门体分流在肝硬化患者性激素改变中的作用

EFFECT OF PORTOSYSTEMIC SHUNTING ON CHANGE OF SEX HORMONES IN LIVER CIRRHOSIS

研究肝硬化患者的门体分流与性激素的关系。采用９９ｍＴｃ─ＭＩＢＩ（甲氧基异晴）测定心／肝放射性摄取比值（Ｈ／Ｌ比值）作为门体分流指标。２０例男性肝硬化患者的雌二醇（Ｅ２）及催乳素（ＰＲＬ）水平明显高于正常对照组（Ｐ＜０．０１），睾酮（Ｔ）及黄体生成素（ＬＨ）明显低于正常对照组（Ｐ＜０．０１），而卵泡刺激素（ＦＳＨ）水平无明显改变（Ｐ＞０．０５）。与正常人群相比，肝硬化患者的Ｈ／Ｌ值明显增高（Ｐ＜０．０１），且与Ｅ２水平有明确的正相关（（ｒ＝０．７８，Ｐ＜０．０１）与ＬＨ有明确的负相关（ｒ＝０．６２，Ｐ＜０．０５），而与其他激素（ＦＳＨ，Ｔ及ＰＲＬ）无明确相关。５种激素与肝细胞功能指标（血清白蛋白、凝血酶原时间、总胆红素）无明确相关。肝硬化时肝细胞功能的损伤可能不是致性激素紊乱的主要原因，而肝硬化时的门体分流可能在引起性激素变化中起着重要的作用。

PURPOSE To explore machanism that can account for change of sex hormones in liver Cirrhosis,we invastigate relationship between portal systemic shunting and sex hormones changes in cirrhotics.METHODS A recently introduced Heart/Liver ratio,a noninvasive measure for portal systemic shunting using 99m Tc─MIBI was applied to 20 male cirrhotics and testosterone(T),estradiol(E2),prolactin(PRL),luteinizing hornone (LH)and follicle─stimulating hormone(FSH)were determined by radioimmunoassay.RESULTS In 20 patients with liver cirrhosis,mean concentration of T was significantly reduced(P<0.01),that of E2 and PRL was significantly increased(P<0.01)and that of FSH was not significantly changed(P>0.05)compared with 30 normal controls.H/L ratio in liver cirrhotics was much higher than that in controls(P<0.01).There is positive correlation between E2 and H/L ratio and negative correlation between H/L ratio and LH. No correlation was found between H/L ratio and other hormones(FSH.T. PRL)and between every hormone measured and serum albumin,prothrombin time and total bilirubin.CONCLUSIONS These data suggest that impairment of hepatocellular function may not be the main cause leading to disturbance of sex hormones in cirrhotics,it is possible that portosystemic shunting plays a very important role in leading to such a disturbance.