肝硬化患者的糖代谢及胰岛β细胞分泌功能变化的临床研究──附71例报告

Changes of glucose metabolism and secretory function of islet β-cell in patients with liver cirrhosis

目的：探讨肝硬化患者糖代谢及胰岛β细胞分泌功能的变化。方法：对２１名正常人和７１例肝硬化患者进行葡萄糖耐量试验、胰岛素和Ｃ肽释放试验，肝硬化组按葡萄糖耐量试验结果分为４小组。分别比较空腹及２小时的血糖、胰岛素和Ｃ肽水平。结果：肝硬化糖代谢异常总发生率占６９％（４９／７１）。糖耐量减低组空腹及２小时的胰岛素、Ｃ肽水平等４项指标高（与其余各组相比，Ｐ＜０．０１），但随着糖代谢紊乱程度的逐渐加重而减少，在重型糖尿病组此４项指标呈显著低水平（与其余各组相比，Ｐ＜０．０１或Ｐ＜０．０５）。结论：肝硬化有较高的糖代谢异常发生率。肝硬化病人存在严重的胰岛素抵抗和高胰岛素血症。胰岛素抵抗和高胰岛素血症可能是β细胞分泌功能紊乱和肝源性糖尿病发生、发展的重要原因。

To investigate the changes of glucose metabolism and secretory function of islet β-cell in liver cirrhosis. Methods: Tests for oral glucose tolerance(OGTT),insulin level and C-peptide release were performed in 71 liver cirrhosis patients and 21 controls .Patients were subdivided into four groups according to OGTT. Insulin and C-peptide at fasting and 2h after meal were compared. Results: The prevalence of abnormal glucose metabolism in cirrhosis was 69%(49/71). Insulin and C-peptide level at fasting and 2h after meal in impaired glucose tolerance subgroup were the highest (p<0.01) compared to other group, which decreased gradu- ally as glucose metabolism disorder worsened and reached the lowest levels in severe diabetes (P<0.01 or 0.05, compared to other subgroups). Conclusion: There is high prevalence of abnormal glucose metabolism, severe insulin resistance (IR) and hyperinsulinemia (HIS)in liver cirrhosis. IR and HIS may play important roles in β-cell secretory function disorder, contributing to occurrence and development of hepatic diabetes.