慢性重型乙型肝炎患者低血糖与能量代谢、胰岛素样生长因子-1的相关性

Correlation between Hypoglycemia and Energy Metabolism and Insulin-like Growth Factor-1 in Patients with Chronic Severe Hepatitis B

目的探讨慢性重型乙型肝炎患者发生低血糖的可能机制。方法分别以20例慢性重型乙型肝炎低血糖患者和20例慢性乙型肝炎患者作为研究组和对照组。采用间接测热法,使用CCM-D营养代谢测定系统测定患者的静息能量消耗(REE)、呼吸商(RQ)及糖、脂肪、蛋白质三种营养底物的氧化率;应用放射免疫法测定空腹血清胰岛素样生长因子-1(IGF-1)、胰岛素、C肽、皮质醇水平。结果慢性重型乙型肝炎患者的REE为(1397.1±452.6)kJ/d,显著低于静息能量消耗预计值(1532.7±277.9)kJ/d(P=0.033);糖氧化率和RQ均显著低于对照组(38.5%vs.56.9%,P=0.002;0.78±0.06vs.0.86±0.04,P=0.000),脂肪氧化率显著高于对照组(38.8%vs.20.1%,P=0.000)。慢性重型乙型肝炎组的糖氧化率与空腹血糖水平呈正相关(r=0.45,P<0.05)。慢性重型乙型肝炎组的血清IGF-1水平显著低于对照组[(11.9±2.6)ng/mlvs.(159.8±35.7)ng/ml,P=0.000],胰岛素水平显著高于对照组[(19.2±10.9)μIU/mlvs.(10.6±7.3)μIU/ml,P=0.034]。结论慢性重型乙型肝炎患者低血糖的发生与血清IGF-1、胰岛素水平密切相关,且空腹血糖水平与糖的氧化利用率呈正相关。

Objective B. Methods To investigate the possible mechanism of hypoglycemia in patients with chronic severe hepatitis B.Methods Twenty patients with chronic severe hepatitis B and hypoglycemia and 20 patients with chronic hepatitis B were enrolled and assigned as the subject group and the control group, respectively. Indirect calorimetry was used to detect resting energy expenditure （REE）, respiratory quotient （RQ） carbohydrate, fat, and protein. Radioimmunoassay was used to detect the levels of fasting , and oxidations of serum insulin-like growth factor-1 （ IGF-1 ）, insulin , C-peptide, and cortisol. Results The REE was （ 1 397. 1 ± 452.6） kJ/d in patients with chronic severe hepatitis B, which was significantly lower than the predicted REE [ （ 1 532.7 ± 277.9） kJ/d （ P = 0. 033 ） ] in patients with chronic severe hepatitis B. The oxidation of carbohydrate and RQ were significantly lower in the subject group than in the control group （ 38.5% vs. 56. 9%, P = 0. 002 0. 78 ＋0.06 vs. O. 86 ＋ 0.04, P = 0. 000） , while the oxidation of fat in the subject group was significantly higher than in the control group （38.8% vs. 20.1% , P = 0. 000）. The oxidation of carbohydrate in patients with chronic severe hepatitis B was positively correlated with the level of the fasting blood glucose （r = 0.45, P 〈 0.05）. The levels of fasting serum IGF-1 were significantly lower in the subject group than in the control group [ （11.9±2.6） ng/ml vs. （159.8±35.7） ng/ml, P=0.000]. The level of serum insulin was significantly higher in the subject group than in the control group [ （ 19. 2 ± 10.9） μIU/ml vs. （ 10.6 ± 7.3 ） μIU/ml, P =0. 034 ]. Conclusions The occurrence of hypoglycemia is closely correlated with the levels of IGF-1 and insulin. The fasting blood glucose level is also positively correlated with the oxidation of carbohydrate in patients with chronie severe hepatitis B.