Becker U
Department of Medicine, Hvidovre Hospital, Copenhagen.
Dan Med Bull. 1993 Sep;40(4):447-59.
In contrast to the numerous studies of men, very few studies have been concerned with sex hormone disturbances in women with chronic alcoholic and non-alcoholic liver diseases. The aim of the study was, to evaluate the effect of ethanol and liver dysfunction on menstrual cycle, serum sex hormone concentrations and hepatic oestrogen receptors in women. In premenopausal female alcoholics ethanol consumption increase the frequency of menstrual disturbances, abortions, and miscarriages, while infertility is not frequent. Acute ethanol intoxication has only minor effects on pituitary-gonadal hormones in premenopausal women, while chronic ethanol abuse lead to reduced concentrations of sulphated steroids, and these changes may be seen before severe liver dysfunction has appeared. In women liver dysfunction lead to earlier occurrence of menopause in comparison with normal controls, while information is insufficient or lacking regarding the influence upon fertility, pregnancy outcome and sexual behavior in women. In postmenopausal women with alcoholic and non-alcoholic liver disease, the main disturbances of sex hormone metabolism consist of elevated oestrone and sex hormone binding globulin (SHBG) concentrations, while serum concentrations of steroid sulphates and 5 alpha-dihydrotestosterone (DHT) are reduced, and the degree of liver dysfunction is a major determinant for the observed disturbances. The presence of high affinity, low capacity, specific oestrogen receptors (ER) in the liver is confirmed using a ligand binding assay (DCC), specificity analyses, and sucrose gradient centrifugation. Furthermore, the sensitivity of an enzyme immunoassay has been improved enabling the quantitative measurement of hepatic ER in 102 small liver biopsies from patients with alcoholic and non-alcoholic liver diseases. The method is suitable for quantitative assessment and ER in small tissue samples, and can be applied to other tissues than the liver. Patients with chronic liver diseases have significantly lower hepatic ER concentrations, and this reduction is determined by the degree of liver dysfunction, while the degree of alcoholic hepatitis or active ethanol consumption are less important factors. The importance of this observation for hepatic physiology and pathophysiology remains to be determined.
与众多针对男性的研究相比，关注慢性酒精性和非酒精性肝病女性性激素紊乱情况的研究极少。本研究的目的是评估乙醇和肝功能障碍对女性月经周期、血清性激素浓度及肝脏雌激素受体的影响。绝经前女性酗酒者中，乙醇摄入会增加月经紊乱、流产和早产的发生率，而不孕情况并不常见。急性乙醇中毒对绝经前女性垂体 - 性腺激素仅有轻微影响，而慢性乙醇滥用会导致硫酸化类固醇浓度降低，且这些变化可能在严重肝功能障碍出现之前就已显现。与正常对照组相比，女性肝功能障碍会导致绝经提前出现，然而关于其对女性生育能力、妊娠结局和性行为的影响，相关信息不足或缺乏。在患有酒精性和非酒精性肝病的绝经后女性中，性激素代谢的主要紊乱表现为雌酮和性激素结合球蛋白（SHBG）浓度升高，而类固醇硫酸盐和5α - 二氢睾酮（DHT）的血清浓度降低，肝功能障碍的程度是观察到的这些紊乱的主要决定因素。通过配体结合分析（DCC）、特异性分析和蔗糖梯度离心法，证实了肝脏中存在高亲和力、低容量的特异性雌激素受体（ER）。此外，酶免疫测定的灵敏度得到了提高，能够对来自酒精性和非酒精性肝病患者的102份小肝活检组织中的肝脏ER进行定量测量。该方法适用于小组织样本中ER的定量评估，并且可应用于肝脏以外的其他组织。慢性肝病患者的肝脏ER浓度显著降低，这种降低由肝功能障碍的程度决定，而酒精性肝炎的程度或乙醇的活跃摄入量则是不太重要的因素。这一观察结果对肝脏生理学和病理生理学的重要性仍有待确定。
