慢性乙型重型肝炎低血糖患者IGF-1水平及其意义

Detection and Clinical Significance of the Serum Free Insulin-like Growth Factor 1 in Patients with Chronic Severe Hepatitis B and Hypoglycemia

目的探讨慢性乙型重型肝炎(简称慢重肝)低血糖患者血清胰岛素样生长因子-1(IGF-1)水平及其与空腹血糖(FBG)、空腹胰岛素(INS)、总胆红素(TBiL)、白蛋白(ALB)、凝血酶原活动度(PTA)和呼吸商(RQ)的关系。方法以20例慢重肝低血糖患者为研究对象,20例慢性乙型肝炎(慢肝)患者为对照组,用免疫放射法测定比较2组患者血清IGF-1及INS水平,采用间接测热法应用CCM-D营养代谢测试系统检测2组患者的呼吸商,探讨其与IGF-1水平的关系。结果慢重肝组血清IGF-1水平(11.9±2.6)μg/L明显低于慢肝组(159.8±35.7)μg/L(P<0.01);慢重肝组中晚期IGF-1水平为(8.99±4.61)μg/L,病死率为60%,早期IGF-1水平为(15.43±3.70)μg/L,病死率为20%,2组间中晚期、早期IGF-1水平及病死率差异有统计学意义(P<0.01);慢重肝组INS水平(19.2±10.9)mIU/L明显高于慢肝组(10.6±7.3)mIU/L(P<0.05);慢重肝患者IGF-1<19.03μg/L,提示预后不佳;慢重肝组血清IGF-1水平与ALB、PTA、RQ正相关性(B=0.O45、B=0.O32、B=0.O65,P均<0.05),与INS负相关(B=-0.053,P<0.05),与TBiL、FBG无相关性(B=0.32、B=0.78,P均>0.05)。结论慢重肝患者血清IGF-1水平显著下降,且与病情严重程度有关,提示IGF-1是反映慢重肝患者预后指标之一,且与低血糖发生密切相关。

Objective To investigate the changes in serum insulin-like growth factor 1 （ IGF-1 ） in patients with chronic severe hepatitis B and hypoglycemia and its relationship to the fasting blood glucose and serum insulin, liver functions and respiratory quotient （RQ）. Methods Twenty patients with severe chronic hepatitis B and hypoglycemia and 20 patients with chronic hepatitis B only as the control were recruited. The levels of serum insulin-like growth factor（ IGF-1 ） and the fasting insulin were detected with RIA in the two groups, and the differences were compared; indirect calorimetry was employed to detect RQ. Results The levels of serum IGF-1 （ 11.9 ± 2.6） μg/L in patients with severe chronic hepatitis B and hypoglycemia were significantly lower than those in patients with chronic hepatitis B and （159.8 ± 35.7）μg/L（ P 〈 0.01 ） ; The levels of serum IGF-1 in patients with intermediate and advanced stages of severe chronic hepatitis B were（8.99 ± 4.61 ）μg/L; case fatality was 60% , The levels of serum IGF-1 in patients with morning stage severe chronic hepatitis B were（ 15.43 ± 3.70） μg/L and case fatality was 20%. The levels of serum insulin with severe chronic hepatitis B （ 19.2 ± 10.9）mlU/L were significantly higher than those in patients with chronic hepatitis B only （ 10.6 ± 7.3 ）mIU/L（ P 〈 0.01 ）. The differences in the levels of serum IGF-1 and case fatality between intermediate and advanced stages and morning stage were significant （P 〈0.01 ）. When the level of serum IGF-1 in patients with severe chronic hepatitis B was lower than 19.03 μg/L. It suggested poor prognosis. The level of IGF-1 in patients with severe chronic hepatitis B and hypoglycemia had positive correlation with the ALB, PTA and RQ （ B = 0. 045, B = 0. 032, B = 0. 065 respectively, P 〈 0.05 ）, and negative correlation with the fasting serum insulin （ B = - 0. 053, P 〈 0.05 ）. However it had no correlation with TBIL and the fasting blood glucose （ B = 0. 32, B = 0. 78 respectively, P 〉 0. 05 ）. Conclusion The level of serum IGF-1 is significantly decreased in patients with severe chronic hepatitis B, and is closely correlated with the severity of the disease, which suggests that IGF-1 might be an indicator of prognosis in patients with severe chronic hepatitis B and has close relationship with the development of hypoglycemia.