藏族男性肝病患者下丘脑-垂体-性腺轴功能的变化及其临床意义

目的　探讨藏族男性肝病患者下丘脑 垂体 性腺轴的变化 ,了解不同类型肝病患者性腺激素水平的变化 ,协助临床对病情和预后的判断。方法　于 1999- 12～ 2 0 0 4 - 0 4在西藏自治区第二人民医院随机选择西藏地区藏族男性肝病患者 93例 ,包括甲型肝炎、乙型肝炎、酒精性肝病、肝硬化及重症肝炎。同时选取西藏地区 19名健康藏族男性作为对照。测定入选者睾酮 (T)、雌二醇 (E2 )、卵泡刺激素 (FSH)、黄体生成素 (LH )、泌乳素(PRL)及促性腺激素释放激素 (LHRH)的水平。资料统计采用双侧 t检测。结果　肝病患者E2 、PRL和LHRH水平与对照组比较均有显著性差异 (P <0 0 1、P <0 0 1、P <0 0 5 )。急性肝炎T、E2 、PRL升高 ,E2 升高 (P <0 0 1、P <0 0 5、P <0 0 1)。出现高雌激素血症和低睾酮血症 :重症肝炎T、FSH、LH、LHRH降低 (P <0 0 1、P<0 0 5、P <0 0 5、P <0 0 1) ,E2 、PRL升高 ,均为P <0 0 1。结论　性激素水平的变化与肝功能受损程度相一致 ,因此临床上测定性激素水平对了解病情、判断预后有着一定的作用。

Functional changes of the hypothalamus-pituitary-gonad axis in Tibetan male patients with chronic hepatic disease and its clinical significance

Objective To study the variations of hypothalamus pituitary-gonad axis in Tibetan male patients with hepatic diseases and to understand the serum levels of gonadal hormone in different hepatic diseases.Methods We randomly selected 93 Tibetan male hepatic patients from Tibet Autonomous Region.The types of hepatic diseases included hepatitis A,hepatitis B,alcoholic hepatitis,cirrhosis and serious hepatitis.Meanwhile we selected 19 healthy Tibetan males as controls from the same region.We detected the serum levels of testoid (T),estradiol (E 2),follicle-stimulating hormone (FSH),luteinizing hormone (LH),prolactin (PRL) and luteinizing hormone-releasing hormone (LHRH).Statistical analysis was performed by double t-test.Results The serum levels of E 2,PRL and LHRH were all significantly different in patients with hepatic disease compared with the control.(P<0.01,P<0.01,P<0.05).Furthermore,the changes were different among patients with acute hepatitis,chronic hepatitis,cirrhosis and serious hepatitis.In Acute hepatitis,T and E 2increased (P<0.01).In chronic hepatitis,T,E 2 and PRL increased,LHRH lowered (P<0.01).The serum levels of T and LHRH were reduced but E 2 increased in patients with cirrhosis,which showed high estrogen with low testoid.(P<0.01,P<0.05,P<0.01).In serious hepatitis,T,FSH,LH,LHRH levels were reduced and E 2,PRL were increased.(P<0.01,P<0.05,P<0.05,P<0.01,P<0.01,P<0.01).Conclusion The variations of serum levels of gonadal hormone are consistent with the injury degree of liver function.It could be useful for predicting the prognosis.