男性肝硬化患者血清雌二醇和睾酮水平变化及其与三联征的关系

目的探讨男性肝硬化患者血清雌二醇（E2）和睾酮（T）水平的变化及其与肝掌、蜘蛛痣和乳房发育三联征发生的关系。方法选择60例男性肝硬化患者和15例健康成年男性，采用放射免疫法检测血清E2和T水平，分析E2、T和E2/T比值与三联征发生的关系。结果男性肝硬化患者血清E2水平与正常对照组比无显著性差异（P〉0．05），而血清T水平明显降低，Child B和C级患者分别为10．0±8．0和7．5±9．8nmol／L，与正常对照组（26．8±6．3nmol／L）比有显著性差异（P〈0．05）；E2/T比值明显升高，Child A、B、C级分别为4．5±2．8，11．0±8．8，16．7±11．2，与正常对照组（2．3±3．5）比均有显著性差异（P〈0．05）；血清E2水平在有无“三联征”发生的患者之间无显著性差异（P〉0．05），血清T水平在蜘蛛痣（＋）组和（-）组分别为7．3±6．0nmol，L和17．0±9．2nmol/L，乳房发育（＋）组和（-）组分别为3．7±2．4nmol／L和15．6±8．8nmol／L，两组间比较差异均有显著性（P〈0．01）；E2/T比值在肝掌（＋）组和（-）组分别为13．9±10．5和5．5±3．6，蜘蛛痣（＋）组和（-）组分别为14．7±9．8和4．8±3．5，乳房发育（＋）组和（-）组分别为19．9±9．7和5．7±4．2，两组间比较差异均有显著性（P〈0．01）。结论男性肝硬化患者血清存在不同程度的性激素紊乱，血清T水平和E2/T比值的紊乱程度与肝硬化时肝功能受损程度有明显的关系，“三联征”的发生与血清E2水平无明显相关，而与E2/T比值关系密切。

Changes of serum estradiol and testosterone levels and their relationships with trilogy in male patients with liver cirrhosis

Objective To evaluate the changes of estradiol（E2） and testosterone（T） and their significance to trilogy （liver palms,vascular spider and mammary development）in the male patients with liver cirrhosis. Methods Serum E2 and T were detected by radioimmunoassay in 60 male patients with liver cirrhosis and 15 healthy male subjects selected as controls. Results Serum E2 levels in male patients with liver cirrhosis were not significantly higher than in controls （P〉 0.05）; and the difference was not significant between with or without trilogy （P〉0.05）. The T levels were significantly lower in patients with Child B （10.0±8.0nmol/L） and Child C （7.5±9.8nmol/L） as compared with healthy controls （26.8± 6.3nmol/L,P〈0.05）,and the E2/T ratio were much higher in Child B （16.7±11.2） and Child C （16.7±11.2） as compared with healthy controls （2.3±3.5,P〈0.05）. Serum T levels were significantly lower in patients with vascular spider （7.3±6.0 nmol/L vs. 17.0±9.2 nmol/L without,P〈0.01 ） and in with mammary development （3.7±2.4nmol/L vs. 15.6±8.8nmol/L with-out,P〈0.01 ）,and E2/T ratios were significantly higher in patients with liver palms （13.9±10.5 vs. 5.5±3.6 without,P〈 0.01）,in with vascular spider （14.7±9.8 vs. 4.8±3.5 without,P〈0.01） and in with mammary development （19.9±9.7 vs. 5.7±4.2 without,P〈0.01 ）. Conclusion Sex hormonal abnormality is frequently happened in male patients with liver cirrhosis. The severity of T and E2/T ratio abnormality is significantly associated with liver dysfunction. E2 level in serum has no significance in appearance of trilogy,while E2/T ratio is quite important.