常用口服降糖药对下丘脑-垂体-性腺轴和性功能的影响

摘要

Oral medications which affect the hypothalamus - pituitary gonadal axis are lack of attention. Sulfonylureas (sulfonylureas, SUs) can stimulate the gonadotropin-releasing hormone (GnRH)secretion in vitro culture of rat hypothalamus front area; Intraventricular injection of SUs can increase circulation of luteinizing hormone (LH) levels, also restore testosterone deficiency rats sexual function. In spite of this, oral SUs l cannot reach high concentrations in central nervous system, so cannot play the role of enhancing sexual function. Metformin inhibits GnRH secretion in cells, suppresses the generation of LH and FSH in cultured pituitary cells, and inhibits testicular testosterone secretion; whereas the early embryonic testicles have potentially adverse impact. However, in the corpus cavernosum, metformin can improve erectile function by increasing the concentration of nitric oxide. TZDS drugs may have inhibitory effect on the function of testosterone synthesis in healthy patients, while improve the erectile function in diabetic patients.%口服降糖药对下丘脑-垂体-性腺轴的影响是目前缺乏足够关注的问题。磺脲类药物(sulfonylureas，SUs)可刺激离体培养的大鼠下丘脑前视区组织块分泌促性腺激素释放激素(gonadotropin- releasing hormone，GnRH)；经脑室内注入的SUs可升高循环中黄体生成素(luteinizing hormone，LH)水平，还可恢复睾酮缺乏大鼠的性功能。尽管如此，口服SUs在中枢无法达到高浓度，故不能发挥增强性功能的作用。二甲双胍可抑制离体培养的GnRH细胞分泌GnRH，抑制原代培养的垂体细胞分泌LH和卵泡刺激素，抑制睾丸分泌睾酮，并对胚胎早期睾丸发育具有潜在的不良影响。然而，在阴茎海绵体局部，二甲双胍可通过增加一氧化氮浓度而改善勃起功能。噻唑烷二酮类药物对健康个体或性功能正常的糖尿病患者的睾酮合成可能具有抑制作用，而在伴有勃起功能障碍的糖尿病患者中则可能改善勃起功能。