肾移植受者性功能变化及女性受者妊娠、子代健康研究
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摘要
慢性肾功能衰竭(Chronic Renal Failure, CRF)是一种由各种病因引起的肾脏损害,并进行性恶化的结果,它是威胁人类健康的常见疾病之一,自然人群发病率为(50-200)人/100万人,近年来平均约以每年8%的速度增加。慢性肾功能衰竭终末期称为尿毒症,是各种病因引起肾脏损害并进行性恶化至终末期、肾功能接近于正常的十分之一左右时出现的一系列综合症状。其发病机制目前尚未明了。除外目前解释CRF的肾小球高灌注、高压力、高滤过,肾小球囊内高压,肾小管高代谢及肾脏代偿性肥大等理论,肾小球和肾间质的变化：肾小球、肾小管间质细胞及肾脏浸润细胞产生的大量细胞因子,也参与了肾功能恶化的过程。
当慢性肾功能衰竭进展到尿毒症期,需要进行肾脏替代性治疗,而肾移植是公认的治疗尿毒症最有效的方法。20世纪70年代,1年尸肾移植物存活率为40%-50%,80年代达到90%以上；2009年,有统计显示肾移植患者十年存活率已经超过60%。全球己累计施行肾移植手术75万例,其中,我国己累计实施86800例,目前每年进行肾移植手术6000例左右。
慢性肾功能衰竭(CRF)患者普遍存在下丘脑-垂体-性腺轴功能异常。性功能障碍是慢性肾功能衰竭男性和女性患者的常见临床表现。慢性肾功能衰竭女性患者性功能障碍的患病风险较健康女性高。月经周期异常与性功能障碍如性欲减退、性高潮缺乏等有关,特别是发生于大部分长期透析治疗的成年女性患者的闭经。患有慢性肾功能衰竭的女性经常会出现性欲减退、难以达到性高潮的情况；而女性尿毒症患者的性生活质量更容易受到血液透析的影响,表现为性生活频次降低、性欲减退和性功能障碍。
慢性肾功能衰竭被认为是阴茎勃起功能障碍(ED)的重要的危险因素。肾移植术后的勃起功能障碍是影响肾移植患者生活质量的重要因素。阴茎勃起功能障碍严重影响患者的生活质量,并可以引起焦虑、丧失自信、缺乏想象、抑郁、人际关系缺乏、丧失自尊等心理障碍。
自1954年Murry教授成功实施第1例挛生兄弟间的肾移植以来,肾脏移植技术在世界各地蓬勃开展,基础和临床研究的学者们克服了免疫、外科技术、伦理等诸多难题,使肾脏移植技术不断走向完善。随着现代的生物医学模式向生物-心理-社会医学模式的转变,生活质量成为肾移植术后患者新的健康指标。对于肾移植患者而言,移植手术仅是第一步,移植肾的存活固然重要,但患者的生活质量和整个身心健康更为重要。而且近年来肾移植受者的生存率和生活质量已经有了显著提高,术后并发症减少,因此其他的评估目标显得更加重要。性功能是肾移植术后患者生活质量重要的组成部分之一,患者的性功能问题已经成为影响其生活质量的重要因素,而有关此部分的研究有限。
第1章肾移植前后绝经期前成年女性性功能评估
目的研究绝经期前成年女性受者肾移植前、后的性功能改变。
方法2009年至2011年在我院接受肾移植手术的女性受者中,将患病前有性生活及术后移植肾功能恢复良好的42例女性受者纳入本研究。入组标准：已婚女性、25～45岁、未停经、透析治疗超过6个月、移植后肾功能恢复正常(血清肌酐44-133μmol/L、GFR>90ml/min)超过6个月。排除标准：子宫和／或卵巢切除术病史、既往高催乳素血症病史、脑垂体疾病、膀胱过度活动症、精神障碍性疾病。共入组女性受者42例。统计肾移植前后月经周期情况、检验患者手术前后性激素水平。采用女性性功能指数(female sexual function index, FSFI)量表分别评估术前、术后患者的性功能。
结果1、肾移植前闭经、月经稀发、月经频发及月经正常的患者分别有18例(42.9%)、10例(23.8%)、5例(11.9%)、9例(21.4%),移植后分别为7例(16.7%)、5例(11.9%)、6例(14.3%)、24例(57.1%)。
2、肾移植后催乳素(PRL)、卵泡刺激素(FSH)及黄体生成素(LH)较肾移植前明显降低,分别由移植前的89.99±27.96ng/ml、34.75±19.26mIU/ml、39.65±17.87mIU/ml降至39.52±26.06ng/ml、11.51±6.0mIU/ml、6.99±4.67mIU/ml。差异有统计学意义(P<0.001)。移植后雌二醇(E2)和孕酮(P)较移植前升高,移植前血清E2、P水平分别为90.01±37.91mIU/ml、20.28±13.83ng/ml,而移植后二者则升高至166.48±62.39mIU/ml、42.51±18.73ng/ml,差异有统计学意义(P<0.001)。
3、移植前19例(45.2%)、术后36例(85.7%)受者有性生活。肾移植前、后女性性功能障碍(FSD)的总发病率分别为90.5%、40.5%(P<0.001)。肾移植前FSFI评分中性欲、性唤起、阴道润滑、性满意度、性高潮及性交痛领域的分值显著低于肾移植后(P<0.001)。移植前患者性欲、性唤起、阴道润滑、性高潮、性满意度、及性交痛评分分别为2.68±1.27、2.43+1.26、2.05±1.39、3.0±1.64、3.15±1.45、3.46±1.24,而移植后此六领域评分分别升高为4.16±1.23、4.49±1.10、4.28±1.21、4.42±1.12、4.38±1.18、4.52±1.22,FSFI各领域评分移植前后差异有统计学意义(P<0.001)。
4、移植前诊断为性功能障碍的15例患者,其移植后FSFI总分及各领域的评分均较移植前明显提高。移植前患者性欲、性唤起、阴道润滑、性高潮、性满意度、及性交痛评分分别为2.49±1.34、2.08±1.27、1.77±1.10、2.68+1.28、2.53+1.05、2.36±1.56,而移植后此六领域评分分别升高为4.18+1.32、4.33±1.30、4.17±±1.39、4.63+0.93、4.31±1.52、4.69±±0.98,FSFI各领域评分移植前后差异有统计学意义(P<0.001)。
结论移植术后肾功能恢复正常后成年女性受者的性功能能够明显改善,性激素水平较移植前明显好转。
第2章肾移植术前后男性受者的性功能变化
目的调查和评价肾移植术前后男性受者的性功能变化状况。
方法1、选择1998—2010年间在我院接受肾移植的4126例受者,将其中患病前有正常性生活及术后移植肾功能恢复良好的男性受者60例纳入本研究。采用问卷调查法对全部60例受者术后首次遗精时间、性生活频次及满意率进行评估。分别于透析期间及术后3个月时采集受者的精液行常规检查,将精子的活动力、存活率及畸形指数作为观察指标。30例健康成年男性作为对照组,对比移植前后精子的活动力、存活率及畸形指数。
2、统计学方法：应用SPSS13.0统计分析软件对数据进行分析,计量资料采用均数±标准差(x±s)表示,对照组分别与移植前、移植后组比较采用one-way ANOVA,若方差齐性,用LSD(Least Significant Difference)法；若方差不齐,用Dunnett's T3方法。配对计量资料的比较采用配对t检验,两组间率的比较采用χ2检验,P<0.05为差异有统计学意义。
结果60例受者中,54例在术后平均48.5d(30～92d)出现首次遗精。移植前受者的精子活动力、存活率及畸形指数指标明显低于健康对照组,差异均有统计学意义(P<0.001)；移植后受者的上述指标均明显好转,术前比较,差异有统计学意义(P<0.001)。移植后精子活动力、存活率与健康对照组比较,差异无统计学意义(P=0.195、P=0.798),而精子畸形指数与健康对照组比较,差异有统计学意义(P=0.002)。患病前所有60例(100%)受者均有性生活能力,其中49例(81.7%)受者性生活频次为2～9次/月,性生活满意率为96.7%(58/60)；而患病后(移植前)50例(83.3%)患者没有性生活,仅10例(16.7%)有性生活,且性生活满意率为5%(3/60)。移植后除4例受者担心性生活会损害移植肾功能拒绝性生活外,其余56例(93.3%)受者均恢复性生活能力,且其中46例(76.7%)受者的性生活频次为2～9次/月,性生活满意率为86.7%(52/60)。术后有性生活能力的受者比例、性生活频次及性生活满意率与术前比较均明显提高。移植后男性受者性生活满意率较移植前明显升高,差异有统计学意义(P<0.001)。移植后男性受者性生活满意率与对照组相比稍有下降。
结论肾移植术后男性受者在移植肾功能恢复正常后,性生活频次及性生活满意率可得到明显改善,大部分受者可以恢复接近患病前水平；移植后精子活动力、存活率及畸形指数指标较移植前明显好转。
第3章女性肾移植受者妊娠结果及子代健康状况研究
目的评价女性肾移植受者妊娠结果及子代健康状况的长期随访结果。
方法回顾性分析1978年4月至2011年4月妊娠>5个月的15例肾移植受者资料,并对其子代进行随访。
结果1、15例受者采用以环孢素(CsA)或他克莫司(Tac)为主的免疫抑制剂方案。12例母、子女身体状况及移植肾功能正常；1例产下一男婴2周后因并发肺部感染、心力衰竭,带正常功能移植肾死亡；2例分别于妊娠第21、23周发生移植肾慢性排斥反应,终止妊娠,经治疗无效后摘除移植肾。13例胎儿均经剖宫产娩出后存活,胎龄(39.5±1.3)周,新生儿体重(2.58±1.44)kg, Apgar评分均为10分。13例婴儿出生时无生理缺陷,体格发育无异,出生后以人工喂养。13例儿童智力、体格以及心理发育与同龄者无异常,7例在婴幼儿期(0-2岁)存在反复呼吸道感染,1例诊断为注意力缺陷多动障碍。目前子代中年龄最大21岁,最小3岁。
2、按照受者服用的主要免疫抑制剂分为CsA组、Tac组。CsA组、Tac组移植孕妇的受孕年龄分别为29.5±3.2岁、29.0±±3.9岁,二者差异无统计学意义(t=0.253,P=0.805)。两组移植至受孕时间分别为64.4+12.6月和41.2±17.9月,差异无统计学意义。CsA组、Tac组新生儿在胎龄、体重、身长方面差异均无统计学意义(t=0.710,P=0.492;t=.0.659,P=0.524；t=0.258,P=0.801).
结论严格妊娠指征,肾移植女性受者可以成功妊娠、分娩,但孕期前后及产后应严密评估、随访,以确保子代、移植肾以及受者自身的安全。
Chronic renal failure (CRF) is caused by a variety of causes kidney damage and results of progressive deterioration. it is a threat to human health, with natural population incidence rate (50-200)/100people in recent years, an average of about increase rate of8%per year. Chronic renal failure or uremia in severe condition is not an independent disease. A variety of reasons cause kidney damage and progressive deterioration. A series of complex symptom will appear when renal function decreased to about10%of normal. Etiological mechanisms of CRF are yet unclear. Currently, hypothesis about CRF mainly on glomerular perfusion, high-pressure, high filtration; glomerular capsule pressure, high metabolism of renal tubular and compensatory hypertrophy, glomerular and interstitial changes:renal glomerular cells, tubular cells and infiltrating cells produce a large number of cytokines which involve in the process of renal function deterioration.
The hypothalamic-pituitary-gonadal axis dysfunction is widespread among patients with chronic renal failure (CRF). Sexual dysfunction is a common clinical manifestation of CRF male and female patients. The risk of female sexual dysfunction in patients with chronic renal failure is higher than in healthy women. Abnormal menstrual cycle and sexual dysfunction, such as loss of libido, lack of orgasm, especially amenorrhea occurs in the majority of long-term dialysis treatment of adult female patients. Abnormal menstrual cycle concerned with sexual dysfunction, such as loss of libido, lack of orgasm, especially amenorrhea which occurs in the majority of long-term dialysis treatment of adult female patients. Female patients with chronic renal failure often suffer some symptoms such as loss of libido, difficulty to reach orgasm. Sexual quality of life of female uremic patients is susceptible to the impact of hemodialysis, which expressed as reduction of frequency of sex, loss of libido and sexual dysfunction.
Chronic renal failure is considered to be one of important risk factors for erectile dysfunction. Erectile dysfunction after renal transplantation is an important factor affecting patients'quality of life after kidney transplantation. Erectile dysfunction seriously affects the quality of life of patients, causes anxiety, loss of self-confidence, lack of imagination, depression, lack of interpersonal relationships, loss of self-esteem and other psychological disorder.
Since the first successful kidney transplantation between identical twins was conducted by Pro. Murry in1954, the renal transplantation has been widely used all over the world. And scholars of basic and clinical researches have overcome numerous difficulties in terms of immunology, surgical techniques and ethnics, which pave the way for the development of renal transplantation. With the transformation of the modern biomedical model to biological-psychological-social model, the quality of life becomes a new health indicator in patients after renal transplantation. For kidney transplant patients, transplant surgery is only the first step. The transplanted kidney survival is important, however, the patient's quality of life and physical and mental health is more important. Survival rates and quality of life of renal transplant recipients in recent years has been significantly improved, and postoperative complications decreased. So, other assessment objective is even more important. Sexual function is an important part of the quality of life of patients after renal transplantation; the patient's sexual function problems have become important factors that affect the quality of life, but study about this part is rather limited.
Chapter1Investigation of sexual function in premenopausal women before and after renal transplantation
Objective To study sexual function in adult premenopausal women before and after renal transplantation.
Methods1.From2009to2011,in our hospital female recipients received kidney transplantation, normal sexual life before the illness and renal function returned to normal after surgery. Inclusion criteria:married women,25to45years old, not menopause, dialysis treatment over six months, normal renal function (serum creatinine44-133μmol/L, GFR>90ml/min) over six months after transplantation. Exclusion criteria:uterine and/or ovarian resection history, previous history of hyperprolactinemia, pituitary disease, overactive bladder, mental disorders were excluded. A total of42women were enrolled in the study.All women underwent a hormonal profile determination, calculated menstrual cycles, and filled out the Female Sexual Function Index (FSFI) administered before and6months after transplantation.
2. Statistical Analysis:All data used SPSS13.0statistical analysis software. Measurement data are expressed as mean±standard deviation (x±s). Differences among the paired measurement data were analyzed by paired t-test. P<0.05was considered statistically significant.
Results1. Before kidney transplantation the cases of amenorrhea, Oligomenorrhea, polimenorrhea, and eumenorrhea were18cases (42.9%),10cases (23.8%),5cases (11.9%) and9cases (21.4%) respectively. After transplantation the cases were7cases (16.7%),5cases (11.9%),6cases (14.3%) and24cases (57.1%) respectively.
2. After renal transplantation prolactin (PRL), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) significantly decreased. The level of PRL, FSH, and LH before transplantation was89.99±27.96ng/ml,34.75±19.26mIU/ml,39.65±17.87mIU/ml. After renal transplantation the level of PRL, FSH and LH dropped to39.52±26.06ng/ml,11.51±6.0mIU/ml,6.99±4.67mIU/ml.The differences among two groups were significant (P<0.001). Estradiol (E2) and progesterone (P) increased compared with the preoperative (P<0.001). The level of E2, P before transplantation was90.01±37.91mIU/ml,20.28±13.83ng/ml. After renal transplantation the level of E2and P increased to166.48±62.39mIU/ml,42.51±18.73ng/ml.The differences among two groups were significant (P<0.001).
3. Nineteen patients (45.2%),36patients(85.7%) before and after surgery respectively acknowledged having an active sexual life. The total incidence of Female Sexual dysfunction (FSD) before and after kidney transplant were90.5%,40.5%(P <0.001).The scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were significantly lower than scores after kidney transplant(P<0.001). The scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were2.68±1.27,2.43±1.26,2.05±1.39,3.0±1.64,3.15±1.45,3.46±1.24respectively. The scores in the six areas above in the post-transplant increased to4.16±1.23,4.49±1.10,4.28±1.21,4.42±1.12,4.38±1.18,4.52±1.22, respectively. The differences of the scores in the six areas between before and after transplantation were significant (P<0.001).
4.15patients were diagnosed with heart disease sexual dysfunction before renal transplantation. Their scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were significantly increased after kidney transplant. The scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were2.49±1.34,2.08±1.27,1.77±1.10,2.68±1.28,2.53±1.05,2.36±1.56, respectively. The scores in the six areas above in the post-transplant increased to4.18±1.32,4.33±1.30,4.17±1.39,4.63±0.93,4.31±1.52,4.69±0.98. The differences of the scores in the six areas between before and after transplantation were significant (P<0.001)
Conclusions A successful transplantation should significantly improve sexual function in premenopausal women, significant improvement in sex hormone levels after transplantation.
Chapter2Investigation of sexual function in male kidney transplant recipients
Objective To investigate and evaluate sexual function in male kidney transplant recipients
Method1、A total of60patients were enrolled in the study,who received a kidney transplant at our hospital between1998-2010. The patients have normal sex activities before illness and have good renal graft function after transplant. Questionnaires used to investigate the first spermatorrhea, sexual ability, sexual frequency and satisfaction rate of all60cases after surgery. Were collected during dialysis and after3months, underwent routine checks of recipients of semen, sperm motility, survival and deformity index as the observed indicators.30healthy adult males as a control group, compared sperm motility, survival, deformity index, the ability of sex life and sexual satisfaction rate indicators before and after transplantation.
2、Statistical Analysis:All data used SPSS13.0statistical analysis software. Measurement data are expressed as mean±standard deviation (x±s). Differences among groups were analyzed by One-way ANOVA. LSD (Least Significant Difference) method should be used in the case of homogeneity of variance; otherwise Dunnett's T3methods should be used in the case of variance nonhomogeneity. Differences among the paired measurement data were analyzed by paired t-test.Chi-square was used to compare the rates between two groups.P<0.05was considered statistically significant.
Result Following the graft function gradually regained.54patients had spermatorrhea in the30-92days after transplantation, and other six cases did not have spermatorrhea because of sexual life.
The sperm motility, survival and deformity index in patients before transplant were significantly lower than the healthy control group, the differences among two groups were significant (P<0.001). The above parameters were significantly improved after transplantation, the differences between groups before and after transplantation were also significant (.P<0.001).The differences of sperm motility, survival between patients before transplant and the healthy control group were not significant (P=0.195、P=0.798). The sperm deformity index in patients after transplant were significantly lower than the healthy control group, the differences among two groups were significant (P=0.002).
All60cases have normal sex activist before CRF. The frequency of sexual life is2to9times/month in49cases (81.7%) before transplantation, and sexual satisfaction rate is96.7%(58/60). Before transplant,50patients (83.3%) did not have sex activity, only10patients underwent sexual life and sexual satisfaction rate was5%(3/60).Postoperative56male patients began to have sex in2-4months with86.7%rate of satisfaction (52/60), except the other4refusing to have sex because worries about graft damage by sex activities. The proportion of recipients after postoperative sexual life skills, sexual frequency and sexual satisfaction were significantly improved. The differences between groups before and after transplantation were also significant (P<0.05),but the differences between control group and post-transplantation group were not significant (P>0.05). After transplantation,the proportion of recipients with active sex life increased, the frequency of sex life and sexual satisfaction rate significantly improved. After transplantation sexual satisfaction rate of patients was significantly higher than the pre-transplant, the differences were significant (P<0.001). The sexual satisfaction rate in the post-transplant group was slight decline compared to those with the control group.
Conclusion After graft function after renal transplantation is back to normal, and the recipient's sex life capability can be obtained improved significantly, most of the recipients can be restored close to the level before the illness.Sperm motility, survivaland Sperm deformity Index improved markedly compared with pre-transplant
Chapter3Pregnancy outcomes in female kidney transplant recipients and follow up for the health of the offspring
Objective To evaluate the pregnancy outcomes in female kidney transplant recipients and the long-term follow up for the health of the offspring.
Methods Clinic data from15female renal transplant recipients with pregnant duration more than5months from April1978to April2011and their offspring were retrospectively analyzed.
Results1.15recipients were taking CsA or Tac based immunosuppressive regimens.12had successful pregnancies with stable and functioning grafts;1died of pulmonary infection and cardiac failure with functioning graft after the delivery of a healthy male infant;2underwent chronic rejection proven by biopsy at week21and23respectively, pregnancy were therefore terminated and the grafts were lost even after rescue. All13newborns were smoothly delivered by cesarean section, they had an average gestational age of39.5±1.3weeks, and a mean birth weight of2.58±1.44kg, Apgar scale for each infant was10, respectively。There were no birth defects, structural malformations, nor learning disabilities in13newborns, and their mothers all chose to bottle-feed.13children had similar intelligent, physical and mental development as the same generation.7children experienced repeated respiratory tract infection during0-2years, and1was diagnosed with attention deficit hyperactivity disorder. The oldest offspring is21years old and the youngest is3years old by far.
2. In accordance with the recipient taking immunosuppressive agents are divided into CsA group and Tac group. After transplantation, women of CsA group and Tac group got pregnant at29.5±3.2year-old and29.0±3.9year-old, the difference was not statistically significant (t=0.253, P=0.805). The time of transplantation to conceive in this two groups were64.4±12.6months and41.2±17.9months, the difference was not statistically significant(t=2.756, P=0.19). The differences of neonatal gestational age, weight, and length differences were not statistically significant (t=0.710,P=0.492; t=-0.659, P=0.524; t=0.258, P=0.801).
Conclusions Female renal kidney recipients could achieve successful pregnancies and deliveries post transplantation with strict criteria. Rigorous assessment and follow-up should be taken during periconceptional and postnatal in case of health of offspring, renal graft and recipients.
当慢性肾功能衰竭进展到尿毒症期,需要进行肾脏替代性治疗,而肾移植是公认的治疗尿毒症最有效的方法。20世纪70年代,1年尸肾移植物存活率为40%-50%,80年代达到90%以上；2009年,有统计显示肾移植患者十年存活率已经超过60%。全球己累计施行肾移植手术75万例,其中,我国己累计实施86800例,目前每年进行肾移植手术6000例左右。
慢性肾功能衰竭(CRF)患者普遍存在下丘脑-垂体-性腺轴功能异常。性功能障碍是慢性肾功能衰竭男性和女性患者的常见临床表现。慢性肾功能衰竭女性患者性功能障碍的患病风险较健康女性高。月经周期异常与性功能障碍如性欲减退、性高潮缺乏等有关,特别是发生于大部分长期透析治疗的成年女性患者的闭经。患有慢性肾功能衰竭的女性经常会出现性欲减退、难以达到性高潮的情况；而女性尿毒症患者的性生活质量更容易受到血液透析的影响,表现为性生活频次降低、性欲减退和性功能障碍。
慢性肾功能衰竭被认为是阴茎勃起功能障碍(ED)的重要的危险因素。肾移植术后的勃起功能障碍是影响肾移植患者生活质量的重要因素。阴茎勃起功能障碍严重影响患者的生活质量,并可以引起焦虑、丧失自信、缺乏想象、抑郁、人际关系缺乏、丧失自尊等心理障碍。
自1954年Murry教授成功实施第1例挛生兄弟间的肾移植以来,肾脏移植技术在世界各地蓬勃开展,基础和临床研究的学者们克服了免疫、外科技术、伦理等诸多难题,使肾脏移植技术不断走向完善。随着现代的生物医学模式向生物-心理-社会医学模式的转变,生活质量成为肾移植术后患者新的健康指标。对于肾移植患者而言,移植手术仅是第一步,移植肾的存活固然重要,但患者的生活质量和整个身心健康更为重要。而且近年来肾移植受者的生存率和生活质量已经有了显著提高,术后并发症减少,因此其他的评估目标显得更加重要。性功能是肾移植术后患者生活质量重要的组成部分之一,患者的性功能问题已经成为影响其生活质量的重要因素,而有关此部分的研究有限。
第1章肾移植前后绝经期前成年女性性功能评估
目的研究绝经期前成年女性受者肾移植前、后的性功能改变。
方法2009年至2011年在我院接受肾移植手术的女性受者中,将患病前有性生活及术后移植肾功能恢复良好的42例女性受者纳入本研究。入组标准：已婚女性、25～45岁、未停经、透析治疗超过6个月、移植后肾功能恢复正常(血清肌酐44-133μmol/L、GFR>90ml/min)超过6个月。排除标准：子宫和／或卵巢切除术病史、既往高催乳素血症病史、脑垂体疾病、膀胱过度活动症、精神障碍性疾病。共入组女性受者42例。统计肾移植前后月经周期情况、检验患者手术前后性激素水平。采用女性性功能指数(female sexual function index, FSFI)量表分别评估术前、术后患者的性功能。
结果1、肾移植前闭经、月经稀发、月经频发及月经正常的患者分别有18例(42.9%)、10例(23.8%)、5例(11.9%)、9例(21.4%),移植后分别为7例(16.7%)、5例(11.9%)、6例(14.3%)、24例(57.1%)。
2、肾移植后催乳素(PRL)、卵泡刺激素(FSH)及黄体生成素(LH)较肾移植前明显降低,分别由移植前的89.99±27.96ng/ml、34.75±19.26mIU/ml、39.65±17.87mIU/ml降至39.52±26.06ng/ml、11.51±6.0mIU/ml、6.99±4.67mIU/ml。差异有统计学意义(P<0.001)。移植后雌二醇(E2)和孕酮(P)较移植前升高,移植前血清E2、P水平分别为90.01±37.91mIU/ml、20.28±13.83ng/ml,而移植后二者则升高至166.48±62.39mIU/ml、42.51±18.73ng/ml,差异有统计学意义(P<0.001)。
3、移植前19例(45.2%)、术后36例(85.7%)受者有性生活。肾移植前、后女性性功能障碍(FSD)的总发病率分别为90.5%、40.5%(P<0.001)。肾移植前FSFI评分中性欲、性唤起、阴道润滑、性满意度、性高潮及性交痛领域的分值显著低于肾移植后(P<0.001)。移植前患者性欲、性唤起、阴道润滑、性高潮、性满意度、及性交痛评分分别为2.68±1.27、2.43+1.26、2.05±1.39、3.0±1.64、3.15±1.45、3.46±1.24,而移植后此六领域评分分别升高为4.16±1.23、4.49±1.10、4.28±1.21、4.42±1.12、4.38±1.18、4.52±1.22,FSFI各领域评分移植前后差异有统计学意义(P<0.001)。
4、移植前诊断为性功能障碍的15例患者,其移植后FSFI总分及各领域的评分均较移植前明显提高。移植前患者性欲、性唤起、阴道润滑、性高潮、性满意度、及性交痛评分分别为2.49±1.34、2.08±1.27、1.77±1.10、2.68+1.28、2.53+1.05、2.36±1.56,而移植后此六领域评分分别升高为4.18+1.32、4.33±1.30、4.17±±1.39、4.63+0.93、4.31±1.52、4.69±±0.98,FSFI各领域评分移植前后差异有统计学意义(P<0.001)。
结论移植术后肾功能恢复正常后成年女性受者的性功能能够明显改善,性激素水平较移植前明显好转。
第2章肾移植术前后男性受者的性功能变化
目的调查和评价肾移植术前后男性受者的性功能变化状况。
方法1、选择1998—2010年间在我院接受肾移植的4126例受者,将其中患病前有正常性生活及术后移植肾功能恢复良好的男性受者60例纳入本研究。采用问卷调查法对全部60例受者术后首次遗精时间、性生活频次及满意率进行评估。分别于透析期间及术后3个月时采集受者的精液行常规检查,将精子的活动力、存活率及畸形指数作为观察指标。30例健康成年男性作为对照组,对比移植前后精子的活动力、存活率及畸形指数。
2、统计学方法：应用SPSS13.0统计分析软件对数据进行分析,计量资料采用均数±标准差(x±s)表示,对照组分别与移植前、移植后组比较采用one-way ANOVA,若方差齐性,用LSD(Least Significant Difference)法；若方差不齐,用Dunnett's T3方法。配对计量资料的比较采用配对t检验,两组间率的比较采用χ2检验,P<0.05为差异有统计学意义。
结果60例受者中,54例在术后平均48.5d(30～92d)出现首次遗精。移植前受者的精子活动力、存活率及畸形指数指标明显低于健康对照组,差异均有统计学意义(P<0.001)；移植后受者的上述指标均明显好转,术前比较,差异有统计学意义(P<0.001)。移植后精子活动力、存活率与健康对照组比较,差异无统计学意义(P=0.195、P=0.798),而精子畸形指数与健康对照组比较,差异有统计学意义(P=0.002)。患病前所有60例(100%)受者均有性生活能力,其中49例(81.7%)受者性生活频次为2～9次/月,性生活满意率为96.7%(58/60)；而患病后(移植前)50例(83.3%)患者没有性生活,仅10例(16.7%)有性生活,且性生活满意率为5%(3/60)。移植后除4例受者担心性生活会损害移植肾功能拒绝性生活外,其余56例(93.3%)受者均恢复性生活能力,且其中46例(76.7%)受者的性生活频次为2～9次/月,性生活满意率为86.7%(52/60)。术后有性生活能力的受者比例、性生活频次及性生活满意率与术前比较均明显提高。移植后男性受者性生活满意率较移植前明显升高,差异有统计学意义(P<0.001)。移植后男性受者性生活满意率与对照组相比稍有下降。
结论肾移植术后男性受者在移植肾功能恢复正常后,性生活频次及性生活满意率可得到明显改善,大部分受者可以恢复接近患病前水平；移植后精子活动力、存活率及畸形指数指标较移植前明显好转。
第3章女性肾移植受者妊娠结果及子代健康状况研究
目的评价女性肾移植受者妊娠结果及子代健康状况的长期随访结果。
方法回顾性分析1978年4月至2011年4月妊娠>5个月的15例肾移植受者资料,并对其子代进行随访。
结果1、15例受者采用以环孢素(CsA)或他克莫司(Tac)为主的免疫抑制剂方案。12例母、子女身体状况及移植肾功能正常；1例产下一男婴2周后因并发肺部感染、心力衰竭,带正常功能移植肾死亡；2例分别于妊娠第21、23周发生移植肾慢性排斥反应,终止妊娠,经治疗无效后摘除移植肾。13例胎儿均经剖宫产娩出后存活,胎龄(39.5±1.3)周,新生儿体重(2.58±1.44)kg, Apgar评分均为10分。13例婴儿出生时无生理缺陷,体格发育无异,出生后以人工喂养。13例儿童智力、体格以及心理发育与同龄者无异常,7例在婴幼儿期(0-2岁)存在反复呼吸道感染,1例诊断为注意力缺陷多动障碍。目前子代中年龄最大21岁,最小3岁。
2、按照受者服用的主要免疫抑制剂分为CsA组、Tac组。CsA组、Tac组移植孕妇的受孕年龄分别为29.5±3.2岁、29.0±±3.9岁,二者差异无统计学意义(t=0.253,P=0.805)。两组移植至受孕时间分别为64.4+12.6月和41.2±17.9月,差异无统计学意义。CsA组、Tac组新生儿在胎龄、体重、身长方面差异均无统计学意义(t=0.710,P=0.492;t=.0.659,P=0.524；t=0.258,P=0.801).
结论严格妊娠指征,肾移植女性受者可以成功妊娠、分娩,但孕期前后及产后应严密评估、随访,以确保子代、移植肾以及受者自身的安全。
Chronic renal failure (CRF) is caused by a variety of causes kidney damage and results of progressive deterioration. it is a threat to human health, with natural population incidence rate (50-200)/100people in recent years, an average of about increase rate of8%per year. Chronic renal failure or uremia in severe condition is not an independent disease. A variety of reasons cause kidney damage and progressive deterioration. A series of complex symptom will appear when renal function decreased to about10%of normal. Etiological mechanisms of CRF are yet unclear. Currently, hypothesis about CRF mainly on glomerular perfusion, high-pressure, high filtration; glomerular capsule pressure, high metabolism of renal tubular and compensatory hypertrophy, glomerular and interstitial changes:renal glomerular cells, tubular cells and infiltrating cells produce a large number of cytokines which involve in the process of renal function deterioration.
The hypothalamic-pituitary-gonadal axis dysfunction is widespread among patients with chronic renal failure (CRF). Sexual dysfunction is a common clinical manifestation of CRF male and female patients. The risk of female sexual dysfunction in patients with chronic renal failure is higher than in healthy women. Abnormal menstrual cycle and sexual dysfunction, such as loss of libido, lack of orgasm, especially amenorrhea occurs in the majority of long-term dialysis treatment of adult female patients. Abnormal menstrual cycle concerned with sexual dysfunction, such as loss of libido, lack of orgasm, especially amenorrhea which occurs in the majority of long-term dialysis treatment of adult female patients. Female patients with chronic renal failure often suffer some symptoms such as loss of libido, difficulty to reach orgasm. Sexual quality of life of female uremic patients is susceptible to the impact of hemodialysis, which expressed as reduction of frequency of sex, loss of libido and sexual dysfunction.
Chronic renal failure is considered to be one of important risk factors for erectile dysfunction. Erectile dysfunction after renal transplantation is an important factor affecting patients'quality of life after kidney transplantation. Erectile dysfunction seriously affects the quality of life of patients, causes anxiety, loss of self-confidence, lack of imagination, depression, lack of interpersonal relationships, loss of self-esteem and other psychological disorder.
Since the first successful kidney transplantation between identical twins was conducted by Pro. Murry in1954, the renal transplantation has been widely used all over the world. And scholars of basic and clinical researches have overcome numerous difficulties in terms of immunology, surgical techniques and ethnics, which pave the way for the development of renal transplantation. With the transformation of the modern biomedical model to biological-psychological-social model, the quality of life becomes a new health indicator in patients after renal transplantation. For kidney transplant patients, transplant surgery is only the first step. The transplanted kidney survival is important, however, the patient's quality of life and physical and mental health is more important. Survival rates and quality of life of renal transplant recipients in recent years has been significantly improved, and postoperative complications decreased. So, other assessment objective is even more important. Sexual function is an important part of the quality of life of patients after renal transplantation; the patient's sexual function problems have become important factors that affect the quality of life, but study about this part is rather limited.
Chapter1Investigation of sexual function in premenopausal women before and after renal transplantation
Objective To study sexual function in adult premenopausal women before and after renal transplantation.
Methods1.From2009to2011,in our hospital female recipients received kidney transplantation, normal sexual life before the illness and renal function returned to normal after surgery. Inclusion criteria:married women,25to45years old, not menopause, dialysis treatment over six months, normal renal function (serum creatinine44-133μmol/L, GFR>90ml/min) over six months after transplantation. Exclusion criteria:uterine and/or ovarian resection history, previous history of hyperprolactinemia, pituitary disease, overactive bladder, mental disorders were excluded. A total of42women were enrolled in the study.All women underwent a hormonal profile determination, calculated menstrual cycles, and filled out the Female Sexual Function Index (FSFI) administered before and6months after transplantation.
2. Statistical Analysis:All data used SPSS13.0statistical analysis software. Measurement data are expressed as mean±standard deviation (x±s). Differences among the paired measurement data were analyzed by paired t-test. P<0.05was considered statistically significant.
Results1. Before kidney transplantation the cases of amenorrhea, Oligomenorrhea, polimenorrhea, and eumenorrhea were18cases (42.9%),10cases (23.8%),5cases (11.9%) and9cases (21.4%) respectively. After transplantation the cases were7cases (16.7%),5cases (11.9%),6cases (14.3%) and24cases (57.1%) respectively.
2. After renal transplantation prolactin (PRL), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) significantly decreased. The level of PRL, FSH, and LH before transplantation was89.99±27.96ng/ml,34.75±19.26mIU/ml,39.65±17.87mIU/ml. After renal transplantation the level of PRL, FSH and LH dropped to39.52±26.06ng/ml,11.51±6.0mIU/ml,6.99±4.67mIU/ml.The differences among two groups were significant (P<0.001). Estradiol (E2) and progesterone (P) increased compared with the preoperative (P<0.001). The level of E2, P before transplantation was90.01±37.91mIU/ml,20.28±13.83ng/ml. After renal transplantation the level of E2and P increased to166.48±62.39mIU/ml,42.51±18.73ng/ml.The differences among two groups were significant (P<0.001).
3. Nineteen patients (45.2%),36patients(85.7%) before and after surgery respectively acknowledged having an active sexual life. The total incidence of Female Sexual dysfunction (FSD) before and after kidney transplant were90.5%,40.5%(P <0.001).The scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were significantly lower than scores after kidney transplant(P<0.001). The scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were2.68±1.27,2.43±1.26,2.05±1.39,3.0±1.64,3.15±1.45,3.46±1.24respectively. The scores in the six areas above in the post-transplant increased to4.16±1.23,4.49±1.10,4.28±1.21,4.42±1.12,4.38±1.18,4.52±1.22, respectively. The differences of the scores in the six areas between before and after transplantation were significant (P<0.001).
4.15patients were diagnosed with heart disease sexual dysfunction before renal transplantation. Their scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were significantly increased after kidney transplant. The scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were2.49±1.34,2.08±1.27,1.77±1.10,2.68±1.28,2.53±1.05,2.36±1.56, respectively. The scores in the six areas above in the post-transplant increased to4.18±1.32,4.33±1.30,4.17±1.39,4.63±0.93,4.31±1.52,4.69±0.98. The differences of the scores in the six areas between before and after transplantation were significant (P<0.001)
Conclusions A successful transplantation should significantly improve sexual function in premenopausal women, significant improvement in sex hormone levels after transplantation.
Chapter2Investigation of sexual function in male kidney transplant recipients
Objective To investigate and evaluate sexual function in male kidney transplant recipients
Method1、A total of60patients were enrolled in the study,who received a kidney transplant at our hospital between1998-2010. The patients have normal sex activities before illness and have good renal graft function after transplant. Questionnaires used to investigate the first spermatorrhea, sexual ability, sexual frequency and satisfaction rate of all60cases after surgery. Were collected during dialysis and after3months, underwent routine checks of recipients of semen, sperm motility, survival and deformity index as the observed indicators.30healthy adult males as a control group, compared sperm motility, survival, deformity index, the ability of sex life and sexual satisfaction rate indicators before and after transplantation.
2、Statistical Analysis:All data used SPSS13.0statistical analysis software. Measurement data are expressed as mean±standard deviation (x±s). Differences among groups were analyzed by One-way ANOVA. LSD (Least Significant Difference) method should be used in the case of homogeneity of variance; otherwise Dunnett's T3methods should be used in the case of variance nonhomogeneity. Differences among the paired measurement data were analyzed by paired t-test.Chi-square was used to compare the rates between two groups.P<0.05was considered statistically significant.
Result Following the graft function gradually regained.54patients had spermatorrhea in the30-92days after transplantation, and other six cases did not have spermatorrhea because of sexual life.
The sperm motility, survival and deformity index in patients before transplant were significantly lower than the healthy control group, the differences among two groups were significant (P<0.001). The above parameters were significantly improved after transplantation, the differences between groups before and after transplantation were also significant (.P<0.001).The differences of sperm motility, survival between patients before transplant and the healthy control group were not significant (P=0.195、P=0.798). The sperm deformity index in patients after transplant were significantly lower than the healthy control group, the differences among two groups were significant (P=0.002).
All60cases have normal sex activist before CRF. The frequency of sexual life is2to9times/month in49cases (81.7%) before transplantation, and sexual satisfaction rate is96.7%(58/60). Before transplant,50patients (83.3%) did not have sex activity, only10patients underwent sexual life and sexual satisfaction rate was5%(3/60).Postoperative56male patients began to have sex in2-4months with86.7%rate of satisfaction (52/60), except the other4refusing to have sex because worries about graft damage by sex activities. The proportion of recipients after postoperative sexual life skills, sexual frequency and sexual satisfaction were significantly improved. The differences between groups before and after transplantation were also significant (P<0.05),but the differences between control group and post-transplantation group were not significant (P>0.05). After transplantation,the proportion of recipients with active sex life increased, the frequency of sex life and sexual satisfaction rate significantly improved. After transplantation sexual satisfaction rate of patients was significantly higher than the pre-transplant, the differences were significant (P<0.001). The sexual satisfaction rate in the post-transplant group was slight decline compared to those with the control group.
Conclusion After graft function after renal transplantation is back to normal, and the recipient's sex life capability can be obtained improved significantly, most of the recipients can be restored close to the level before the illness.Sperm motility, survivaland Sperm deformity Index improved markedly compared with pre-transplant
Chapter3Pregnancy outcomes in female kidney transplant recipients and follow up for the health of the offspring
Objective To evaluate the pregnancy outcomes in female kidney transplant recipients and the long-term follow up for the health of the offspring.
Methods Clinic data from15female renal transplant recipients with pregnant duration more than5months from April1978to April2011and their offspring were retrospectively analyzed.
Results1.15recipients were taking CsA or Tac based immunosuppressive regimens.12had successful pregnancies with stable and functioning grafts;1died of pulmonary infection and cardiac failure with functioning graft after the delivery of a healthy male infant;2underwent chronic rejection proven by biopsy at week21and23respectively, pregnancy were therefore terminated and the grafts were lost even after rescue. All13newborns were smoothly delivered by cesarean section, they had an average gestational age of39.5±1.3weeks, and a mean birth weight of2.58±1.44kg, Apgar scale for each infant was10, respectively。There were no birth defects, structural malformations, nor learning disabilities in13newborns, and their mothers all chose to bottle-feed.13children had similar intelligent, physical and mental development as the same generation.7children experienced repeated respiratory tract infection during0-2years, and1was diagnosed with attention deficit hyperactivity disorder. The oldest offspring is21years old and the youngest is3years old by far.
2. In accordance with the recipient taking immunosuppressive agents are divided into CsA group and Tac group. After transplantation, women of CsA group and Tac group got pregnant at29.5±3.2year-old and29.0±3.9year-old, the difference was not statistically significant (t=0.253, P=0.805). The time of transplantation to conceive in this two groups were64.4±12.6months and41.2±17.9months, the difference was not statistically significant(t=2.756, P=0.19). The differences of neonatal gestational age, weight, and length differences were not statistically significant (t=0.710,P=0.492; t=-0.659, P=0.524; t=0.258, P=0.801).
Conclusions Female renal kidney recipients could achieve successful pregnancies and deliveries post transplantation with strict criteria. Rigorous assessment and follow-up should be taken during periconceptional and postnatal in case of health of offspring, renal graft and recipients.
引文
[1]Fryckstedt J, Hylander B.Sexual function in patients with end-stage renal disease [J].Scand J Urol Nephrol,2008,42(5):466-471.
[2]Bellinghieri G,Santoro D, Mallamace A, et al.Sexual dysfunction in chronic renal failure [J].J Nephrol,2008,21 Suppl 13:S113-117.
[3]Lew-Starowicz M, Gellert R.The sexuality and quality of life of hemodialyzed patients-ASED multicenter study [J].J Sex Med,2009,6(4):1062-71.
[4]Kettas E, Cayan F, Akbay E, et al. Sexual dysfunction and associated risk factors in women with end-stage renal disease[J]. J Sex Med 2008;5(4):872-7|.
[5]Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol 1999;10(6):1381-8.
[6]Anantharaman P, Schmidt RJ. Sexual function in chronic kidney disease. Adv Chronic Kidney Dis 2007;14(2):119-25.
[7]Leavey SF, Weitzel WF.Endocrine abnormalities in chronic renal failure [J].Endocrinol Metab Clin North Am,2002,31(1):107-119.
[8]宋亚香,李新华,朱开元.男性慢性肾功能衰竭病人血清性激素水平测定的临床意义[J].上海铁道大学学报,2000,21(9)：43-45.
[9]Soykan A, Bolas H, Kutlay S, et al.Do sexual dysfunctions get better during dialysis? Results of a six-month prospective follow-up study from Turkey [J].Int J Impot Res,2005,17(4):359-363.
[10]Watnick S.Pregnancy and contraceptive counseling of women with chronic kidney disease and kidney transplants [J].Adv Chronic Kidney Dis,2007, 14(2):126-131.
[11]Bogieevic M, Stefanovic V.Relationship between parathyroid hormone and pituitary-testicular axis in patients on maintenance hemodialysis [J].Exp Clin Endoerinol,1988,92(3):357-362.
[12]Jalali GR, Roozbeh J, Mohammadzadeh A, et al.Im.pact of oral zinc therapy on the level of sex hormones in male patients on hemodialysis [J].Ren Fail,32,(4):417-419.
[13]Bailie GR, Elder SJ, Mason NA, et al. Sexual dysfunction in dialysis patients treated with antihypertensive or antidepressive medications:results from the DOPPS [J].Nephrol Dial Transplant,2007,22(4):1163-1170.
[14]Santoro A. Anemia in renal insufficiency [J]. Rev Clin Exp Hematol,2002, Suppll:12-20.
[15]Palmer BF. Sexual dysfunction in uremia [J]. J Am Soc Nephrol,1999, 10(6):1381-1388.
[16]Handelsman DJ, Liu PY. Androgen therapy in chronic renal failure [J]. Baillieres Clin ndocrinol Metab,1998,12 (3):485-500.
[17]Lawrence IG, Price DE, Howlett TA,et al. Erythropoietin and sexual dysfunction [J]. Nephrol Dial Transplant,1997,12(4):741-747.
[1]Toorians AW, Janssen E, Laan E, et al. Chronic renal failure and sexual functioning:clinical status versus objectively assessed sexual response. Nephrol, Dial, Transplant 1997;12(12):2654-63
[2]Basok EK, Atsu N, Rifaioglu MM,, et al. Assessment of female sexual function and quality of life in predialysis, peritoneal dialysis, hemodialysis, and renal transplant patients. Int Urol Nephrol 2009;41(3):473-81.
[3]Holley JL, Schmidt RJ, Bender FH, et al. Gynecologic and reproductive issues in women on dialysis. Am J Kidney Dis.1997; 29:685-90.
[4]Wolf G, Chen S, Han DC, et al. Leptin and renal disease. Am J Kidney Dis. 2002; 39:1-11.
[22]Sievertsen GD, Lim VS, Nakawatase C, et al. Metabolic clearance and secretion rates of human prolactin in normal subjects and in patients with chronic renal failure. J Clin Endocrinol Metab.1980; 50:846-52.
[23]Holley j L.The hypothalamic-pituitary axis in men and women with chronic kidney disease [J]. Adv Chronic Kidney Dis,2004,11(4):337-341.
[24]Torre DL, Falomi A. Pharmacological causes of hyperprolactinemia [J]. Ther Clin Risk Manag,2007,3(5):929-951.
[25]Kadioglu P, Yalin AS, Tiryakioglu O, et al.Sexual dysfunction in women with hyperprolactinemia:a pilot study report [J]. J Urol,2005,174(5):1921-1925.
[26]Corona G, Mannucei E, Fisher AD, et al.Efect of hyperprolactinemia in male patients consulting for sexual dysfunction [J]. J Sex Med,2007, 4(5):1485-1493.
[1]Kettas E, Cayan F, Akbay E, et al. Sexual dysfunction and associated risk factors in women with end-stage renal disease[J]. J Sex Med,2008,5(4):872-7|.
[2]Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol,1999, 10(6):1381-8.
[3]Anantharaman P, Schmidt RJ. Sexual function in chronic kidney disease[J]. Adv Chronic Kidney Dis,2007,14(2):119-25.
[4]Rosen R, Brown C, Heiman J, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function[J]. J Sex Marital Ther,2000,26(2):191-208.
[5]Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores[J]. J Sex Marital Ther, 2005,31(1):1-20.
[6]Lombardi G, Mondaini N, Macchiarella A,, et al. Clinical female sexual outcome after sacral neuromodulation implant for lower urinary tract symptom (LUTS) [J]. J Sex Med,2008,5(6):1411-7.
[7]Toorians AW, Janssen E, Laan E, et al. Chronic renal failure and sexual functioning:clinical status versus objectively assessed sexual response[J]. Nephrol, Dial, Transplant 1997,12(12):2654-63
[8]Basok EK, Atsu N, Rifaioglu MM,, et al. Assessment of female sexual function and quality of life in predialysis, peritoneal dialysis, hemodialysis, and renal transplant patients[J]. Int Urol Nephrol 2009,41(3):473-81.
[9]Holley JL, Schmidt RJ, Bender FH, et al. Gynecologic and reproductive issues in women on dialysis[J]. Am J Kidney Dis,1997,29:685-90.
[10]Wolf G, Chen S, Han DC, et al. Leptin and renal disease[J]. Am J Kidney Dis,2002,39:1-11.
[11]Sievertsen GD, Lim VS, Nakawatase C, et al. Metabolic clearance and secretion rates of human prolactin in normal subjects and in patients with chronic renal failure[J]. J Clin Endocrinol Metab.1980,50:846-52.
[12]Peng YS, Chiang CK, Kao TW, et al. Sexual dysfunction in female hemodialysis patients:a multicenter study [J]. Kidney Int 2005,68(2):760-5.
[13]Tavallaii SA, Fathi-Ashtiani A, Nasiri M, et al.Correlation between sexual function and postrenal transplant quality of life:does gender matter? [J] J Sex Med 2007,4(6):1610-8.
[14]Kadioglu P, Yalin AS, Tiryakioglu O, et al. Sexual dysfunction in women with hyperprolactinemia:a pilot study report [J]. J Urol 2005,174(5):1921-5.
[15]auchmanova L, Carrano R, Sabbatini M, et al. Hypothalamic-pituitary-gonadal axis function after successful kidney transplantation in men and women [J]. Hum Reprod 2004,19(4):867-73.
[16]Kingsberg SA, Janata JW. Female sexual disorders:assessment, diagnosis, and treatment [J]. Urol Clin North Am 2007,34(4):497-506.
[17]Basson R, Schultz WW. Sexual sequelae of general medical disorders [J]. Lancet 2007,369(9559):409-24.
[1]Lim VS, Henriquez C, Sieverstem C, et al. Gonadal dysfunction in chronic renal failure[J]. Dialy Transplant,1978,7:896-898.
[2]Palmer BF. Sexural dysfunction in uremia [J].J Am Soc Nephrol,1999, 10:138-142.
[3]Diemont WL, Vruggink PA, Meuleman EJ, et al. Sexual dysfunction after renal replacement therapy[J].Am J Kidney Dis 2000,35(5):845-851.
[4]Mehrsai A, Nikoobakht M, Khanlarpoor T, et al. Improvement of erectile dysfunction after kidney transplantation:the role of the associated factors [J]. J Urol,2006,3:240-244.
[5]Espinoza, Gracida C, Cancino J, et al.Prevalence of Erectile Dysfunction in Kidney Transplant Recipients [J]. Transplantation Proceedings,2006,38: 916-917.
[6]车文骏,何小舟,巢志复等.男性患者肾移植前后的阴茎勃起功能研究[J].中华器官移植杂志,2005,6：151-153.
[7]田晓辉,薛武军,李大庆,等.肾移植患者阴茎勃起功能影响因素分析[J].中华男科学杂志,2007,13：431-434.
[8]Kaufman JM. Impotence and chronic renal failure:a study of the hemodynamic pathophysiology [J]. J Urol,1994,151:612-618.
[9]El-Assmy A, El-Bahnasawy MS, Dawood A, et al. Vasculogenic Erectile Dysfunction in Renal Transplant Recipients [J]. Scunii J Ural Nephro,2004,38: 511-516.
[10]El-Bahnasawy MS, El-Assmy A, et al. Dawood A, Effect of the use internal iliac artery for renal transplantation on penile vascularity and erectile function: a prospective study [J]. J Urol,2004; 172:2335-9.
[11]Ibrahim A. Abdel-Hamid. Mechanisms of vasculogenic erectile dysfunction after kidney transplantation [J]. BJU Int.2004;94(4):497-500.
[12]El-Bahnasawy MS, El-Assmy A, El-Sawy E, et al. Critical evaluation of the factors influencing erectile function after renal transplantation [J]. International Journal of Impotence Research,2004,16:521-526.
[13]Rebollol P, Ortegal F, Valde's C, et al. Factors associated with erectile dysfunction in male kidney transplant recipients [J]. International Journal of Impotence Research,2003,15,433-438.
[14]Sharma RK, Fasn, Prasad N, et al. Treatment of Erectile Dysfunction With Sildenafil Citrate in Renal Allograft Recipients:A Randomized, Double-Blind, Placebo-Controlled Crossover Trial [J]. Am J Kidney Dis,2006,48:128-133.
[15]刘锋,张良甫,姬西宁.构椽酸西地那非治疗男性肾移植受者勃起功能障碍[J].中华男科学杂志,2004,10,：455-457.
[16]许龙根,成军,宋启哲,等.肾移植前后男性性生活状况比较[J].中华男科学,2003,9(4)：270-272.
[17]张绢厚,边金平,何刚,等.同种异体肾移植68例术后性功能调查[J].山西医药杂志,2002,31(1)：42-43.
[18]Semple CG, Beastall GH, Henderson IS, et al. The pituitary-testicular axis of uraemic subjects on haemodialysis and continuous ambulatory peritoneal dialysis [J]. Acta Endocrinol,1982,101(3),464-467.
[19]包瑾芳,刘军,姚建.男性血液透析患者性激素水平的变化[J].中国血液净化,2006,5(9)：675-676.
[20]Odone P, Ortensia A, Boccalatte G, et al. Evaluation of the reproductive endocrine system in a population of hemodialyzed adult males[J]. Minerva Urol Nefrol.1991 Jul-Sep,231-236. Minerva Urol Nefrol,1991,43(3):231-6.
[21]Glass CA, Fielding DM, Evans C, et al. Factors related to sexual functioning in male patients undergoing hemodialysis and with kidney transplants [J]. Arch Sex Behav,1987,16(3):189-207.
[22]邓祥军,麻金木.慢性肾功能衰竭患者性激素紊乱临床意义及机理研究概况[J].黑龙江中医药杂志,2005,(6)：60-62.
[23]张卫东张思孝.男性肾移植患者性功能变化的调查[J].临床泌尿外科杂志,1996,11(2)：111-112.
[24]赵国富仇连峰王志余.男性肾移植67例术后性功能变化的临床观察[J].中原医刊,1998,25(9)：45-46.
[25]Rodriguez RR, Burgos RFJ, Gomez DV, et al. Endocrine changes and sexual dysfunction in kidney transplantation and hemodialysis:comparative study [J]. Actas Urol ESP,1996,20(8):697-701.
[26]Rosas SE, Soffe M, Franklin E, et al. Prevelence and deferminants of erectile dysfunction in hemodialysis patients[J]. Kidney Int,2001,59:2259-2266.
[27]Naya Y, Soh J, Ochiai A, et al. Significant decrease of the international index of erectile function in male renal failure patients freated with hemodialysis [J]. Int J Impot Res,2002,14:172-177.
[28]王翔,黄炯伟,付伟金,等.肾移植患者勃起功能障碍的相关因素研究[J].中国男科学杂志,2009,23(12)：32-41.
[29]Kaufman JM, Hatzichristou DG, Mulhall JP, et al. Impotence and chronic renal failure:a study of the hemodynamic pathophysiology. J Urol.1994; 151(3):612-8.
[30]Weiss T, Windthorst C, Weiss C, et al. Acute effects of haemodialysis on cutaneous microcirculation in patients with peripheral arterial occlusive disease [J].Nephrol Dial Transplant.1998,13(9):2317-21.
[31]Bellinghieri G, Santoro G, Santoro D, et al. Ultrastructural changes of corpora cavernosa in men with erectile dysfunction and chronic renal failure [J].Semin Nephrol,2004,24(5):488-91.
[32]Prieto Castro RM, Anglada Curado FJ, Regueiro Lopez JC, et al. Treatment with sildenafil citrate in renal transplant patients with erectile dysfunction.BJU Int,2001,88(3):241-243.
[33]Coppola A, Cuomo G. Pituitary-testicular evaluation in patients with chronic renal insufficiency in hemodialysis treatment [J].Minerva Med,1990, 81(6):461-4.
[34]Rodriguez R, Burgos Revilla EJ, Gomez Dosantos V, et al. Endocrine changes and sexual dysfunction in kidney transplantation and hemodialysis:comparative study [J]. Actas Urol Esp,1996,20(8):697-701.
[35]唐智胜,姜书传.血液透析对男性终末期肾衰患者垂体-睾丸轴的影响[J].中华器官移植杂志,1992,13(1)：45-46.
[36]De Celis R, Pedron-Nuevo N. Male fertility of kidney transplant patients with one to ten years of evolution using a conventional immunosuppressive regimen [J]. Arch Androl.1999,42(1):9-20.
[37]Diemont WL, Vruggink PA, Meuleman EJ, et al. Sexual dysfunction after renal replacement therapy [J]. Am J Kidney Dis,2000,35(5):845-851.
[38]王书龙,张艮甫,黄赤兵,等.男性肾移植受者性功能状态的调查[J].中华男科学,2003,9(5)：358-360.
[39]郑军华,闵志廉.肾移植术后性功能及生育能力的调查[J].男性学杂志,1995,9(1)：4-6
[40]周梅生,朱有华,闵志廉,等.男性患者肾移植前后性相关激素、微量元素及勃起功能情况调查[J].中华器官移植杂志,2004,25(6)：328-330.
[1]Armenti VT, Constantinescu S, Moritz MJ, et al. Pregnancy after transplantation [J]. Transplant Rev,2008,22:223-240.
[2]黄剑刚,陈椿,高春章,等.同种异体肾移植术后妊娠的若干问题(附1例足月分娩报告)[J].中华器官移植杂志,1983,4：26-27.
[3]韩献萍,苗芸,于立新,等.肾移植术后妊娠对移植肾的影响[J].中华器官移植杂志,2003,24：28-30.
[4]中华医学会儿科学会呼吸学组,《中华儿科杂志》编辑委员会.反复呼吸道感染的临床概念和处理原则.中华儿科杂志,2008,46：108-109.
[5]Xu LG, Jin LM, Zhu XF, et al. A report of 212 male renal transplant recipients who fathered 216 offspring after transplantation [J].Transplantation,2008, 86(10):1480-1.
[6]Sturgiss SN, Davison JM. Effect of pregnancy on the longterm function of renal allografts:an update [J]. Am J Kidney Dis,1995,26:54-6.
[7]Hou S. Pregnancy in women requiring dialysis for renal failure [J]. Am J Kidney Dis.1987,9:368-73.
[8]Coscia LA, Constantinescu S, Moritz MJ,,et al. Report from the National Transplantation Pregnancy Registry (NTPR):outcomes of pregnancy after transplantation [J]. Clin Transpl.2007:29-42.
[9]Timing, Conditions, and Complications of Post-operative Conception and Pregnancy in Female Renal Transplant Recipients [J].Cell Biochem Biophys.2011,61(2):421-426.
[l0]徐龙根,韩澍,刘永,等.女性肾移植受者术后生育22例报告[J].中华器官移植杂志.2009；30(3)：40-42.
[11]Davison JM, Coscia LA, Silva P, et al. Outcomes of successive pregnancies in female kidney transplant recipients reporting pre-eclampsia in their first post-transplant pregnancy [J]. Hypertens Pregnancy,2006,25(Supp 1):27-29.
[12]Xu L, Yang Y, Shi JG, Wang H, et al.Unwanted pregnancy among Chinese transplant recipients [J]. Eur J Contracept Reprod Health Care,2011, 16(4):270-276.
[13]Gardiner SJ, Begg EJ. Breastfeeding during tacrolimus therapy [J]. Obstet Gynecol,2006,107:453-455.
[14]韩献萍,于立新.肾移植术后妊娠与分娩的临床观察[J].中华器官移植杂志,1993,13：167-169.
[15]Lavelanet AF, Coscia LA, Moritz MJ, et al. Long-term follow-up in the offspring of Sandimmune treated female kidney recipients [J].. Am J Transplant, 2006,6(Suppl 2):164-165.
[16]Sifontis NM, Coscia LA, Constantinescu S, et al. Pregnancy outcomes in solid organ transplant recipients with exposure to mycophenolate mofetil or sirolimus [J].. Transplantation,2006,82:1698-702.
[17]Josephson MA, McKay DB. Pregnancy in the renal transplant recipient [J]. Obstet Gynecol Clin North Am,2010,37:211-22.
[18]Baylis C. Glomerular filtration and volume regulation in gravid animal models [J]. Baillieres Clin Obstet Gynaecol,1994,8:235-64.
[19]Armenti VT, Radomski JS, Moritz MJ, et al. Report from the National Transplantation Pregnancy Registry (NTPR):outcomes of pregnancy after transplantation [J]. Clin Transpl,2000,123-34.
[20]Armenti VT, Ahlswede A, et al. Variables affecting birthweight and graft survival in 197 pregnancies incyclosporine treated female kidney transplant recipients [Jj.Transplantaion,1995,59:476-9.
[21]Kashanizadeh N, Nemati E, Sharifi-Bonab M, Impact of pregnancy on the outcome of kidney transplantation [J]. Transplant Proc.2007,39(4):1136-8.
[22]First MR, Combs CA, Weiskittel P, et al. Lack of effect of pregnancy on renal allograft survival or function [J].Transplantation.1995,59(4):472-6.
[23]Lindheimer MD, Davison JM, Katz Al. The kidney and hypertension in pregnancy:twenty exciting years [J]. Semin Nephrol.2001,21(2):173-89.
[24]Salmela KT, Kyllonen LE, Holmberg C, et al. Impaired renal function after pregnancy in renal transplant recipients [J]. Transplantation.1993, 56(6):1372-5.
[25]Sibanda N, Briggs JD, Davison JM, et al. Pregnancy after organ transplantation: a report from the UK Transplant pregnancy registry. Transplantation.2007, 83(10):1301-7.
[26]Sturgiss SN, Davison JM. Effect of pregnancy on the longterm function of renal allografts:an update [J]. Am J Kidney Dis,1995,26:54-6.
[27]Salmela K, Kyllonen L, Holmberg C, et al. Influence of pregnancy on kidney graft function [J].Transplant Proc,1993,25:1302
[1]Fryckstedt J, Hylander B.Sexual function in patients with end-stage renal disease [J].Scand J Urol Nephrol,2008,42(5):466-471.
[2]Bellinghieri G,Santoro D, Mallamace A, et a l. Sexual dysfunction in chronic renal failure [J].J Nephrol,2008,21 Suppl 13:S113-117.
[3]Lew-Starowicz M, Gellert R.The sexuality and quality of life of hemodialyzed patients-ASED multicenter study [J].J Sex Med,2009,6(4):1062-71.
[4]Leavey SF, Weitzel WF.Endocrine abnormalities in chronic renal failure [J].Endocrinol Metab Clin North Am,2002,31(1):107-119.
[5]宋亚香,李新华,朱开元.男性慢性肾功能衰竭病人血清性激素水平测定的临床意义[J].上海铁道大学学报,2000,21(9)：43-45.
[6]Soykan A, Bo las H, Kutlay S, et al.Do sexual dysfunctions get better during dialysis? Results of a six-month prospective follow-up study from Turkey [J].Int J Impot Res,2005,17(4):359-363.
[7]Watnick S.Pregnancy and contraceptive counseling of women with chronic kidney disease and kidney transplants [J].Adv Chronic Kidney Dis,2007, 14(2):126-131.
[8]Bogieevic M, Stefanovic V.Relationship between parathyroid hormone and pituitary-testicular axis in patients on maintenance hemodialysis [J].Exp Clin Endoerinol,1988,92(3):357-362.
[9]Jalali GR, Roozbeh J, Mohammadzadeh A, et al.Impact of oral zinc therapy on the level of sex hormones in male patients on hemodialysis [J].Ren Fail,32,(4):417-419.
[10]Bailie GR, Elder SJ, Mason NA, et al. Sexual dysfunction in dialysis patients treated with antihypertensive or antidepressive medications:results from the DOPPS [J].Nephrol Dial Transplant,2007,22(4):1163-1170.
[11]Santoro A. Anemia in renal insufficiency [J]. Rev Clin Exp Hematol,2002, Suppl 1:12-20.
[12]Palmer BF. Sexual dysfunction in uremia [J]. J Am Soc Nephrol,1999, 10(6):1381-1388.
[13]Handelsman DJ, Liu PY. Androgen therapy in chronic renal failure [J]. Baillieres Clin ndocrinol Metab,1998,12 (3):485-500.
[14]Lawrence IG, Price DE, Howlett TA,et al. Erythropoietin and sexual dysfunction [J]. Nephrol Dial Transplant,1997,12(4):741-747.
[15]李振新.药源性的男性性功能障碍[J].医药导报,2000,19(12)：536-538.
[16]Ho Hey j L.The hypothalamic-pituitary axis in men and women with chronic kidney disease [J]. Adv Chronic Kidney Dis,2004,11(4):337-341.
[17]Torre DL, Falomi A. Pharmacological causes of hyperprolactinemia [J]. Ther Clin Risk Manag,2007,3(5):929-951.
[18]Kadioglu P, Yalin AS, Tiryakioglu O, et al.Sexual dysfunction in women with hyperprolactinemia:a pilot study report [J]. J Urol,2005,174(5):1921-1925.
[19]Corona G, Mannucei E, Fisher AD, et a 1.Effect of hyperprolactinemia in male patients consulting for sexual dysfunction [J]. J Sex Med,2007, 4(5):1485-1493.
[20]Chahal J, Schlechte J.Hyperprelactinemia.Pituitary,2008,11(2):141-146.
[21]Chanson P, Boron-Chazot F, Chabre O, et al.Drug treatment of hyperprelaetinemia [J]. Ann Endocrinol,2007,68(3):113-117.
[1]Mattix Kramer HJ, Tolkoff-Rubin NE, Williams WW, et al. Reproductive and contraceptive characteristics of premenopausal kidney transplant recipients [J]. Prog Transplant,2003,13(3):193-196.
[2]沈维,陈江华,袁静,等.肾移植术后妊娠分娩3例分析[J].中国实用妇科与产科杂志,2005,21(2)：117-118.
[3]Murray JE, Reid DE, Harrison JH, et al. Successful pregnancies after human renal transplantation [J]. N Engl J Med,1963,269(3):341-343.
[4]Miniero R, Tardivo I, Curtoni ES, et al. Pregnancy after renal transplantationin Italian patients:focus on fetal outcome [J]. J Nephrol,2002,15 (6):626-632.
[5]Pezeshki M, Taherian AA, Gharavy M, et al. Menstrual characteristics and pregnancy in women after renal transplantation[J]. Int J Gynaecol Obstet,2004, 85(2):119-125.
[6]Walcott W O, Derick DE, Jolley JJ, et al. Successful pregnancy in a liver transplant patient [J]. Am J Obstet Gynecol,1978,132(3):340-341.
[7]Mass K, Quint EH, Punch MR, et al. Gynecological and reproductive function after liver transplantation [J]. Transplantation,1996,62 (4):476-469.
[8]Kairaitis LK, Nankivell BJ, Lawrence S, et al. Successful obstetric outcome after simultaneous pancreas and kidney transplantation [J]. Med J Aust, 1999,170(8):368-370.
[9]Jain A, Venkataramanan R, Fung JJ, et al. Pregnancy after liver transplantation under tacrolimus [J]. Transplantation,1997,64(4):559-565.
[10]Davison JM. Renal transplantation and pregnancy [J]. Am J Kidney Dis,1987,9 (4):374-380.
[11]Armenti VT, Moritz MJ, Radomski JS, et al. Pregnancy and transplantation [J]. Graft,2000,3 (2):59.
[12]Armenti VT, Herrine SK, Radomski JS, et al. Pregnancy after liver transplantation [J]. Liver Transpl,2000,6(6):671-685.
[13]陈真,文天夫.肝移植术后妊娠[J].中国普外基础与临床杂志,2006,13(4)：487-489,492.
[14]Jain AB, Reyes J, Marcos A, et a.l Pregnancy after liver transplantation with tacrolimus immunosuppression:a single center's experience update at 13 years[J].Transplantation,2003,76(5):827-832.
[15]Nagy S, Bush MC, Berkowitz R, et al. Pregnancy outcom e in liver transplant recipients [J]. Obstet Gynecol,2003,102(1):121-128.
[16]姜楠,杨扬,陈规划,等.同种异体肝移植术后成功妊娠分娩1例[J].中国实用外科杂志,2005,25(7)：443-444.
[17]Cardonick E, MoritzM, Armenti V, et al. Pregnancy in patients with organ transplantation:a review[J]. Obstet Gynecol Surg,2004,59(3):214-222.
[18]EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV:long term management of the transplant recipient [J]. Nephrol Dial Transplant,2002,17 (14):1-67.
[19]Seehofer D, MeiselH, Rayes N, et al. Prospective evaluation of the clinical utility of different methods for the detection of human cytomegalovirus disease after liver transplantation [J]. Am J Transplant,2004,4 (8):1331-1337.
[20]Fowler KB, Stagno S, Pass RF, et al. The outcome of congenital cytomegalovirus infect ion in relation to maternal antibody status [J]. N Engl J Med,1992,326 (10):663-667.
[21]Stanley CW, Gottlieb R, Zager R, et al. Developmental well-being in offspring of women receiving cyclosporine post-renal transplant [J]. Transplant Proc,1999, 1(1-2):241-242.
[22]Preis K, Leszczynska K, Krolikowska B, et al. Pregnancy, delivery and puerperium in patients after liver transplantation [J]. Ginekol Pol,2003,74 (10): 1246-1250.
[1]Holley JL, Schmidt RJ, Bender FH, et al. Gynecologic and reproductive issues in women on dialysis [J]. Am J Kidney Dis,1997,29:685-90.
[2]Wolf G, Chen S, Han DC, et al. Leptin and renal disease [J]. Am J Kidney Dis. 2002,39:1-11.
[3]Sievertsen GD, Lim VS, Nakawatase C, et al. Metabolic clearance and secretion rates of human prolactin in normal subjects and in patients with chronic renal failure [J]. J Clin Endocrinol Metab,1980,50:846-52.
[4]Ghazizadeh S, Lessan-Pezeshki M, Mahdavi M, et al. Menstrual problems among kidney transplant recipients [J]. Transplant Proc,2003,35:2720-1.
[5]Lessan-Pezeshki M. Pregnancy after renal transplantation:points to consider. Nephrol Dial Transplant,2002,17:703-7.
[6]Thurm JA. Effect of chronic renal disease on sexual functioning [J]. Med Asp Human Sex,1976,10:81.
[7]Palmer BF. Sexual dysfunction in uremia [J]. J Am Soc Nephrol,1999, 10:1381-8.
[8]Diemont WL, Vruggink PA, Meuleman EJ, et al. Sexual dysfunction after renal replacement therapy [J]. Am J Kidney Dis,2000,35:845-51.
[9]Muir JW, Besser GM, Edwards CR, et al. Bromocriptine improves reduced libido and potency in men receiving maintenance hemodialysis. Clin Nephrol, 1983,20:308-14.
[10]Rizzoni G, Ehrich JH, Broyer M, et al. Successful pregnancies in women on renal replacement therapy:report from the EDTA Registry [J]. Nephrol Dial Transplant,1992,7:279-87.
[11]Hou S. Pregnancy in women requiring dialysis for renal failure [J]. Am J Kidney Dis.1987,9:368-73.
[12]Chao AS, Huang JY, Lien R, et al. Pregnancy in women who undergo long-term hemodialysis [J]. Am J Obstet Gynecol,2002,187:152-6.
[13]Chang H, Miller MA, Bruns FJ. Tidal peritoneal dialysis during pregnancy improves clearance and abdominal symptoms [J]. Perit Dial Int,2002, 22:272-4.
[14]Redrow M, Cherem L, Elliott J, et al. Dialysis in the management of pregnant patients with renal insufficiency [J].Medicine (Baltimore),1988,67:199-208.
[15]Sturgiss SN, Davison JM. Effect of pregnancy on the longterm function of renal allografts:an update [J]. Am J Kidney Dis,1995,26:54-6.
[16]Lessan-Pezeshki M, Ghazizadeh S, Khatami MR,et al. Fertility and contraceptive issues after kidney transplantation in women [J]. Transplant Proc, 2004,36:1405-6.
[17]Murray JE, Reid DE, Harrison JH, et al. Successful pregnancies after human renal transplantation [J]. N Engl J Med,1963,269:341-3.
[18]Davison JM. Pregnancy in renal allograft recipients:prognosis and management [J]. Baillieres Clin Obstet Gynaecol,1987,1:1027-45.
[19]Sgro MD, Barozzino T, Mirghani HM, et al. Pregnancy outcome post renal transplantation [J]. Teratology,2002,65:5-9.
[20]Baylis C. Glomerular filtration and volume regulation in gravid animal models [J]. Baillieres Clin Obstet Gynaecol,1994,8:235-64.
[21]Armenti VT, Radomski JS, Moritz MJ, et al. Report from the National Transplantation Pregnancy Registry (NTPR):outcomes of pregnancy after transplantation [J]. Clin Transpl,2000,123-34.
[22]Armenti VT, Ahlswede A, et al. Variables affecting birthweight and graft survival in 197 pregnancies incyclosporine treated female kidney transplant recipients [J].Transplantaion,1995,59:476-9.
[23]Salmela K, Kyllonen L, Holmberg C, et al. Influence of pregnancy on kidney graft function [J].Transplant Proc,1993,25:1302.
[24]Kashanizadeh N, Nemati E, Sharifi-Bonab M, et al. Impact of pregnancy on the outcome of kidney transplantation [J]. Transplant Proc,2007,39:1136-8.
[25]Sibanda N, Briggs JD, Davison JM, et al. Pregnancy After Organ Transplantation:A Report From the U.K. Transplant Pregnancy Registry [J].Transplantation,2007,83.1301-1307.
[2]Bellinghieri G,Santoro D, Mallamace A, et al.Sexual dysfunction in chronic renal failure [J].J Nephrol,2008,21 Suppl 13:S113-117.
[3]Lew-Starowicz M, Gellert R.The sexuality and quality of life of hemodialyzed patients-ASED multicenter study [J].J Sex Med,2009,6(4):1062-71.
[4]Kettas E, Cayan F, Akbay E, et al. Sexual dysfunction and associated risk factors in women with end-stage renal disease[J]. J Sex Med 2008;5(4):872-7|.
[5]Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol 1999;10(6):1381-8.
[6]Anantharaman P, Schmidt RJ. Sexual function in chronic kidney disease. Adv Chronic Kidney Dis 2007;14(2):119-25.
[7]Leavey SF, Weitzel WF.Endocrine abnormalities in chronic renal failure [J].Endocrinol Metab Clin North Am,2002,31(1):107-119.
[8]宋亚香,李新华,朱开元.男性慢性肾功能衰竭病人血清性激素水平测定的临床意义[J].上海铁道大学学报,2000,21(9)：43-45.
[9]Soykan A, Bolas H, Kutlay S, et al.Do sexual dysfunctions get better during dialysis? Results of a six-month prospective follow-up study from Turkey [J].Int J Impot Res,2005,17(4):359-363.
[10]Watnick S.Pregnancy and contraceptive counseling of women with chronic kidney disease and kidney transplants [J].Adv Chronic Kidney Dis,2007, 14(2):126-131.
[11]Bogieevic M, Stefanovic V.Relationship between parathyroid hormone and pituitary-testicular axis in patients on maintenance hemodialysis [J].Exp Clin Endoerinol,1988,92(3):357-362.
[12]Jalali GR, Roozbeh J, Mohammadzadeh A, et al.Im.pact of oral zinc therapy on the level of sex hormones in male patients on hemodialysis [J].Ren Fail,32,(4):417-419.
[13]Bailie GR, Elder SJ, Mason NA, et al. Sexual dysfunction in dialysis patients treated with antihypertensive or antidepressive medications:results from the DOPPS [J].Nephrol Dial Transplant,2007,22(4):1163-1170.
[14]Santoro A. Anemia in renal insufficiency [J]. Rev Clin Exp Hematol,2002, Suppll:12-20.
[15]Palmer BF. Sexual dysfunction in uremia [J]. J Am Soc Nephrol,1999, 10(6):1381-1388.
[16]Handelsman DJ, Liu PY. Androgen therapy in chronic renal failure [J]. Baillieres Clin ndocrinol Metab,1998,12 (3):485-500.
[17]Lawrence IG, Price DE, Howlett TA,et al. Erythropoietin and sexual dysfunction [J]. Nephrol Dial Transplant,1997,12(4):741-747.
[1]Toorians AW, Janssen E, Laan E, et al. Chronic renal failure and sexual functioning:clinical status versus objectively assessed sexual response. Nephrol, Dial, Transplant 1997;12(12):2654-63
[2]Basok EK, Atsu N, Rifaioglu MM,, et al. Assessment of female sexual function and quality of life in predialysis, peritoneal dialysis, hemodialysis, and renal transplant patients. Int Urol Nephrol 2009;41(3):473-81.
[3]Holley JL, Schmidt RJ, Bender FH, et al. Gynecologic and reproductive issues in women on dialysis. Am J Kidney Dis.1997; 29:685-90.
[4]Wolf G, Chen S, Han DC, et al. Leptin and renal disease. Am J Kidney Dis. 2002; 39:1-11.
[22]Sievertsen GD, Lim VS, Nakawatase C, et al. Metabolic clearance and secretion rates of human prolactin in normal subjects and in patients with chronic renal failure. J Clin Endocrinol Metab.1980; 50:846-52.
[23]Holley j L.The hypothalamic-pituitary axis in men and women with chronic kidney disease [J]. Adv Chronic Kidney Dis,2004,11(4):337-341.
[24]Torre DL, Falomi A. Pharmacological causes of hyperprolactinemia [J]. Ther Clin Risk Manag,2007,3(5):929-951.
[25]Kadioglu P, Yalin AS, Tiryakioglu O, et al.Sexual dysfunction in women with hyperprolactinemia:a pilot study report [J]. J Urol,2005,174(5):1921-1925.
[26]Corona G, Mannucei E, Fisher AD, et al.Efect of hyperprolactinemia in male patients consulting for sexual dysfunction [J]. J Sex Med,2007, 4(5):1485-1493.
[1]Kettas E, Cayan F, Akbay E, et al. Sexual dysfunction and associated risk factors in women with end-stage renal disease[J]. J Sex Med,2008,5(4):872-7|.
[2]Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol,1999, 10(6):1381-8.
[3]Anantharaman P, Schmidt RJ. Sexual function in chronic kidney disease[J]. Adv Chronic Kidney Dis,2007,14(2):119-25.
[4]Rosen R, Brown C, Heiman J, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function[J]. J Sex Marital Ther,2000,26(2):191-208.
[5]Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores[J]. J Sex Marital Ther, 2005,31(1):1-20.
[6]Lombardi G, Mondaini N, Macchiarella A,, et al. Clinical female sexual outcome after sacral neuromodulation implant for lower urinary tract symptom (LUTS) [J]. J Sex Med,2008,5(6):1411-7.
[7]Toorians AW, Janssen E, Laan E, et al. Chronic renal failure and sexual functioning:clinical status versus objectively assessed sexual response[J]. Nephrol, Dial, Transplant 1997,12(12):2654-63
[8]Basok EK, Atsu N, Rifaioglu MM,, et al. Assessment of female sexual function and quality of life in predialysis, peritoneal dialysis, hemodialysis, and renal transplant patients[J]. Int Urol Nephrol 2009,41(3):473-81.
[9]Holley JL, Schmidt RJ, Bender FH, et al. Gynecologic and reproductive issues in women on dialysis[J]. Am J Kidney Dis,1997,29:685-90.
[10]Wolf G, Chen S, Han DC, et al. Leptin and renal disease[J]. Am J Kidney Dis,2002,39:1-11.
[11]Sievertsen GD, Lim VS, Nakawatase C, et al. Metabolic clearance and secretion rates of human prolactin in normal subjects and in patients with chronic renal failure[J]. J Clin Endocrinol Metab.1980,50:846-52.
[12]Peng YS, Chiang CK, Kao TW, et al. Sexual dysfunction in female hemodialysis patients:a multicenter study [J]. Kidney Int 2005,68(2):760-5.
[13]Tavallaii SA, Fathi-Ashtiani A, Nasiri M, et al.Correlation between sexual function and postrenal transplant quality of life:does gender matter? [J] J Sex Med 2007,4(6):1610-8.
[14]Kadioglu P, Yalin AS, Tiryakioglu O, et al. Sexual dysfunction in women with hyperprolactinemia:a pilot study report [J]. J Urol 2005,174(5):1921-5.
[15]auchmanova L, Carrano R, Sabbatini M, et al. Hypothalamic-pituitary-gonadal axis function after successful kidney transplantation in men and women [J]. Hum Reprod 2004,19(4):867-73.
[16]Kingsberg SA, Janata JW. Female sexual disorders:assessment, diagnosis, and treatment [J]. Urol Clin North Am 2007,34(4):497-506.
[17]Basson R, Schultz WW. Sexual sequelae of general medical disorders [J]. Lancet 2007,369(9559):409-24.
[1]Lim VS, Henriquez C, Sieverstem C, et al. Gonadal dysfunction in chronic renal failure[J]. Dialy Transplant,1978,7:896-898.
[2]Palmer BF. Sexural dysfunction in uremia [J].J Am Soc Nephrol,1999, 10:138-142.
[3]Diemont WL, Vruggink PA, Meuleman EJ, et al. Sexual dysfunction after renal replacement therapy[J].Am J Kidney Dis 2000,35(5):845-851.
[4]Mehrsai A, Nikoobakht M, Khanlarpoor T, et al. Improvement of erectile dysfunction after kidney transplantation:the role of the associated factors [J]. J Urol,2006,3:240-244.
[5]Espinoza, Gracida C, Cancino J, et al.Prevalence of Erectile Dysfunction in Kidney Transplant Recipients [J]. Transplantation Proceedings,2006,38: 916-917.
[6]车文骏,何小舟,巢志复等.男性患者肾移植前后的阴茎勃起功能研究[J].中华器官移植杂志,2005,6：151-153.
[7]田晓辉,薛武军,李大庆,等.肾移植患者阴茎勃起功能影响因素分析[J].中华男科学杂志,2007,13：431-434.
[8]Kaufman JM. Impotence and chronic renal failure:a study of the hemodynamic pathophysiology [J]. J Urol,1994,151:612-618.
[9]El-Assmy A, El-Bahnasawy MS, Dawood A, et al. Vasculogenic Erectile Dysfunction in Renal Transplant Recipients [J]. Scunii J Ural Nephro,2004,38: 511-516.
[10]El-Bahnasawy MS, El-Assmy A, et al. Dawood A, Effect of the use internal iliac artery for renal transplantation on penile vascularity and erectile function: a prospective study [J]. J Urol,2004; 172:2335-9.
[11]Ibrahim A. Abdel-Hamid. Mechanisms of vasculogenic erectile dysfunction after kidney transplantation [J]. BJU Int.2004;94(4):497-500.
[12]El-Bahnasawy MS, El-Assmy A, El-Sawy E, et al. Critical evaluation of the factors influencing erectile function after renal transplantation [J]. International Journal of Impotence Research,2004,16:521-526.
[13]Rebollol P, Ortegal F, Valde's C, et al. Factors associated with erectile dysfunction in male kidney transplant recipients [J]. International Journal of Impotence Research,2003,15,433-438.
[14]Sharma RK, Fasn, Prasad N, et al. Treatment of Erectile Dysfunction With Sildenafil Citrate in Renal Allograft Recipients:A Randomized, Double-Blind, Placebo-Controlled Crossover Trial [J]. Am J Kidney Dis,2006,48:128-133.
[15]刘锋,张良甫,姬西宁.构椽酸西地那非治疗男性肾移植受者勃起功能障碍[J].中华男科学杂志,2004,10,：455-457.
[16]许龙根,成军,宋启哲,等.肾移植前后男性性生活状况比较[J].中华男科学,2003,9(4)：270-272.
[17]张绢厚,边金平,何刚,等.同种异体肾移植68例术后性功能调查[J].山西医药杂志,2002,31(1)：42-43.
[18]Semple CG, Beastall GH, Henderson IS, et al. The pituitary-testicular axis of uraemic subjects on haemodialysis and continuous ambulatory peritoneal dialysis [J]. Acta Endocrinol,1982,101(3),464-467.
[19]包瑾芳,刘军,姚建.男性血液透析患者性激素水平的变化[J].中国血液净化,2006,5(9)：675-676.
[20]Odone P, Ortensia A, Boccalatte G, et al. Evaluation of the reproductive endocrine system in a population of hemodialyzed adult males[J]. Minerva Urol Nefrol.1991 Jul-Sep,231-236. Minerva Urol Nefrol,1991,43(3):231-6.
[21]Glass CA, Fielding DM, Evans C, et al. Factors related to sexual functioning in male patients undergoing hemodialysis and with kidney transplants [J]. Arch Sex Behav,1987,16(3):189-207.
[22]邓祥军,麻金木.慢性肾功能衰竭患者性激素紊乱临床意义及机理研究概况[J].黑龙江中医药杂志,2005,(6)：60-62.
[23]张卫东张思孝.男性肾移植患者性功能变化的调查[J].临床泌尿外科杂志,1996,11(2)：111-112.
[24]赵国富仇连峰王志余.男性肾移植67例术后性功能变化的临床观察[J].中原医刊,1998,25(9)：45-46.
[25]Rodriguez RR, Burgos RFJ, Gomez DV, et al. Endocrine changes and sexual dysfunction in kidney transplantation and hemodialysis:comparative study [J]. Actas Urol ESP,1996,20(8):697-701.
[26]Rosas SE, Soffe M, Franklin E, et al. Prevelence and deferminants of erectile dysfunction in hemodialysis patients[J]. Kidney Int,2001,59:2259-2266.
[27]Naya Y, Soh J, Ochiai A, et al. Significant decrease of the international index of erectile function in male renal failure patients freated with hemodialysis [J]. Int J Impot Res,2002,14:172-177.
[28]王翔,黄炯伟,付伟金,等.肾移植患者勃起功能障碍的相关因素研究[J].中国男科学杂志,2009,23(12)：32-41.
[29]Kaufman JM, Hatzichristou DG, Mulhall JP, et al. Impotence and chronic renal failure:a study of the hemodynamic pathophysiology. J Urol.1994; 151(3):612-8.
[30]Weiss T, Windthorst C, Weiss C, et al. Acute effects of haemodialysis on cutaneous microcirculation in patients with peripheral arterial occlusive disease [J].Nephrol Dial Transplant.1998,13(9):2317-21.
[31]Bellinghieri G, Santoro G, Santoro D, et al. Ultrastructural changes of corpora cavernosa in men with erectile dysfunction and chronic renal failure [J].Semin Nephrol,2004,24(5):488-91.
[32]Prieto Castro RM, Anglada Curado FJ, Regueiro Lopez JC, et al. Treatment with sildenafil citrate in renal transplant patients with erectile dysfunction.BJU Int,2001,88(3):241-243.
[33]Coppola A, Cuomo G. Pituitary-testicular evaluation in patients with chronic renal insufficiency in hemodialysis treatment [J].Minerva Med,1990, 81(6):461-4.
[34]Rodriguez R, Burgos Revilla EJ, Gomez Dosantos V, et al. Endocrine changes and sexual dysfunction in kidney transplantation and hemodialysis:comparative study [J]. Actas Urol Esp,1996,20(8):697-701.
[35]唐智胜,姜书传.血液透析对男性终末期肾衰患者垂体-睾丸轴的影响[J].中华器官移植杂志,1992,13(1)：45-46.
[36]De Celis R, Pedron-Nuevo N. Male fertility of kidney transplant patients with one to ten years of evolution using a conventional immunosuppressive regimen [J]. Arch Androl.1999,42(1):9-20.
[37]Diemont WL, Vruggink PA, Meuleman EJ, et al. Sexual dysfunction after renal replacement therapy [J]. Am J Kidney Dis,2000,35(5):845-851.
[38]王书龙,张艮甫,黄赤兵,等.男性肾移植受者性功能状态的调查[J].中华男科学,2003,9(5)：358-360.
[39]郑军华,闵志廉.肾移植术后性功能及生育能力的调查[J].男性学杂志,1995,9(1)：4-6
[40]周梅生,朱有华,闵志廉,等.男性患者肾移植前后性相关激素、微量元素及勃起功能情况调查[J].中华器官移植杂志,2004,25(6)：328-330.
[1]Armenti VT, Constantinescu S, Moritz MJ, et al. Pregnancy after transplantation [J]. Transplant Rev,2008,22:223-240.
[2]黄剑刚,陈椿,高春章,等.同种异体肾移植术后妊娠的若干问题(附1例足月分娩报告)[J].中华器官移植杂志,1983,4：26-27.
[3]韩献萍,苗芸,于立新,等.肾移植术后妊娠对移植肾的影响[J].中华器官移植杂志,2003,24：28-30.
[4]中华医学会儿科学会呼吸学组,《中华儿科杂志》编辑委员会.反复呼吸道感染的临床概念和处理原则.中华儿科杂志,2008,46：108-109.
[5]Xu LG, Jin LM, Zhu XF, et al. A report of 212 male renal transplant recipients who fathered 216 offspring after transplantation [J].Transplantation,2008, 86(10):1480-1.
[6]Sturgiss SN, Davison JM. Effect of pregnancy on the longterm function of renal allografts:an update [J]. Am J Kidney Dis,1995,26:54-6.
[7]Hou S. Pregnancy in women requiring dialysis for renal failure [J]. Am J Kidney Dis.1987,9:368-73.
[8]Coscia LA, Constantinescu S, Moritz MJ,,et al. Report from the National Transplantation Pregnancy Registry (NTPR):outcomes of pregnancy after transplantation [J]. Clin Transpl.2007:29-42.
[9]Timing, Conditions, and Complications of Post-operative Conception and Pregnancy in Female Renal Transplant Recipients [J].Cell Biochem Biophys.2011,61(2):421-426.
[l0]徐龙根,韩澍,刘永,等.女性肾移植受者术后生育22例报告[J].中华器官移植杂志.2009；30(3)：40-42.
[11]Davison JM, Coscia LA, Silva P, et al. Outcomes of successive pregnancies in female kidney transplant recipients reporting pre-eclampsia in their first post-transplant pregnancy [J]. Hypertens Pregnancy,2006,25(Supp 1):27-29.
[12]Xu L, Yang Y, Shi JG, Wang H, et al.Unwanted pregnancy among Chinese transplant recipients [J]. Eur J Contracept Reprod Health Care,2011, 16(4):270-276.
[13]Gardiner SJ, Begg EJ. Breastfeeding during tacrolimus therapy [J]. Obstet Gynecol,2006,107:453-455.
[14]韩献萍,于立新.肾移植术后妊娠与分娩的临床观察[J].中华器官移植杂志,1993,13：167-169.
[15]Lavelanet AF, Coscia LA, Moritz MJ, et al. Long-term follow-up in the offspring of Sandimmune treated female kidney recipients [J].. Am J Transplant, 2006,6(Suppl 2):164-165.
[16]Sifontis NM, Coscia LA, Constantinescu S, et al. Pregnancy outcomes in solid organ transplant recipients with exposure to mycophenolate mofetil or sirolimus [J].. Transplantation,2006,82:1698-702.
[17]Josephson MA, McKay DB. Pregnancy in the renal transplant recipient [J]. Obstet Gynecol Clin North Am,2010,37:211-22.
[18]Baylis C. Glomerular filtration and volume regulation in gravid animal models [J]. Baillieres Clin Obstet Gynaecol,1994,8:235-64.
[19]Armenti VT, Radomski JS, Moritz MJ, et al. Report from the National Transplantation Pregnancy Registry (NTPR):outcomes of pregnancy after transplantation [J]. Clin Transpl,2000,123-34.
[20]Armenti VT, Ahlswede A, et al. Variables affecting birthweight and graft survival in 197 pregnancies incyclosporine treated female kidney transplant recipients [Jj.Transplantaion,1995,59:476-9.
[21]Kashanizadeh N, Nemati E, Sharifi-Bonab M, Impact of pregnancy on the outcome of kidney transplantation [J]. Transplant Proc.2007,39(4):1136-8.
[22]First MR, Combs CA, Weiskittel P, et al. Lack of effect of pregnancy on renal allograft survival or function [J].Transplantation.1995,59(4):472-6.
[23]Lindheimer MD, Davison JM, Katz Al. The kidney and hypertension in pregnancy:twenty exciting years [J]. Semin Nephrol.2001,21(2):173-89.
[24]Salmela KT, Kyllonen LE, Holmberg C, et al. Impaired renal function after pregnancy in renal transplant recipients [J]. Transplantation.1993, 56(6):1372-5.
[25]Sibanda N, Briggs JD, Davison JM, et al. Pregnancy after organ transplantation: a report from the UK Transplant pregnancy registry. Transplantation.2007, 83(10):1301-7.
[26]Sturgiss SN, Davison JM. Effect of pregnancy on the longterm function of renal allografts:an update [J]. Am J Kidney Dis,1995,26:54-6.
[27]Salmela K, Kyllonen L, Holmberg C, et al. Influence of pregnancy on kidney graft function [J].Transplant Proc,1993,25:1302
[1]Fryckstedt J, Hylander B.Sexual function in patients with end-stage renal disease [J].Scand J Urol Nephrol,2008,42(5):466-471.
[2]Bellinghieri G,Santoro D, Mallamace A, et a l. Sexual dysfunction in chronic renal failure [J].J Nephrol,2008,21 Suppl 13:S113-117.
[3]Lew-Starowicz M, Gellert R.The sexuality and quality of life of hemodialyzed patients-ASED multicenter study [J].J Sex Med,2009,6(4):1062-71.
[4]Leavey SF, Weitzel WF.Endocrine abnormalities in chronic renal failure [J].Endocrinol Metab Clin North Am,2002,31(1):107-119.
[5]宋亚香,李新华,朱开元.男性慢性肾功能衰竭病人血清性激素水平测定的临床意义[J].上海铁道大学学报,2000,21(9)：43-45.
[6]Soykan A, Bo las H, Kutlay S, et al.Do sexual dysfunctions get better during dialysis? Results of a six-month prospective follow-up study from Turkey [J].Int J Impot Res,2005,17(4):359-363.
[7]Watnick S.Pregnancy and contraceptive counseling of women with chronic kidney disease and kidney transplants [J].Adv Chronic Kidney Dis,2007, 14(2):126-131.
[8]Bogieevic M, Stefanovic V.Relationship between parathyroid hormone and pituitary-testicular axis in patients on maintenance hemodialysis [J].Exp Clin Endoerinol,1988,92(3):357-362.
[9]Jalali GR, Roozbeh J, Mohammadzadeh A, et al.Impact of oral zinc therapy on the level of sex hormones in male patients on hemodialysis [J].Ren Fail,32,(4):417-419.
[10]Bailie GR, Elder SJ, Mason NA, et al. Sexual dysfunction in dialysis patients treated with antihypertensive or antidepressive medications:results from the DOPPS [J].Nephrol Dial Transplant,2007,22(4):1163-1170.
[11]Santoro A. Anemia in renal insufficiency [J]. Rev Clin Exp Hematol,2002, Suppl 1:12-20.
[12]Palmer BF. Sexual dysfunction in uremia [J]. J Am Soc Nephrol,1999, 10(6):1381-1388.
[13]Handelsman DJ, Liu PY. Androgen therapy in chronic renal failure [J]. Baillieres Clin ndocrinol Metab,1998,12 (3):485-500.
[14]Lawrence IG, Price DE, Howlett TA,et al. Erythropoietin and sexual dysfunction [J]. Nephrol Dial Transplant,1997,12(4):741-747.
[15]李振新.药源性的男性性功能障碍[J].医药导报,2000,19(12)：536-538.
[16]Ho Hey j L.The hypothalamic-pituitary axis in men and women with chronic kidney disease [J]. Adv Chronic Kidney Dis,2004,11(4):337-341.
[17]Torre DL, Falomi A. Pharmacological causes of hyperprolactinemia [J]. Ther Clin Risk Manag,2007,3(5):929-951.
[18]Kadioglu P, Yalin AS, Tiryakioglu O, et al.Sexual dysfunction in women with hyperprolactinemia:a pilot study report [J]. J Urol,2005,174(5):1921-1925.
[19]Corona G, Mannucei E, Fisher AD, et a 1.Effect of hyperprolactinemia in male patients consulting for sexual dysfunction [J]. J Sex Med,2007, 4(5):1485-1493.
[20]Chahal J, Schlechte J.Hyperprelactinemia.Pituitary,2008,11(2):141-146.
[21]Chanson P, Boron-Chazot F, Chabre O, et al.Drug treatment of hyperprelaetinemia [J]. Ann Endocrinol,2007,68(3):113-117.
[1]Mattix Kramer HJ, Tolkoff-Rubin NE, Williams WW, et al. Reproductive and contraceptive characteristics of premenopausal kidney transplant recipients [J]. Prog Transplant,2003,13(3):193-196.
[2]沈维,陈江华,袁静,等.肾移植术后妊娠分娩3例分析[J].中国实用妇科与产科杂志,2005,21(2)：117-118.
[3]Murray JE, Reid DE, Harrison JH, et al. Successful pregnancies after human renal transplantation [J]. N Engl J Med,1963,269(3):341-343.
[4]Miniero R, Tardivo I, Curtoni ES, et al. Pregnancy after renal transplantationin Italian patients:focus on fetal outcome [J]. J Nephrol,2002,15 (6):626-632.
[5]Pezeshki M, Taherian AA, Gharavy M, et al. Menstrual characteristics and pregnancy in women after renal transplantation[J]. Int J Gynaecol Obstet,2004, 85(2):119-125.
[6]Walcott W O, Derick DE, Jolley JJ, et al. Successful pregnancy in a liver transplant patient [J]. Am J Obstet Gynecol,1978,132(3):340-341.
[7]Mass K, Quint EH, Punch MR, et al. Gynecological and reproductive function after liver transplantation [J]. Transplantation,1996,62 (4):476-469.
[8]Kairaitis LK, Nankivell BJ, Lawrence S, et al. Successful obstetric outcome after simultaneous pancreas and kidney transplantation [J]. Med J Aust, 1999,170(8):368-370.
[9]Jain A, Venkataramanan R, Fung JJ, et al. Pregnancy after liver transplantation under tacrolimus [J]. Transplantation,1997,64(4):559-565.
[10]Davison JM. Renal transplantation and pregnancy [J]. Am J Kidney Dis,1987,9 (4):374-380.
[11]Armenti VT, Moritz MJ, Radomski JS, et al. Pregnancy and transplantation [J]. Graft,2000,3 (2):59.
[12]Armenti VT, Herrine SK, Radomski JS, et al. Pregnancy after liver transplantation [J]. Liver Transpl,2000,6(6):671-685.
[13]陈真,文天夫.肝移植术后妊娠[J].中国普外基础与临床杂志,2006,13(4)：487-489,492.
[14]Jain AB, Reyes J, Marcos A, et a.l Pregnancy after liver transplantation with tacrolimus immunosuppression:a single center's experience update at 13 years[J].Transplantation,2003,76(5):827-832.
[15]Nagy S, Bush MC, Berkowitz R, et al. Pregnancy outcom e in liver transplant recipients [J]. Obstet Gynecol,2003,102(1):121-128.
[16]姜楠,杨扬,陈规划,等.同种异体肝移植术后成功妊娠分娩1例[J].中国实用外科杂志,2005,25(7)：443-444.
[17]Cardonick E, MoritzM, Armenti V, et al. Pregnancy in patients with organ transplantation:a review[J]. Obstet Gynecol Surg,2004,59(3):214-222.
[18]EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV:long term management of the transplant recipient [J]. Nephrol Dial Transplant,2002,17 (14):1-67.
[19]Seehofer D, MeiselH, Rayes N, et al. Prospective evaluation of the clinical utility of different methods for the detection of human cytomegalovirus disease after liver transplantation [J]. Am J Transplant,2004,4 (8):1331-1337.
[20]Fowler KB, Stagno S, Pass RF, et al. The outcome of congenital cytomegalovirus infect ion in relation to maternal antibody status [J]. N Engl J Med,1992,326 (10):663-667.
[21]Stanley CW, Gottlieb R, Zager R, et al. Developmental well-being in offspring of women receiving cyclosporine post-renal transplant [J]. Transplant Proc,1999, 1(1-2):241-242.
[22]Preis K, Leszczynska K, Krolikowska B, et al. Pregnancy, delivery and puerperium in patients after liver transplantation [J]. Ginekol Pol,2003,74 (10): 1246-1250.
[1]Holley JL, Schmidt RJ, Bender FH, et al. Gynecologic and reproductive issues in women on dialysis [J]. Am J Kidney Dis,1997,29:685-90.
[2]Wolf G, Chen S, Han DC, et al. Leptin and renal disease [J]. Am J Kidney Dis. 2002,39:1-11.
[3]Sievertsen GD, Lim VS, Nakawatase C, et al. Metabolic clearance and secretion rates of human prolactin in normal subjects and in patients with chronic renal failure [J]. J Clin Endocrinol Metab,1980,50:846-52.
[4]Ghazizadeh S, Lessan-Pezeshki M, Mahdavi M, et al. Menstrual problems among kidney transplant recipients [J]. Transplant Proc,2003,35:2720-1.
[5]Lessan-Pezeshki M. Pregnancy after renal transplantation:points to consider. Nephrol Dial Transplant,2002,17:703-7.
[6]Thurm JA. Effect of chronic renal disease on sexual functioning [J]. Med Asp Human Sex,1976,10:81.
[7]Palmer BF. Sexual dysfunction in uremia [J]. J Am Soc Nephrol,1999, 10:1381-8.
[8]Diemont WL, Vruggink PA, Meuleman EJ, et al. Sexual dysfunction after renal replacement therapy [J]. Am J Kidney Dis,2000,35:845-51.
[9]Muir JW, Besser GM, Edwards CR, et al. Bromocriptine improves reduced libido and potency in men receiving maintenance hemodialysis. Clin Nephrol, 1983,20:308-14.
[10]Rizzoni G, Ehrich JH, Broyer M, et al. Successful pregnancies in women on renal replacement therapy:report from the EDTA Registry [J]. Nephrol Dial Transplant,1992,7:279-87.
[11]Hou S. Pregnancy in women requiring dialysis for renal failure [J]. Am J Kidney Dis.1987,9:368-73.
[12]Chao AS, Huang JY, Lien R, et al. Pregnancy in women who undergo long-term hemodialysis [J]. Am J Obstet Gynecol,2002,187:152-6.
[13]Chang H, Miller MA, Bruns FJ. Tidal peritoneal dialysis during pregnancy improves clearance and abdominal symptoms [J]. Perit Dial Int,2002, 22:272-4.
[14]Redrow M, Cherem L, Elliott J, et al. Dialysis in the management of pregnant patients with renal insufficiency [J].Medicine (Baltimore),1988,67:199-208.
[15]Sturgiss SN, Davison JM. Effect of pregnancy on the longterm function of renal allografts:an update [J]. Am J Kidney Dis,1995,26:54-6.
[16]Lessan-Pezeshki M, Ghazizadeh S, Khatami MR,et al. Fertility and contraceptive issues after kidney transplantation in women [J]. Transplant Proc, 2004,36:1405-6.
[17]Murray JE, Reid DE, Harrison JH, et al. Successful pregnancies after human renal transplantation [J]. N Engl J Med,1963,269:341-3.
[18]Davison JM. Pregnancy in renal allograft recipients:prognosis and management [J]. Baillieres Clin Obstet Gynaecol,1987,1:1027-45.
[19]Sgro MD, Barozzino T, Mirghani HM, et al. Pregnancy outcome post renal transplantation [J]. Teratology,2002,65:5-9.
[20]Baylis C. Glomerular filtration and volume regulation in gravid animal models [J]. Baillieres Clin Obstet Gynaecol,1994,8:235-64.
[21]Armenti VT, Radomski JS, Moritz MJ, et al. Report from the National Transplantation Pregnancy Registry (NTPR):outcomes of pregnancy after transplantation [J]. Clin Transpl,2000,123-34.
[22]Armenti VT, Ahlswede A, et al. Variables affecting birthweight and graft survival in 197 pregnancies incyclosporine treated female kidney transplant recipients [J].Transplantaion,1995,59:476-9.
[23]Salmela K, Kyllonen L, Holmberg C, et al. Influence of pregnancy on kidney graft function [J].Transplant Proc,1993,25:1302.
[24]Kashanizadeh N, Nemati E, Sharifi-Bonab M, et al. Impact of pregnancy on the outcome of kidney transplantation [J]. Transplant Proc,2007,39:1136-8.
[25]Sibanda N, Briggs JD, Davison JM, et al. Pregnancy After Organ Transplantation:A Report From the U.K. Transplant Pregnancy Registry [J].Transplantation,2007,83.1301-1307.
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