男性肝硬化失代偿期患者性激素水平变化及临床意义

目的 :探讨男性肝硬化失代偿期患者性激素水平变化及与肝功能损害关系。方法 :采用放射免疫法检测 45例男性肝硬化失代偿期患者 (肝硬化组 )和 2 0例健康男性 (对照组 )的血清性激素睾酮 (T)、雌酮(E1)、雌二醇 (E2 )、雌三醇 (E3 )水平 ,并采用Child pugh分级法将上述病例分为A级组、B级组和C级组进行比较。结果 :肝硬化组T明显低于对照组 (P <0 .0 1) ,E1(P <0 .0 1)、E3 (P <0 .0 5 )明显高于对照组 ,均有显著性差异 ,E2 无明显差异。从ChildA级到ChildC级T水平呈渐进性显著下降、E1水平呈渐进性显著上升。肝硬化组Child pugh积分与T浓度成负相关 (r =-0 .5 3 ,P <0 .0 1) ,与E1、浓度成正相关 (r =0 .5 11,P <0 .0 1) ,与雌二醇 (E2 )、雌三醇 (E3 )浓度无明确相关。 45例肝硬化患者中有 3 2例有女性化征 ,有女性化征E1浓度明显高于无女性化征E1浓度。结论 :肝硬化存在不同程度的性激素紊乱 ,其紊乱程度与肝硬化时肝功能受损程度有明显关系 ,测定性激素水平变化 ,可以作为临床判断预后、疗效的一个指标。

Change of serum levels of sex hormone and clinical significance in the male patients with hepatocirrhosis in the stage of decompensation

Objective: To explore the relationship between serum levels of sex hormone. and severity of liver dysfunction in the male patients with cirrhosis in the stage of decompensation.Methods: Serum components of sex hormone, testosterone(T), Estrone(E 1), Estradiol(E 2), and estriol(E 3) were measured by radioimmunoassay in 45 cases (14Child-pugh class A, 19Child-pugh class B, 12Child-pugh class C) decompensated cirrhosis,then compared with 20 cases normal subjects. Results: In cirrhosis group, the serum T level was significantly lower than contronl group(P<0.01),E 1(P<0.01) ,E 3(P<0.05) were significantly higer than control group. No difference was found in serum E 2 level between two groups (P>0.05). T levels progressively and significantly decreased from cirrhosis Child A to C.E1 levels progressively and significantly increased from cirrhosis Child A to C.Child-pugh score was correlated positively with E 1 (r=0.511,P<0.01)and was correlated negatively with T(r=- 0.53,P<0.01)in cirrhosis group. Not correlated with E 2, E 3. 32 patients of 45 cirrhosis have femi-nation,E 1 levels significantly higher in cirrhotic patients with feminization(P<0.05) than without feminization. Conclusion: Hepatocirrhosis hadvarying amounts ofdisorder in levels of sex hormone in serum, depending on liver function lesion gravity, the determination of above hormone could be deserved as a standard for clinical state of illness.