Study On The Effects Of Different Treatment Methods On The Levels Of Sex Hormones And Gonadal Function In Patients With β-Thalassemia Major

Objective: To observe the effects of allogeneic hematopoietic stem cell transplantation(HSCT)treatment and conventional treatment of β-thalassemia major on gonadal function and sex hormone levels,and to compare the effects of different transplant ages on the levels of sex hormones in patients withβ-thalassemia major after transplantation,in order to provide reference for the prevention and treatment of gonadal dysfunction in patients with β-thalassemia major.Methods: This study Collected 368 patients who were diagnosed withβ-thalassemia major from January 2012 to December 2020 in the First Affiliated Hospital of Guangxi Medical University as the research objects.Among them,there were 191 cases in the non-transplantation group(121 males and 70 females)who received only blood transfusion therapy without hematopoietic stem cell transplantation,and those who underwent HSCT treatment and survived at least2 years after transplantation were included in the transplantation group,a total of177 cases(115 males and 63 females).In addition,a total of 85 healthy people(49 males and 36 females)who excluded thalassemia and other diseases were randomly selected as the control group.There was no significant difference in age and gender composition ratio among the three groups(P>0.05).Medical history and physical examination were performed on all subjects,and blood was collected from 8 to 10 in the morning on an empty stomach.Chemiluminescence method was used to detect follicle-stimulating hormone(FSH)and luteinizing hormone(LH),testosterone(TESTO)and estradiol(ESTRDL)in the three groups,and compared their the sex hormone levels.Gonadal function was evaluated for women ≥13 years old and men≥14 years old.FSH<2 IU/l,LH<2IU/l,testosterone<2 ng/ml(males)or estradiol<30 pg/ml(females)is diagnosed as hypogonadotropic hypogonadism,and FSH>10 IU/l,LH>10 IU/l,Testosterone <2 ng/ml(males)or estradiol <30pg/ml(females)is diagnosed as hypergonadotropic hypogonadism,and compared the effects of transplantation on sex hormone levels in different age groups in the transplantation group.Serum ferritin was collected from the HSCT treatment group before and after transplantation(at least 2 years after transplantation)and the non-transplantation group.Blood was also collected in the early morning on an empty stomach and detected by electrochemiluminescence immunoassay.All data were statistically analyzed by SPSS 25.0 statistical software,P<0.05 considered statistically different.Results:(1)General situation comparison: The level of serum ferritin after HSCT was significantly reduced compared with that before and without HSCT(P<0.05).(2)The results of the assessment of gonadal function: There was no hypogonadism in the control group.In the non-transplantation group,there were9 women who were≥13 years old and 27 men who were≥14 years old at the last follow-up.In the transplantation group,there were 9 women who were ≥ 13 years old and 11 men who were≥14 years old at the last follow-up.A total of 32patients(57.1%)had hypogonadism in the non-transplantation group and transplantation group.There were 7 cases in the transplantation group,of which7 cases were women(77.8%),0 cases were men(0.0%),and there were 25 cases in the non-transplantation group,including 5 women(55.6%)and 20 men(74.1%).The types of hypogonadism in the transplantation group were all hypergonadotropic hypogonadism,while those in the non-transplantation group were all hypogonadotropin hypogonadism.(3)Comparison of different sexes with hypogonadism: Both females and males in the non-transplantation group were prone to hypogonadotropic hypogonadism(P>0.05),and females in the transplantation group had a higher risk of hypergonadotropic hypogonadism than males(P<0.05).(4)Women had a higher risk of increased gonadotropin during transplantation in adolescence than in childhood(P<0.05).(5)Comparison of sex hormone levels in different treatment groups at various ages:In prepubertal females,the level of FSH in the transplantation group was higher than in the control group and the non-transplantation group.In adolescent women,compared with the control group and the non-transplantation group,the FSH and LH of the transplantation group were increased,and the estradiol level was lower than that of the control group(P<0.05).In prepubertal and adolescent women,the non-transplantation group only showed that the FSH level of adolescent women was lower than in the control group(P<0.05).In prepubertal males,compared with the control group,the transplantation group had no significant difference in FSH,LH and testosterone levels(P>0.05),and the non-transplantation group only showed that the level of LH was higher(P<0.05).Compared with the transplantation group,the level of LH in non-transplantation group was significantly higher,while the testosterone was lowered(P<0.05).In adolescent men,compared to the control group,the levels of LH and testosterone in the transplantation group were higher.And in the non-transplantation group,the FSH was lower than in the control group,while the levels of FSH,LH and testosterone were lower than those in the transplantation group(P<0.05).Conclusions: Patients with thalassemia major are at risk of developing hypogonadism whether they choose conventional treatment or allogeneic hematopoietic stem cell transplantation.For patients treated with routine blood transfusion therapy,attention should be paid to regular monitoring of serum ferritin.While blood transfusion therapy improves anemia,regular iron treatment is also required to avoid hypogonadism caused by iron overload.HSCT treatment should be performed as soon as possible.Early transplantation in male patients can avoid hypogonadotropic hypogonadism caused by long-term iron overload.Although female patients are prone to hypergonadotropic hypogonadism after HSCT treatment,early transplantation,such as in early childhood,may reduce the risk of developing hypogonadism.In short,whether it is conventional blood transfusion therapy or transplantation therapy for thalassemia patients,their gonadal hormones,gonadal function and sexual development should be followed up for a long time.In addition to improving the survival of these patients,attention should be paid to avoid reducing the occurrence of endocrine complications such as gonadal dysfunction.