中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2013年
5期
354-358
,共5页
杜阿帅%杨京%陆爽%曾经章
杜阿帥%楊京%陸爽%曾經章
두아수%양경%륙상%증경장
肝硬化%皮肤损害%性激素%肝功能
肝硬化%皮膚損害%性激素%肝功能
간경화%피부손해%성격소%간공능
Liver cirrhosis%Skin lesion%Sex hormone%Liver function
目的 探讨男性肝硬化患者面部皮肤损害的发生机制与性激素水平及肝功能等相关影响因素的关系.方法 随机选择同期50例有面部皮肤损害(蜘蛛痣、毛细血管扩张、特殊类型皮疹)的肝硬化患者为病例组,30例无面部皮肤损害的肝硬化患者为对照组,检测血清中黄体生成素(LH)、卵泡刺激素(FSH)、催乳素(PRL)、雌二醇(E2)、孕酮(PRGE)、睾酮(T)水平,两组间比较采用t检验.肝硬化的严重程度按照Child-Pugh评分,分为A、B、C级,两组各级之间的比较采用单因素方差分析.对皮肤损害的相关因素:丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血清总胆红素(TBil)、血清白蛋白(Alb)、凝血酶原时间(PT-SEC)、血肌酐(CREA)、血小板计数(PLT)水平,以及是否酗酒采用成组logistic回归方法进行评估.结果 (1)男性肝硬化面部皮肤损害患者血清LH、FSH、E2水平和E2/T值分别高于对照组(t值分别为2.01、2.03、2.08、2.98,P值均＜0.05)；T水平在三组皮肤损害患者中均低于对照组(t值分别为-2.20、-3.77、-2.01,P值均＜0.05);(2)有皮肤损害组E2水平随着肝功能损害程度的加重依次降低,而无皮肤损害组E2水平随着肝功能损害程度的加重依次增高,两组间E2值的差异均无统计学意义(F=3.59,P＞ 0.05).有皮肤损害组和无皮肤损害组T水平随着肝功能损害程度的加重均依次降低,两组之间T值的差异有统计学意义(F=3.70,P＜0.05);(3)多因素相关风险度显示:长期酗酒及AST的升高会使面部皮肤损害发病率增高,其OR值分别为4.46、11.87,95％置信区间分别为1.45 ～ 13.7和1.24～ 113.1,P值均＜0.05.结论 男性肝硬化面部皮肤损害患者血清中存在不同程度的性激素紊乱,肝硬化皮疹的严重程度与长期酗酒及肝功能的好坏有关.总之,酒精和肝功能受损以及性激素紊乱在肝硬化皮肤损害的发病机制中发挥重要作用.
目的 探討男性肝硬化患者麵部皮膚損害的髮生機製與性激素水平及肝功能等相關影響因素的關繫.方法 隨機選擇同期50例有麵部皮膚損害(蜘蛛痣、毛細血管擴張、特殊類型皮疹)的肝硬化患者為病例組,30例無麵部皮膚損害的肝硬化患者為對照組,檢測血清中黃體生成素(LH)、卵泡刺激素(FSH)、催乳素(PRL)、雌二醇(E2)、孕酮(PRGE)、睪酮(T)水平,兩組間比較採用t檢驗.肝硬化的嚴重程度按照Child-Pugh評分,分為A、B、C級,兩組各級之間的比較採用單因素方差分析.對皮膚損害的相關因素:丙氨痠轉氨酶(ALT)、天鼕氨痠轉氨酶(AST)、血清總膽紅素(TBil)、血清白蛋白(Alb)、凝血酶原時間(PT-SEC)、血肌酐(CREA)、血小闆計數(PLT)水平,以及是否酗酒採用成組logistic迴歸方法進行評估.結果 (1)男性肝硬化麵部皮膚損害患者血清LH、FSH、E2水平和E2/T值分彆高于對照組(t值分彆為2.01、2.03、2.08、2.98,P值均＜0.05)；T水平在三組皮膚損害患者中均低于對照組(t值分彆為-2.20、-3.77、-2.01,P值均＜0.05);(2)有皮膚損害組E2水平隨著肝功能損害程度的加重依次降低,而無皮膚損害組E2水平隨著肝功能損害程度的加重依次增高,兩組間E2值的差異均無統計學意義(F=3.59,P＞ 0.05).有皮膚損害組和無皮膚損害組T水平隨著肝功能損害程度的加重均依次降低,兩組之間T值的差異有統計學意義(F=3.70,P＜0.05);(3)多因素相關風險度顯示:長期酗酒及AST的升高會使麵部皮膚損害髮病率增高,其OR值分彆為4.46、11.87,95％置信區間分彆為1.45 ～ 13.7和1.24～ 113.1,P值均＜0.05.結論 男性肝硬化麵部皮膚損害患者血清中存在不同程度的性激素紊亂,肝硬化皮疹的嚴重程度與長期酗酒及肝功能的好壞有關.總之,酒精和肝功能受損以及性激素紊亂在肝硬化皮膚損害的髮病機製中髮揮重要作用.
목적 탐토남성간경화환자면부피부손해적발생궤제여성격소수평급간공능등상관영향인소적관계.방법 수궤선택동기50례유면부피부손해(지주지、모세혈관확장、특수류형피진)적간경화환자위병례조,30례무면부피부손해적간경화환자위대조조,검측혈청중황체생성소(LH)、란포자격소(FSH)、최유소(PRL)、자이순(E2)、잉동(PRGE)、고동(T)수평,량조간비교채용t검험.간경화적엄중정도안조Child-Pugh평분,분위A、B、C급,량조각급지간적비교채용단인소방차분석.대피부손해적상관인소:병안산전안매(ALT)、천동안산전안매(AST)、혈청총담홍소(TBil)、혈청백단백(Alb)、응혈매원시간(PT-SEC)、혈기항(CREA)、혈소판계수(PLT)수평,이급시부후주채용성조logistic회귀방법진행평고.결과 (1)남성간경화면부피부손해환자혈청LH、FSH、E2수평화E2/T치분별고우대조조(t치분별위2.01、2.03、2.08、2.98,P치균＜0.05)；T수평재삼조피부손해환자중균저우대조조(t치분별위-2.20、-3.77、-2.01,P치균＜0.05);(2)유피부손해조E2수평수착간공능손해정도적가중의차강저,이무피부손해조E2수평수착간공능손해정도적가중의차증고,량조간E2치적차이균무통계학의의(F=3.59,P＞ 0.05).유피부손해조화무피부손해조T수평수착간공능손해정도적가중균의차강저,량조지간T치적차이유통계학의의(F=3.70,P＜0.05);(3)다인소상관풍험도현시:장기후주급AST적승고회사면부피부손해발병솔증고,기OR치분별위4.46、11.87,95％치신구간분별위1.45 ～ 13.7화1.24～ 113.1,P치균＜0.05.결론 남성간경화면부피부손해환자혈청중존재불동정도적성격소문란,간경화피진적엄중정도여장기후주급간공능적호배유관.총지,주정화간공능수손이급성격소문란재간경화피부손해적발병궤제중발휘중요작용.
Objective To investigate the relationship between serum sex hormone levels,liver function,and pathogenic mechanisms related to cutaneous lesions involving the facial skin in male patients with liver cirrhosis.Methods Fifty male cirrhotic patients with facial skin lesions,including spider angiomas,angiotelectasis and special type rash,(mean age:48.1 ± 12.2 years) were randomly selected for study and enrolled as the case group.Thirty cirrhotic male patients without facial skin lesions (mean age:44.5 ± 11.7 years) were enrolled as the control group.Serum levels of luteinizing hormone (LH),follicular stimulating hormone (FSH),prolactin (PRL),estradiol (E2),progesterone (PRGE),and testosterone (T) were detected and compared between cases and controls by the t-test.All patients were sub-categorized according to severity of cirrhosis (Child-Pugh classification) and comparisons between cases and controls were carried out by single factor analysis of variance.Logistic regression modeling was used to evaluate whether the presence of skin lesions is related to changes in markers of liver impairment,including alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil),serum albumin (Alb),prothrombin time (PT-SEC),creatinine (CREA),platelet count (PLT),and alcoholism.Results In the cases with spider veins,LH level was significantly elevated (t =2.01) and T level was significantly decreased (t =-2.20) (both,P ＜ 0.05 vs.controls).In the cases with telangiectasia,the LH level (t =3.76,E2 (t =2.08)and E2/T ratio (t =2.98) were significantly elevated and T level was significantly decreased (t =-3.77) (all,P ＜ 0.05vs.controls).In the cases with special type rash,FSH level was significantly elevated (t =2.03) and T level was significantly decreased (t =-2.01) (both,P ＜ 0.05 vs.controls).In the case group,E2 levels decreased as severity of liver damage increased,while in the control group,E2 levels increased as severity of liver damage increased;however,the difference in average E2 values of the two groups did not reach statistical significance (P ＞ 0.05).In both cases and controls,the T levels were decreased as the severity of liver damage increased (F =3.70,P ＜0.05).Multivariate logistic regression analysis showed that increased incidence of facial skin lesions is associated with alcoholism (odds ratio (OR) =4.46,95％ confidence interval (CI) =1.45-13.7,P ＜ 0.05) and elevated serum levels of AST (OR =11.87,95％ CI =1.24-113.1,P ＜ 0.05).Conclusion Alcoholism,impaired liver function,and perturbed levels of circulating sex hormones are associated with cirrhosis-related facial lesions and may play important roles in the pathogenesis of cutaneous lesions in patients with cirrhosis.
