肝炎后肝硬化的性激素变化及其意义

Determination of Sex Hormones in Liver Cirrhosis and Its Clinical Significance

为了解肝炎后肝硬化的性激素变化及影响性激素改变的有关因素。本文采用放射免疫法对３５例男性肝炎后肝硬化进行了血清睾酮（Ｔ），雌二醇（Ｅ_２），催乳素（ＰＲＬ），黄体生成素（ＬＨ）及卵泡刺激素（ＦＳＨ）的测定。结果发现，肝硬化患者的Ｔ及ＬＨ平均浓度明显低于正常对照组（Ｐ＜０．０１），Ｅ_２及ＰＲＬ的平均浓度明显高于正常人（Ｐ＜０．０１），而ＦＳＨ的平均浓度与正常人相比则无明显改变（Ｐ＞０．０５）。各激素与血清白蛋白，凝血酶原时间及总胆红素之间无明确相关。按Ｃｈｉｌｄ分级，Ｃ级患者的Ｅ_２水平高于Ａ级和Ｂ级患者（Ｐ＜０．０５），而各组间的Ｔ、ＰＲＬ、ＬＨ及ＦＳＨ浓度无统计学意义。３５例肝硬化中，１０例发生女性乳房发育，占２８．６％。有乳房发育和无乳房发育间各激素浓度无统计学差异。这些结果提示，肝炎后肝硬化存在着性激素的改变，肝细胞功能的损害在性激素紊乱中起着某些作用，但其他因素如门体分流可能起着更重要的作用。

In order to understand change of sex hormones in posthepatic liver cirrhosis and find out factors that have influence upon sex hormones,testosterone (T),estradiol (E_2),prolactin (PRL), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were assayed in 35 patients with liver cirrhosis by radio-immunoassay. Our results showed that mean concentration of T and LH was significantly reduced (P<0. 01),that of E_2 and PRL was significantly increased (P<0. 01 )and that of FSH was not significantly changed (P>0. 05) compared with 30 normal controls. No correlation was found between sex hormons and total bilirubin,albumin or prothrombin time. Level of E_2 in patients with C grade of Child classification was much higher than that in patients with A or B grade (P<0. 05). 10 patients of 35 cirrhotics have gynecomstia (28. 6 %). There was no difference in T,E_2,PRL,LH and FSH between the patients with gynecomstia and without gynecomstia. Our data suggests that disturbance of sex hormone exists in cirrhosis. Although impairment of hepatocellular function may play some role is leading to disturbance of sex hormones in cirrhotics,other factors such as portosystemic shunting may play more important part in leading such disturbance.