性激素及其受体与肝硬化的相关性

Correlations of the expression of sex hormones and their receptors with the evolution of hepatic cirrhosis

目的:探讨性激素及其受体与肝硬化进展的相关性,为肝硬化临床无创性诊断筛选出较敏感、特异的诊断标志物.方法:2008-01/2009-04上海市中医医院消化内科门诊及住院男性乙型肝炎、肝硬化患者49例,其中乙型肝炎肝组9例,肝硬化代偿期9例,肝硬化失代偿期组31例;正常对照组为健康体检者25例.通过放射免疫法检测E2、T水平;Real-time PCR检测慢性肝病患者外周血白细胞ER、AR mRNA表达水平,观察以上各检测指标与肝硬化进展的相关性.结果:慢性肝病,特别是肝硬化患者E2水平,ER、AR表达水平较正常对照组均有升高,T水平较正常对照组明显降低.慢性肝病患者肝功能评分与患者E2水平均存在正相关(r=0.914,P<0.01),与T水平存在负相关(r=-0.833,P<0.01),与ER表达水平存在正相关(r=0.896,P<0.01),与AR表达水平存在正相关(r=0.905,P<0.01).结论:慢性乙型肝炎、肝硬化代偿期、肝硬化失代偿期患者性激素及其受体水平存在显著差异,随着病情发展,肝功能损伤越严重,这些指标呈规律性变化.

AIM： To investigate the correlations of the expression of sex hormones and their receptors with the evolution of hepatic cirrhosis and search more sensitive and specific diagnostic markers for hepatic cirrhosis. METHODS： A total of 49 male patients treated at Shanghai Hospital of Traditional Chinese Medicine from January 2008 to April 2009 were included in the study, of which 9 had chronic hepatitis B （CHB）, 9 had compensated cirrhosis,and 31 had decompensated cirrhosis. A control group was composed of 25 healthy individuals. The levels of estradiol （E2） and testosterone （T） in serum were examined by radioimmunoassay. The expression of estrogen receptor （ER） and androgen receptor （AR） mRNAs in peripheral leukocytes was examined by real-time PCR. The correlations of the above parameters with the evolution of hepatic cirrhosis were then analyzed. RESULTS： Compared with healthy controls, serum E2 level and the expression of sex hormone receptors in peripheral leukocytes significantly increased, and serum T level decreased in patients with chronic liver disease, particularly cirrhosis. The liver function score in patient with chronic liver disease had a positive correlation with serum E2 level （r=0.914, P 〈 0.01）, but a negative correlation with serum T level （r = -0.833, P 〈 0.01）. Both the expression of ER （r = 0.896, P 〈 0.01） and AR （r = 0.905, P 〈 0.01） had a positive correlation with the liver function score in patients with chronic liver disease. CONCLUSION： The expression levels of sex hormones and their receptors vary greatly among patients with CHB, compensated cirrhosis and decompensated cirrhosis, and exhibit regular changes with the worsening of disease and liver function.