摘要:
Objective To investigate the relationship between the mechanism of gynecomastia and serum hormone levels ,as well as liver function in male patients with liver cirrhosis .Methods Forty‐six male patients with liver cirrhosis and gynecomastia were collected as gynecomastia group from March 2013 to March 2014 ,and at the same period seventy male patients with liver cirrhosis but without gynecomastia were studied as non‐gynecomastia group . The condition of mammogenesis and maximum of breast thickness were measured by bilateral breast ultrasound .Hormones including luteinizing hormone (LH) ,follicle‐stimulating hormone (FSH) , prolactin (PRL) ,estradiol (E2) ,progesterone (PRGE) ,and testosterone (T);liver function including alanine aminotransferase (ALT) ,aspartate aminotransferase (AST) ,total bilirubin (TBil) and serum albumin (Alb);blood coagulation function including prothrombin time (PT) ,platelet count (PLT) were examined and the Child‐Pugh scores were calculated .t‐test was performed for results comparison between gynecomastia group and non‐gynecomastia groups .Chi‐square test was used to compare the difference in drinking rate between two groups . The patients of gynecomastia group and non‐gynecomastia group were further divided into Child‐Pugh Grade A ,B and C subgroups according to Child‐Pugh scores and the patients of gynecomastia group were divided into subgroups according etiology such as posthepatitic cirrhosis ,alcoholic liver cirrhosis and posthepatitic cirrhosis combined with alcoholc cirrhosis .Single factor analysis of variance was applied to compare the laboratory findings between subgroups ,and least‐significant difference mothod was used to further compared the differences between two subgroups .Results Among forty‐six male patients with liver cirrhosis and gynecomastia ,the mean thickness of breast was (7 .56 ± 2 .84) mm .All the differences of TBil ,Alb ,PT and Child‐Pugh score of Child‐Pugh grade patient were statistically significant between gynecomastia group and no gynecomastia group ((96 .72 ± 75 .86)μmol /L vs (60 .57 ± 54 .00)μmol /L ,(29 .12 ± 4 .90) g/L vs (33 .86 ± 6 .86) g/L ,(19 .06 ± 4 .76) s vs (15 .54 ± 2 .57) s ,11 .54 ± 0 .91 vs 10 .33 ± 0 .57 ,respectively ,t=2 .79 ,-4 .33 ,4 .58 ,2 .22 ,all P0 .05) .PRL and E2/T ratio ((404 .49 ± 297 .26) mU/L and 68 .74 ± 46 .37) were higher than those of non‐gynecomastia group ((279 .77 ± 111 .57) mU/L and 13 .60 ± 11 .55) ,and T was lower than that of non‐gynecomastia group ((7 .15 ± 5 .74) nmol/L vs (15 .46 ± 8 .53) nmol/L) ,and the differences were statistically significant (t=2 .72 ,7 .90、-6 .27;all P0 .05) .T level of gynecomastia group gradually decreased ,and those of Child‐Pugh B ,C subgroup ((8 .20 ± 7 .58) nmol/L and (4 .18 ± 3 .76) nmol/L) were siginificantly lower than that of Child‐Pugh A subgroup of non‐gynecomastia group ((17 .64 ± 9 .04) nmol/L ,F=9 .37 ,P<0 .05) .The E2/T levels of gynecomastic group gradually increased .There was significant difference in E2/T level between Child‐Pugh C subgroup of gynecomastia group (105 .49 ± 94 .42) and Child‐Pugh A grade subgroup of non‐gynecomastia group (11 .38 ± 9 .60 ,F=12 .57 ,P<0 .05) .Conclusions There are different degrees of sex hormone disorder in the serum of male patients with liver cirrhosis and gynecomastia which is more significant in PRL ,T and E2/T .T and E2/T level are correlated with the degree of liver functional impairment .Gynecomastia in alcoholic liver cirrhosis is more severe than that of posthepatitic liver cirrhosis .%目的:探讨男性肝硬化患者乳腺发育症的发病机制与血清性激素水平及肝功能相关指标的关系。方法收集2013年3月至2014年3月有乳腺发育的男性肝硬化患者46例为乳腺发育组,同期无乳腺发育的男性肝硬化患者70例作为无乳腺发育组。行双侧乳腺多普勒超声观察患者乳腺发育情况、测量乳腺发育最大值(厚度)。检测血清中性激素,包括黄体生成素(L H )、卵泡刺激素(FS H )、催乳素、雌二醇、孕酮、睾酮;肝功能,包括ALT、AST、TBil、白蛋白;凝血功能,包括PT、PLT水平;计算Child‐Pugh评分分值。采用 t检验比较乳腺发育组与无乳腺发育组的上述指标差异。采用卡方检验比较乳腺发育组与无乳腺发育组间饮酒率的差异。将乳腺发育组和无乳腺发育组分别按照肝功能Child‐Pugh评分进一步分为A级、B级、C级3个亚组,并将乳腺发育组患者按病因(肝炎肝硬化、酒精性肝硬化和肝炎合并酒精性肝硬化)分为3个亚组,采用单因素方差分析比较各亚组间实验室检查结果的总体差异,LSD法进一步比较两组间差异。结果男性肝硬化患者乳腺发育组患者46例,乳腺厚度平均为(7.56±2.84) mm。乳腺发育组TBil、白蛋白、PT、Child‐Pugh C级患者的Child‐Pugh评分分值与无乳腺发育组相比,差异均有统计学意义[分别为(96.72±75.86)μmol /L比(60.57±54.00)μmol /L、(29.12±4.90) g/L比(33.86±6.86) g/L、(19.06±4.76)s比(15.54±2.57)s、(11.54±0.91)分比(10.33±0.57)分,t=2.79、-4.33、4.58、2.22,P均<0.05]。乳腺发育组饮酒比例[74%(34/46)]增加,与无乳腺发育组[53%(37/70)]相比,差异有统计学意义(χ2=5.183,P<0.05)。乳腺发育组患者的雌二醇水平与无乳腺发育组患者差异无统计学意义( P>0.05),催乳素、雌二醇睾酮比值(E2/T )[(404.49±297.26) m U/L、68.74±46.37]高于无乳腺发育组[(279.77±111.57) m U/L、13.60±11.55],睾酮[(7.15±5.74) nmol/L]低于无乳腺发育组[(15.46±8.53) nmol/L],差异均有统计学意义(t=2.72、7.90、-6.27,P均<0.05)。在乳腺发育组患者中,酒精性肝硬化患者乳腺较肝炎肝硬化患者明显增厚[(9.25±3.59) mm比(6.67±2.48) mm],孕酮水平较肝炎肝硬化患者降低[(0.61±0.51) nmol/L比(1.49±1.47) nmol/L],差异均有统计学意义(F=3.634、2.674,P均<0.05)。随着肝功能损伤程度的加重,乳腺发育组雌二醇水平依次增高,但与无乳腺发育组比较差异均无统计学意义(P均>0.05);乳腺发育组睾酮水平依次降低,Child‐Pugh B、C级[(8.20±7.58)、(4.18±3.76) nmol/L]与无乳腺发育组Child‐Pugh A级[(17.64±9.04) nmol/L]相比,差异有统计学意义(F=9.37,P<0.05);E2/T均依次增高,乳腺发育组Child‐Pugh C级(105.49±94.42)与无乳腺发育组Child‐Pugh A级(11.38±9.60)相比,差异有统计学意义( F=12.57,P<0.05)。结论男性肝硬化乳腺发育患者血清中存在不同程度的性激素紊乱,以催乳素、睾酮、E2/T为著。睾酮、E2/T水平与肝功能受损程度有关。酒精性肝硬化乳腺发育的严重程度较肝炎肝硬化明显。