男性肝硬化患者面部皮肤损害与血清性激素水平及肝功能的关系

Facial skin lesions in male patients with liver cirrhosis： role of serum sex hormones and correlation withimpaired liver function

目的探讨男性肝硬化患者面部皮肤损害的发生机制与性激素水平及肝功能等相关影响因素的关系。方法随机选择同期50例有面部皮肤损害（蜘蛛痣、毛细血管扩张、特殊类型皮疹）的肝硬化患者为病例组，30例无面部皮肤损害的肝硬化患者为对照组，检测血清中黄体生成素（LH）、卵泡刺激素（FSH）、催乳素（PRL）、雌二醇（E2）、孕酮（PRGE）、睾酮（T）水平，两组间比较采用t检验。肝硬化的严重程度按照Child-Pugh评分，分为A、B、C级，两组各级之间的比较采用单因素方差分析。对皮肤损害的相关因素：丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、血清总胆红素（TBil）、血清白蛋白（Alb）、凝血酶原时间（Pr-sEc）、血肌酐（CREA）、血小板计数（PLT）水平，以及是否酗酒采用成组logistic回归方法进行评估。结果（1）男性肝硬化面部皮肤损害患者血清LH、FSH、E2水平和E2／T值分别高于对照组（f值分别为2．01、2．03、2．08、2．98，P值均〈0．05）；T水平在三组皮肤损害患者中均低于对照组（t值分别为-2．20、-3．77、．2．01，P值均〈0．05）；（2）有皮肤损害组E2水平随着肝功能损害程度的加重依次降低，而无皮肤损害组E2水平随着肝功能损害程度的加重依次增高，两组间E2值的差异均无统计学意义（F=3．59，P〉0．05）。有皮肤损害组和无皮肤损害组T水平随着肝功能损害程度的加重均依次降低，两组之间T值的差异有统its意义（F=3．70，P〈0．05）；（3）多因素相关风险度显示：长期酗酒及AST的升高会使面部皮肤损害发病率增高，其OR值分别为4．46、11．87，95％置信区间分别为1．45～13．7和1．24～113．1，P值均〈0．05。结论男性肝硬化面部皮肤损害患者血清中存在不同程度的性激素紊乱，肝硬化皮疹的严重程度与长期酗酒及肝功能的好坏有关。总之，酒精和肝功能受损以及性激素紊乱在肝硬化皮肤损害的发病机制中发挥重要作用。

Objective To investigate the relationship between serum sex hormone levels, liver function, and pathogenic mechanisms related to cutaneous lesions involving the facial skin in male patients with liver cirrhosis. Methods Fitty male cirrhotic patients with facial skin lesions, including spider angiomas, angiotelectasis and special type rash, （mean age： 48.1 ± 12.2 years） were randomly selected for study and enrolled as the case group. Thirty cirrhotic male patients without facial skin lesions （mean age： 44.5 ±11.7 years） were enrolled as the control group. Serum levels of luteinizing hormone （LH）, follicular stimulating hormone fiSH）, prolaetin （PRL）, estradiol （E2）, progesterone （PRGE）, and testosterone （T） were detected and compared between cases and conlrols by the t-test. All patients were sub-categorized according to severity of cirrhosis （Child-Pugh classification） and comparisons between cases and conlrols were carried out by single factor analysis of variance. Logistic regression modeling was used to evaluate whether the presence of skin lesions is related to changes in markers of liver impairment, including alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBil）,serum albumin （Alb）, prothrombin time （PT-SEC）, creatinine （CREA）, platelet count （PLT）, and alcoholism. Results In the cases with spider veins, LH level was significantly elevated （t = 2.01） and T level was significantly decreased （t= -2.20） （both, P 〈 0.05 vs. controls）. In the cases with telangiectasia, the LH level （t= 3.76, E2 （t= 2.08） and E2/T ratio （t= 2.98） were significantly elevated and T level was significantly decreased （t= -3.77） （all, P 〈 0.05 vs. controls）. In the cases with special type rash, FSH level was significantly elevated （t = 2.03） and T level was significantly decreased （t = -2.01） （both, P 〈 0.05 vs. controls）. In the case group, E2 levels decreased as severity of liver damage increased, while in the control group, E2 levels increased as severity of liver damage increased; however, the difference in average E2 values of the two groups did not reach statistical significance （P 〉 0.05）. In both cases and controls, the T levels were decreased as the severity of liver damage increased （F = 3.70,P 〈 0.05）. Multivariate logistic regression analysis showed that increased incidence of facial skin lesions is associated with alcoholism （odds ratio （OR） = 4.46, 95% confidence interval （C/） = 1.45-13.7, P 〈 0.05） and elevated serum levels of AST （OR = 11.87, 95% CI = 1.24-113.1, P 〈 0.05）. Conclusion Alcoholism, impaired liver function, and perturbed levels of circulating sex hormones are associated with cirrhosis-related facial lesions and may play important roles in the pathogenesis of cutaneous lesions in patients with cirrhosis.