原发性肝癌患者糖代谢的临床分析

Clinical analysis on glucose metabolism in patients with primary liver carcinoma

目的探讨原发性肝癌患者糖代谢的临床特征。方法检测原发性肝癌患者82例及健康对照组35例空腹及服糖后血糖、胰岛素、C肽水平，计算胰岛素抵抗指数（IR）、胰岛β细胞功能指数（IS）及胰岛素指数（INSindex）。结果与对照组比较，肝癌组空腹血糖差异无统计学意义（P〉0．05），服糖后血糖显著升高（P〈0．05）；肝癌组空腹及服糖后胰岛素和C肽值均呈显著性升高（P〈0．001）。肝癌患者空腹IR、IS均明显高于对照组（P〈0．05），而INSindex值显著低于对照组（P〈0．05）。结论原发性肝癌患者在空腹血糖正常时已存在胰岛素抵抗、空腹高胰岛素血症和糖负荷后的胰岛素分泌障碍，故极易发生糖代谢异常，且发病隐匿。肝源性糖代谢异常的防治应从血糖正常时开始，保护胰岛β细胞功能尤其重要。

Objective To explore the clinical feature of glucose metabolism in patients with primary liver carcinoma （PLC）. Methods Levels of blood glucose ,serum insulin and serum C peptide were estimated in fasting state and 0.5,1,2,3 h respectively after an oral ingestion of glucose with a dose of 75 g in 82 cases of PLC and other 35 controls. The insulin resistant index and β cell function index for each patient were recorded and calculated. Results There was no significant difference of serum levels of fasting glucose between test group and control group. The serum glucose level after glucose intaking and the serum levels of blood serum insulin and serum C peptide after glucose intaking were significantly higher more than that of control group （P 〈0.001）. The insulin resistant index and β cell function index were both significantly higher than that in control group （P 〈0.05） while the INS index were significantly lower than those in the control group （P 〈0.05）. Conclusion Insulin resistance, hyper-insulinemia in fasting state and dysfunction in early-stage insulin secretion exist in patients with PLC when their glucose level in normal at the fasting status. It is not only easy but also hidden to occur glucose metabolism abnormality. Thus the prevention of hepatogenous diabetes should start from the state of normal glucose regulation, especially the preservation of islet β cell function.