男性肝病肝损害程度对血清性激素水平的影响

Influence of liver function damage in liver diseases on serum sex hormones in male

[目的]探讨男性慢性肝炎、肝硬化、慢加急肝衰竭患者的肝损害程度对血清性激素的影响。[方法]收集男性肝病患者84例,其中肝炎肝硬化患者42例,慢性肝炎患者32例,慢加急及亚急性肝衰竭患者10例;同期入选相同年龄段健康体检男性人群42例为对照组。采用放射免疫法检测外周血清雌二醇(estradiol,E2)、卵泡刺激素(follicle-stimulating hormone,FSH)、促黄体生成素(luteotropic hormone,LH)、催乳素(prolactin,PRL)、黄体酮(progesterone,PROG)、睾酮(testosterone,TSTO)和硫酸去氢表雄酮(dehydroepiandrosterone sulfate,DHEA-SO4)7种性激素水平,观察患者的性激素水平特点。[结果]慢性肝炎者PRL水平显著高于对照组(t=2.804,P=0.015)。E2、PRL水平随着肝功能恶化而递增,而DHEA-SO4水平则在肝硬化者下降,肝衰竭者升高,在分级不同的肝硬化患者比较中差异有统计学意义,Spearman相关分析显示,E2、PRL与肝功能Child-Pugh分级呈正相关性(r=0.572,0.550;P=0.003,0.004),而FSH、LH、PROG、TSTO和DHEA-SO4水平与肝功能Child-Pugh分级无关。[结论]PRL是反映早期肝损害的敏感指标,同时PRL和E2也是反映肝硬化肝功能损害程度的可靠指标,与肝功能Child-Pugh分级具有一定的正相关性;肝衰竭患者E2、PRL、DHEA-SO4水平明显高于肝硬化者和健康人。

[Objective]To explore the effect of liver damage on serum sex hormones in male patients with chronic hepatitis,liver cirrhosis,acute-on-chronic and subacute-on-chronic liver failure.[Methods]Eighty-four male patients with liver disease were selected,including 42 liver cirrhosis,32 chronic hepatitis and 10 acute,subacute-on-chronic liver failure patients.At the same time,42 cases of male population were selected as the control group.Seven sex hormones,estradiol（E2）,follicle stimulating hormone（FSH）,luteotropic hormone（LH）,prolactin（PRL）,progesterone（PROG）,testosterone（TSTO）and Dehydroepiandrosterone sulfate（DHEA-SO4）were tested by radioimmunoassay,and were observed in the serum of male patients with chronic hepatitis,liver cirrhosis and acute,subacute liver failure.[Results]The level of PRL in chronic hepatitis group was significantly higher than that in control group（t=2.804,P=0.015）.The levels of E2,PRL increased with the deterioration of liver function.While the level of DHEA-SO4 de-creased in liver cirrhosis group,and increased in liver failure group.There were statistical differences in three groups.Spearman correlation analysis showed that E2 and PRL were positively correlated with liver function Child-Pugh grades,while FSH,LH,PROG,TSTO and DHEA-SO4 levels were not associated with Child-Pugh grades.（r=0.572 and 0.550,P=0.003 and 0.004）.[Conclusion]PRL is a sensitive index for early liver damage.PRL and E2 are positively correlation with liver function child-pugh grades,which are reliable indicators of liver damage in cirrhosis.Levels of E2,PRL and DHEA-SO4 in patients with hepatic failure are significantly higher than those in cirrhosis and control group.