慢性乙肝性肝硬化症男性患者血清性激素、钙调节激素和骨转换指标的变化

Changes in biochemical markers of bone turnover,sex hormones and calcium regulating hormones in male patients with chronic hepatitis B induced liver cirrhosis

目的 慢性严重肝脏损害常合并肝性骨病。为了探讨终末期肝病患者的钙调节激素变化和骨转换率状态 ,我们回顾性分析了 17例乙肝后肝硬化失代偿的男性患者 ,并和年龄、身高、体重相匹配的健康男性进行对照研究。方法 肝硬化组和对照组均检测其血清性激素 [雄激素 (T)、雌激素 (E2 ) ],钙调节激素 [甲状旁腺素 (PTH)、降钙素 (CT)和 2 5羟维生素D3(2 5 -OHVD3) ]和骨转换指标 [血清骨钙素 (BGP)和尿脱氧吡啶啉 肌酐比值 (Dpd Cr) ]以及钙 (Ca2 + )、磷 (PO3- )和碱性磷酸酶 (ALP)。结果 显示与对照组相比 ,肝硬化组血清T明显降低、E2 水平和E2 T比值显著升高 ;血清PTH显著升高、2 5 -OHVD3明显降低 ,而CT差异不大。其中E2 升高和 2 5 -OHVD3降低有极显著意义。肝硬化组血清BGP和Ca2 + 水平明显降低、尿Dpd Cr比值和尿Ca2 + Cr比值明显升高。而血清CT和PO3- 差异不大。结论 我们认为慢性严重肝硬化患者骨量减低 ,呈现出骨形成降低、骨吸收增强之特征 ,与维生素D和性激素代谢异常有关 。

Objective\ To estimate the bone turnover and hormonal status of the bone disease in patients with end stage liver disease. Methods\ A prospective study was performed on 17 male patients with chronic hepatitis B induced liver cirrhosis(cirrhotic group)and 17 healthy volunteers matched with sex,age,weight and height(control group).serum estradial(E 2),testosterone(T),calcitolin,parathyroid hormaone (PTH),25 hydroxyvitamin D 3,osteocalcin,calcium,phosphorus,and ALP levels,and urinary deoxyhydroxyproline/creatinine(Dpd/Cr)ratio and Ca 2+ /Cr ratio were assessed. Results\ Cirrhotic patients showed lower serum testosterone levels than controls and showed increased serum estradial and E 2/T ratio.Serum osteocalcin,25 hydroxyvitamin D 3 and calcium levels were significantly lower in cirrhotic group than in control group,and serum PTH,urinary Dpd/Cr ratio and Ca 2+ /Cr ratio were markedly increased in cirrhotic group compared to control group.Serum calcitolin and phosphorus had no differences between the two groups. Conclusion\ Significant disorders of mineral metabolism,such as vitamin D deficiency,increased parathyroid hormone levels,and hypogonadism are involved,and reduced bone formation and increased bone resorption occurs in end stage cirrhotic patients that decreased in bone mass,particularly in the lumbar spine.\;