男性肝移植受者血清性激素水平及性功能的研究

Changes of sex hormone levels and sexual function in male patients after liver transplantation

目的探讨男性肝移植受者术后血清性激素恢复过程及性生活质量。方法采集69例原发病为良性肝病的已婚男性肝脏移植受者移植前后1—6个月血清标本，采用放射免疫法分析测定血清睾酮、雌二醇，采用酶联免疫吸附法性激素结合球蛋白的浓度，选择同期本院健康已婚体检男性23例为健康对照组。随访研究组69例肝移植术后存活半年以上的24—45岁患者的性功能状态。结果患者肝移植术前血清雌二醇和性激素结合球蛋白明显高于健康对照组（雌二醇：87．56±31．21vs．26．00±9．12，u=9．30，P〈0．0001，性激素结合球蛋白：134．50±30．68VS．51．04±12．05，u=12．69，P〈0．0001）；睾酮明显低于健康对照组（睾酮：2．02±1．28vs．4．82±1．48，u=一8．73，P〈0．0001）；与患者术前终末期肝病模型评分（modelforend—stageliverdisease，MELD）相关（分别r=0．80，r=-0．77，r=0．72，均P〈0．0001），术后2周时血清雌二醇与健康对照组相比差异无统计学意义，术后1个月时血清睾酮和性激素结合球蛋白与健康对照组相比差异无统计学意义。结论男性肝移植术后1个月内血清雌二醇、血清睾酮和性激素结合球蛋白水平恢复正常，术后半年时性功能得到明显改善。

Objective investigate changes of sex hormone levels and sexual function in male patients after liver transplantation. Methods Blood samples were taken from 69 male patients receiving liver transplantation pretransplantation and postoperative 3rd, 7th, 14th day, 1st and 3rd month respectively. Serum estradiol and testosterone were measured by radioimmunoassay. Serum sex hormone binding globulin was measured by ELISA. Sixty-nine discharged adult male liver transplant recipients （ age ranging 24 -45 years） with a normally functioning allograft for at least 6 months were questioned on their pre-and post-operative sexual function compared with 23 adult healthy controls. Results Pretransplantation serum estradiol and sex hormone binding globulin were significantly higher （87.56＋31.21 vs. 26.00＋9.12, u=9.30,P〈0.0001, 134.50＋30.68 vs. 51.04 ＋12.05,u=12.69, P 〈0. 0001, respectively） , and testosterone was lower than normal controls （2. 02±1.28 vs. 4. 82 ± 1.48, u = - 8.73, P 〈 0. 0001 ） and levels were correlated with MELD scores （ r = 0. 80, P 〈 0. 0001,r = - 0. 77, P 〈0. 0001 ,r =0. 72 ,P 〈0. 0001, respectively）. Sex hormone levels were back to normal on postoperative 2nd week （serum estradiol） or 1 st month （serum testosterone and sex hormone binding globulin）. Compared with pretransplant status, sexual function improved significantly when evaluated on postoperative 6th month. Conclusions Levels of serum sex hormone were correlated with MELD scores before liver transplant. After liver transplant, estradiol was back to normal level on postoperative 2rid week, testosterone and sex hormone binding globulin back to normal level on postoperative 1 st month. Sexual function significantly improves after liver transplantation.