糖尿病增加肝硬化患者发生肝性脑病风险的临床研究

Diabetes Mellitus is Associated with Hepatic Encephalopathy in Patients with Cirrhosis

目的观察糖尿病(DM)对肝硬化患者发生肝性脑病(HE)风险的影响。方法回顾性比较肝硬化合并DM与未合并DM的患者HE发病率及严重程度的差异,分析糖化血红蛋白(GHb)水平与HE发病率及严重程度的关系。结果在197例肝硬化患者中,DM患病率为21.8%;HE在肝硬化合并DM组的患病率为83.7%,显著高于不合并DM组的37.7%(P<0.05);在DM组中,GHb≥8%亚组中HE患病率为91.3%,显著高于GHb<8%亚组的75.0%(P<0.05);Ⅲ、Ⅳ期HE患者占DM组HE患者的61.1%,显著高于不合并DM组的32.8%(P<0.05);Ⅲ、Ⅳ期HE患者占DM并GHb≥8%亚组HE患者的76.2%,显著高于DM并GHb<8%亚组的40.0%(P<0.05)。结论肝硬化和DM可能存在伴随关系,DM可能增加肝硬化患者发生HE的风险。积极控制血糖可能有助于降低肝硬化患者HE的发病率,提高肝硬化患者的生存率。

Objective To investigate whether diabetes mellitus （DM） was associated with the incidence of hepatic encephalopathy（HE） in patients with liver cirrhosis. Methods By retrospectively analysis of 197 patients with liver cirrhosis, we studied the incidence and severity of HE in patients with or without DM, and in DM patients with glycolated hemoglobn （GHb） above 8% or below 8%. Results In this study,21.8% patients had HE;the incidence of HE in patients with DM was higher than that patients without DM（83.7% vs 37.7%, P 〈 0. 05 ）. In the patients with DM, patients with serum GHb≥ 8% have higher incidence of HE than patients with serum GHb 〈8% （91.3% vs 75.0% , P 〈0.05）. Severity of HE was also greater in DM group than in non-diabetic group（61.1% vs 32.8% , P 〈0.05） and in patients with serum GHb≥8% in patients than serum GHb 〈 8% （ 76.2% vs 40.0%, P 〈 0.05 ）. Conclusion DM may be associated with liver cirrhosis and may increase the incidence of HE in patients with liver cirrhosis. Therefore, early blood glucose intervention may decrease the risk and mortality of HE in patients with liver cirrhosis.