarian failure exaggerated responses were observed after LH/FSH-RH and there was no change in high basal LH levels after clomiphene. Patients with absent or impaired responses to LH/FSH-RH failed to respond to clomiphene. All patients with anovulatory menstrual cycles responded to both LH/FSH-RH and clomiphene, while seven out of 13 amenorrhoeic patients with a normal LH/FSH-RH response showed an early LH rise during clomiphene treatment and six were unresponsive. These results suggest a difference between the two groups at hypothalamic level with consequent therapeutic implications.  相似文献   

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13.
目的探讨腹腔镜下卵巢囊肿剥除术中不同止血方法对卵巢良性囊肿患者应激反应、卵巢功能以及T细胞亚群的影响。方法:选取我院于2017年1月~2019年1月间接收的80例卵巢良性囊肿患者,根据随机数字表法分为A组(n=40)和B组(n=40)A组患者术中采用双极电凝止血,B组患者术中采用缝合止血,比较两组患者卵巢功能[卵泡刺激素(FSH)、雌二醇(E2)以及黄体生成素(LH)]、应激反应[促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)以及皮质醇(Cor)]、T细胞亚群及并发症发生率。结果:两组患者术后3个月FSH、LH均升高,但B组低于A组(P<0.05);E2降低,但B组高于A组(P<0.05)。两组患者术后3个月ACTH、NE、Cor均升高,但B组低于A组(P<0.05)。两组患者术后3个月CD3+、CD4+/CD8+、CD4+均降低但B组高于A组(P<0.05);CD8+升高,但B组低于A组(P<0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论:与双极电凝止血相比,腹腔镜下卵巢囊肿剥除术中采用缝合止血可减轻卵巢功能损害,降低应激反应,减轻免疫抑制,且不增加并发症发生率。  相似文献   

14.
目的:探究腹腔镜下卵巢囊肿剥除术后缝合与电凝止血对卵巢功能的影响。方法:选择2014年5月~2015年12月期间我院收治卵巢囊肿患者78例为研究对象,两组患者均行腹腔镜下卵巢囊肿剥除术,根据患者术中止血方式的不同将其分为观察组(41例)和对照组(37例);观察组术中采用双极电凝止血,对照组患者性术中采用缝合止血;观察并比较术后4周、12周两组患者促卵泡生长激素(FSH)、促黄体激素(LH)、雌二醇(E2)及窦状卵泡计数(Shape of sinus follicle count,AFC),对比两组术后12周卵巢功能恢复情况。结果:术后4周两组患者FSH、LH水平较术前升高,E2及AFC水平较术前降低,差异均有统计学意义(P0.05);术后12周对照组FSH、LH、E2及AFC水平与术前比较,差异无统计学意义(P0.05),观察组患者FSH、LH水平较术前升高,E2及AFC水平较术前降低,且观察组患者FSH、LH水平高于对照组,E2及AFC水平低于对照组,差异均有统计学意义(P0.05);术后12周,观察组患者出现排卵异常、经量过少及经期延长的发生率均高于对照组(P0.05)。结论:缝合止血在腹腔镜下卵巢囊肿剥除术止血对患者卵巢功能的损伤作用小于电凝止血,术后卵巢功能恢复快,临床上应当优选缝合止血,降低对卵巢功能的影响。  相似文献   

15.
摘要 目的:研究达英-35治疗多囊卵巢综合征合并不孕症的疗效及对患者血清卵泡刺激素(FSH)、促黄体生成素(LH)、总氧化态(TOS)、抗氧化态(TAS)水平的影响。方法:选取2015年8月至2016年7月我院收治的76例多囊卵巢综合征合并不孕症患者,根据随机数字法分为观察组和对照组,38例每组。对照组使用克罗米芬,观察组在此基础上加以达英-35。比较两组患者临床疗效,治疗前后血清FSH、LH、TOS、TAS水平、卵泡数、卵巢体积、体重指数的变化及不良反应的发生情况。结果:治疗后,观察组临床总有效率显著高于对照组[89.47%(34/38) vs. 60.53%(23/38)](P<0.05);两组患者的血清FSH、LH、TOS水平、卵泡数、卵巢体积、体重指数明显减少较治疗前均显著降低(P<0.05),而血清TAS水平较治疗前显著上升(P<0.05),且观察组的血清FSH、LH、水平明显低于对照组(P<0.05),而血清TAS水平显著高于对照组(P<0.05)。观察组和对照组的不良反应的发生率比较无明显差异(P>0.05)。结论:达英-35治疗多囊卵巢综合征合并不孕症患者能有效提高患者的临床疗效和改善其临床症状,且安全性高,这可能与其有效改善患者血清FSH、LH、TOS、TAS水平有关。  相似文献   

16.
This study compared serum and follicular fluid inhibin and gonadotropin profiles between chronic cystic ovarian diseased (CCOD) and normal cyclic dairy cows. Blood samples and follicular fluid were collected from CCOD cows (n=15) and cyclic cows in the follicular phase of the estrous cycle (control, n=6) and analyzed for inhibin, follicle stimulating hormone (FSH) and luteinizing hormone (LH) concentrations. There was a significant increase in inhibin and a decrease in FSH and LH concentrations in the follicular fluid of CCOD cows compared with those of cyclic cows (P < 0.05). Mean serum inhibin, FSH and LH concentrations between CCOD and cyclic cows were not differnt (P > 0.05), however, there was a tendency for serum inhibin to be higher and FSH to be lower in CCOD cows compared to cyclic animals (P < 0.1). The FSH pulse frequency also was lower in CCOD cows than in cyclic cows (P < 0.05). These data suggest that increased production of inhibin from cystic follicles of CCOD cows alters pituitary FSH secretion and subsequently reduces the concentration of FSH in follicular fluid. As a result, decreased FSH stimulation at the ovarian level could ultimately lead to the reduction in follicular LH and FSH receptor concentrations, resulting in abnormal follicular steroidogenesis in CCOD dairy cows.  相似文献   

17.
姜彩霞  麻莉  丁晓萍  海宁  隋东强 《生物磁学》2013,(35):6956-6959
目的:探讨腹腔镜卵巢囊肿剥除术中采用序贯式止血法对卵巢功能的影响。方法:将100例行腹腔镜卵巢囊肿剥除术患者按照抽签法随机地均分为对照组与观察组,对照组给予传统双极电凝治疗,观察组采取序贯式止血法,靠近卵巢门的髓质出血镜下缝合,远离卵巢门行皮质渗血电凝处理。比较两组患者手术前后雌二醇(Estradiol,E2)、促卵泡激素(Follicle-stimulating hormonc,FSH)、促黄体生成素(Luteotropic hormone,LH)及围绝经期综合征发生情况。结果:对照组术前与术后3个月及术后6个月E2、FSH及LH差异均具有统计学意义,观察组手术前后激素水平差异无统计学意义,且观察组术后与对照组术后上述指标差异均具有统计学意义;对照组患者术后月经紊乱、植物神经功能紊乱的发生率分别为14.00%与12.00%,观察组为2.00%及0%,两组差异具有显著的统计学意义。结论:序贯式止血法应用于腹腔镜卵巢囊肿剥除术中影响卵巢功能,效果显著,值得在临床上加以推广并应用。  相似文献   

18.
Chronic (2-4 days) constant-rate infusions of mammalian gonadotropin releasing hormone (GnRH) were performed in female bullfrogs, Rana catesbeiana. The magnitude and temporal relationship of profiles of plasma follicle-stimulating hormone (FSH), luteinizing hormone (LH) and sex steroids [testosterone (T), estradiol-17 beta (E2) and progesterone (P)] during GnRH infusion were dependent on ovarian stage. However, in all females, the same biphasic increase in plasma gonadotropins was apparent and initial elevations in gonadotropins were accompanied by correlated increments in plasma T and E2. Complete pituitary "desensitization" to chronic GnRH infusion was not observed. Females in early follicular stages were relatively unresponsive to infusions of 1.0-10.0 micrograms/h GnRH; elevations in plasma LH were marginal and FSH was unchanged. Females with fully developed (preovulatory) ovaries were more responsive: infusion of 1.0 micrograms/h GnRH produced significant elevations in plasma LH by 2 h followed by even larger increases ("surges") after 12 h. This LH "surge" was preceded by a decline in plasma T and E2 and was accompanied by abrupt elevations in plasma P and by ovulation. Postovulatory females showed a more gradual and smaller increase in plasma LH. Infusion of GnRH in the female bullfrog establishes a clear relationship between pituitary responsiveness and the ovarian cycle not evident from acute GnRH injection; GnRH was most effective immediately before ovulation. These data are also the first to detail periovulatory changes in plasma gonadotropins and ovarian steroids in an amphibian.  相似文献   

19.
摘要 目的:分析血清骨钙素(OC)、血小板反应蛋白-1(TSP-1)、血管生成素样蛋白2(ANGPTL2)与多囊卵巢综合征(PCOS)患者胰岛素抵抗(IR)、性激素和卵巢间质血流的关系。方法:选取2020年1月~2022年4月内蒙古自治区人民医院收治的125例PCOS患者(PCOS组),根据稳态模型评估(HOMA)-IR分为IR组68例和非IR组57例,另选取同期67例体检健康成年女性(对照组)。收集研究对象HOMA-IR和性激素、卵巢间质血流指标,采用酶联免疫吸附法检测血清OC、TSP-1、ANGPTL2水平。比较PCOS组与对照组、IR组与非IR组之间性激素、卵巢间质血流指标、血清OC、TSP-1、ANGPTL2水平的差异。采用Pearson/Spearman相关性分析法分析PCOS患者血清OC、TSP-1、ANGPTL2水平与HOMA-IR、性激素和卵巢间质血流指标的相关性。结果:PCOS组HOMA-IR、黄体生成素(LH)、LH/促卵泡生成素(FSH)、睾酮(T)、收缩期峰值速度(PSV)、ANGPTL2水平高于对照组,搏动指数(PI)和阻力指数(RI)、OC、TSP-1水平低于对照组(P<0.05)。IR组LH、LH/FSH、T、PSV、ANGPTL2水平高于非IR组,PI、RI、OC、TSP-1水平低于非IR组(P<0.05)。Pearson/Spearman相关性分析显示,PCOS患者血清OC、TSP-1水平与HOMA-IR、LH、LH/FSH、T、PSV呈负相关,与PI、RI呈正相关(P<0.05);血清ANGPTL2水平与PCOS患者HOMA-IR、LH、LH/FSH、T、PSV呈正相关,与PI、RI呈负相关(P<0.05)。结论:血清OC、TSP-1在PCOS患者血清中低表达,ANGPTL2在PCOS患者血清中高表达,三者与PCOS患者IR、性激素和卵巢间质血流密切相关。  相似文献   

20.
Follicle-stimulating hormone (FSH) enhances the conversion of testosterone or androstenedione into estradiol by stimulating the aromatase enzyme system. Estradiol also enhances FSH action. Thus, a synergistic action of FSH and estradiol may be required for maturation of ovarian follicles. We hypothesized that estradiol may be required for FSH action. Thus, blocking estrogen synthesis should prevent FSH-induced increases in FSH receptors. Hypophysectomized rats were divided into five groups and injected subcutaneously with: 1) saline, 2) cyanoketone (0.05 mg, blocks the conversion of pregnenolone to progesterone), 3) ovine FSH (oFSH, 200 micrograms), 4) cyanoketone then oFSH 24 h later, or 5) cyanoketone plus estradiol [or progesterone, testosterone, promegestrone (R5020), dihydrotestosterone (DHT), 2 mg], then FSH 24 h later. Animals were decapitated at 0, 12 or 24 h after an injection of oFSH, and membrane receptors for FSH and luteinizing hormone (LH), plus nuclear receptors for estradiol from granulosa cells, were measured. LH receptor levels were increased only after administration of FSH and estradiol. At 0 and 24 h, numbers of FSH or estradiol receptors were similar in saline- and cyanoketone-treated animals. FSH alone increased (P less than 0.01) FSH and estradiol receptors 3-fold and 4-fold, respectively, over controls by 12 and 24 h. Cyanoketone prevented these increases in FSH and estradiol receptors. Estradiol replacement fully reversed the effects of cyanoketone on FSH action. Replacement with progesterone and testosterone was able to only partially restore levels of FSH receptors; however, estradiol receptor numbers were also increased.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

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