肝硬变患者糖代谢及胰岛β-细胞功能的研究

Study on Glucose Metabolism and Pancreatic β-cell Function in Patients with Liver Cirrhosis

目的：研究肝硬变（LC）患者胰岛β-细胞功能及糖代谢状况。方法：采用静脉法糖耐量试验、胰岛素（INS）、C肽（C－P）释放试验对36例LC患者测定了血糖（GS）、INS和C－P；用放免法测定了基础血浆皮质醇（F）、生长激素（GH）、生长抑素（SS）和胰高血糖素（GN）。结果：36例中17例糖耐量减退（IGT组），19例糖耐量正常（NGT组）；IGT组胰岛素释放指数明显低于对照组，C－P、INS曲线下面积显著小于对照组，约2／5的患者基础血浆F、GH、SS、GN升高；NGT组糖耐量曲线近似正常，其中11例INS、C－P分泌反应减弱，约1／3的患者生糖激素升高。给5例患者作了心得安试验，服药后第五天空腹血糖与试验前相近，但C－P、INS分泌明显增加。结论：LC患者精耐量减退十分常见，与肝功能减退、外周胰岛素抵抗、胰岛β-细胞储备功能下降等有关；门静脉高压着服用心得安可改善胰岛β-细胞功能。

篛bjective: To study the functional alteration of pancreatic βcells and glucose (GS)metabo1ism in patients with liver cirrhosis (LC). Methods:Insulin releasing test(IRT) was performed in36LC patients. Blood samples were collected before and 30, 60, l20 and 180 minutes after glucose loadintravenously, and detected for glucose, insulin (INS) and C-peptide (C-P). Basal plasma cortisol (F),growth hormone (GH), somatostatin (SS) and glucagon (GN ) were simultaneously determined by ra-dioimmunoassay (RIA). Results:of 36 patients, 17 had impaired glucose tolerance (IGT group), 19 withnormal glucose tolerance (NGT group). In IGT group glucose tolerance curve was much higher,insulingeneration index(IGI) was much lower and the area under curve (AUC) of C-P and insulin were signifi-cantly smaller when compared with controls. In 4/l0 IGT patients basal plasma F,GH,SS and GN levelswere higher than normal subjects. 11 out of l9 NGT cases showed a reduced secretion response of C-Pand insulin to glucose load,and 1/3 revealed lower basal plasma F,GH,SS and GN concentrations. 5 LCpatients received propranolol test. 5 days after orally administration of propranolol basal blood glucoselevel remained normal, while plasma C-P, insulin and GS/INS ratio increased significantly. Conclu-sions:Glucose intolerance was a very frequent complication in LC patients. It is advisable to add insulinwhen the infusion of glucose solution is necessary. Propranolol might improve insulin sensitivity in pa-tients with portal hypertension.