Chronic hepatitis C infection and sex hormone levels:: effect of disease severity and recombinant interferon-α therapy
Chronic hepatitis C infection and sex hormone levels:: effect of disease severity and recombinant interferon-α therapy
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DOI：
10.1111/j.1445-5994.2006.01093.x
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发表时间：
2006-06-01
影响因子：
2.1
通讯作者：
Yeap, B. B.
中科院分区：
文献类型：
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作者：
Nguyen, H. V.;Mollison, L. C.;Yeap, B. B.
背景：我们的目的是研究雄激素状况与肝病严重程度的标志之间的关系，并确定干扰素-α治疗对丙型肝炎患者性激素水平的影响。方法：我们审计了35名慢性丙型肝炎患者和11名在弗里曼特尔医院接受干扰素-α治疗的丙型肝炎患者的肝活检和性激素数据。结果：我们发现，在改良的Knoell组织学活动指数上，纤维化评分低(0-2)的男性更有可能有较低的性激素结合球蛋白(SHBG)水平(38.2+/-13.2vs66.6+/-43.3nmol/L，P<；游离睾酮水平(380.4+/-102.0比255.9+/-83.0pmo1/L，P=0.001)高于肝纤维化积分(3~6分)。SHBG与肝纤维化积分呈正相关(r=0.37，P=0.032)。游离睾酮水平与肝纤维化积分呈负相关(r=-0.43，P=0.011)。在干扰素-α治疗的前6个月内，总睾酮有一过性下降，下降至5.7+/-4.2nmol/L(P=0.014)，而游离睾酮未受影响。结论：肝病越重，游离睾酮水平越低，SHBG越高。干扰素-α治疗降低了总睾酮，但没有降低性腺功能低下的水平，游离睾酮也没有下降。这些数据表明，丙型肝炎中的肝病通过增加SHBG间接调节雄激素状态。在丙型肝炎感染的背景下，雄激素缺乏的筛查应该选择性地以患有更严重的肝病或有记录的更高级别的纤维化的男性为目标。
Background: We aimed to investigate the associations between androgen status and markers of liver disease severity and to determine the effect of interferon-alpha (IFN-alpha) treatment on sex hormone levels in the context of hepatitis C infection.Methods: We audited liver biopsy and sex hormone data from 35 men with chronic hepatitis C and a separate group of 11 men with hepatitis C who received IFN-alpha treatment at Fremantle Hospital.Results: We found that men with low fibrosis scores (0-2) on the modified Knodell histological activity index were more likely to have lower sex hormone-binding globulin (SHBG) levels (38.2 +/- 13.2 vs 66.6 +/- 43.3 nmol/L, P < 0.001) and higher free testosterone levels (380.4 +/- 102.0 vs 255.9 +/- 83.0 pmol/L, P = 0.01) than those with higher fibrosis scores (3-6). SHBG directly correlated with fibrosis scores (r = 0.37, P = 0.032). Free testosterone levels inversely correlated with liver fibrosis scores (r = -0.43, P = 0.011). A transient reduction in total testosterone of 5.7 +/- 4.2 nmol/L (P = 0.014) occurred within the first 6 months of IFN-alpha therapy although free testosterone was unaffected.Conclusion: More severe liver disease was associated with lower free testosterone and higher SHBG. IFN-alpha therapy reduced total testosterone but not to hypogonadal levels, with no decline in free testosterone. These data suggest that liver disease in hepatitis C infection modulates androgen status indirectly via increased SHBG. Screening for androgen deficiency in the context of hepatitis C infection should selectively target men with more severe liver disease or documented higher grade fibrosis.