胰岛素抵抗及血清生长激素水平对重型肝炎预后影响的研究

Insulin resistance and serum growth hormone level in patients with hepatitis gravis

目的研究胰岛素抵抗及血清生长激素(GH)水平对重型肝炎预后的影响。方法观察组选择重型肝炎36例,正常对照组20例,采用放射免疫法测定空腹血清胰岛素和GH水平,计算胰岛素敏感性指数(ISI),分析各型重型肝炎与血清胰岛素、ISI和GH的关系。结果重型肝炎患者血清胰岛素和GH水平较正常对照组显著升高(P<0.05),并随亚急性重型肝炎(亚重肝)、急性重型肝炎(急重肝)、慢性重型肝炎(慢重肝)的病情加重而升高,重型肝炎患者ISI水平显著低于正常对照组(P<0.05),并随着亚重肝、急重肝、慢重肝的次序降低。慢重肝的空腹血清胰岛素和GH水平显著高于亚重肝(P<0.05);亚重肝、急重肝、慢重肝的肝损害与胰岛素水平呈正相关系(r=0.537,P<0.01),与GH水平呈正相关系(r=0.317,P<0.05),与ISI呈负相关系(r=-0.412,P<0.01),ISI与GH呈负相关系(r=-0.3765,P<0.05)。结论重型肝炎患者存在高胰岛素血症、胰岛素抵抗和高GH血症,他们与肝功能损害程度及其预后有关。

Objective To do some research on the insulin resistance and serum growth hormone（GH） level in patients with hepatitis gravis. Methods Choosing 36 patients with hepatitis gravis and 20 healthy controls for detecting the serum insulin and GH concentrations by radioimmunoassay and calculating the insulin sensitivity index （ISI） ; and analyzing the correlations between hepatitis gravis and serum insulin levels, ISI or serum GH levels. Resuits The serum insulin and GH levels in hepatitis gravis were higher significantly than those in healthy controls and（P〈 0.05） the ISI in patients with hepatitis gravis was lower significantly than that in healthy controls. The serum insulin and GH levels in chronic serious hepatitis were higher significantly than those in healthy controls（ P 〈 0.05 ）. There were significant positive correlations between sever viral hepatitis and serum insulin level（ r = 0. 537, P 〈 0.01 ） and between hepatitis gravis and serum GH level（ r = 0.317, P 〈 0.05 ）, and negative correlation. Between hepatitis gravis and ISI （ r = - 0. 412, P 〈 0.01 ） and that of ISI and GH（ r = - 3. 765, P 〈 0.05）. Conclusion There are hyperinsulinemia,insulin resistance and high serum GH level in patients with hepatitis gravis and the level of serum insulin, ISI and GH are closed correlated with hepatitis gravis and may reflect compromised hepatic function.