慢性丙型肝炎患者并糖尿病的危险因素分析

Chronic Hepatitis C Patients with Diabetes and Its Related Factors

【目的】探讨慢性丙型肝炎(CHC)与糖尿病(DM)的关系及其相关因素。【方法】对200例CHC并DM患者(CHC+DM组)与242例CHC不合并DM患者(CHC组)的谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、总胆红素(TB)、空腹血糖、空腹胰岛素、血甘油三酯及血清丙型肝炎病毒(HCV)RNA等相关指标进行检测、分析,比较两组之间各指标的差异,并将CHC+DM组分为携带者、轻度、中度、重度及不同年龄段进行对照比较,探讨CHC易发生DM的相关因素。【结果】①CHC+DM组血清空腹血糖、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、AST、ALT、GGT高于CHC组(P<0.01);②CHC+DM组肝硬化比例(24.0%)、肝癌比例(6.0%)、高血压比例(29.0%)明显高于CHC组(3.3%、0.5%、2.1%;P<0.01);③丙肝并糖尿病与病变程度及年龄呈正相关(P<0.01),CHC+DM组中度、重度患者比例明显大于CHC组,差异有统计学意义(P<0.01),年龄>50岁CHC的DM发病率显著高于对照组(P<0.01);④多因素回归分析表明,年龄、ALT、GGT、肝硬化、高血压及HOMA-IR与丙肝糖尿病发生呈正相关(P<0.05)。【结论】年龄>50岁、ALT、GGT、HOMA-IR、肝硬化、高血压及肝癌这些因素与CHC并DM密切相关。

[ Objective ] To investigate the relationship of chronic hepatitis C （CHC） patients combined with diabetes mellitus and its related factors. [ Methods ] Clinical data of 200 patients with CHC combined with diabetes mellitus （CHC ＋ DM group） and 242 patients with barely CHC （CHC group） were collected and analyzed, the comparative data including alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, 3,-glutamyl （GGT）, total bilirubin （TB）, fasting plasma glucose, fasting insulin blood triglycerides and other related indicators, serum hepatitis C virus （hepatitis C virus, HCV） RNA was also detected. All the clinical data were compared according to the severity of chronic hepatitis C. [Results] （1） Serum fasting glucose, fasting insulin, insulin resistance index （HOMA-IR）, AST, ALT, and GGT in CHC ＋ DM group were significantly higher than those in CHC group. （2） The incidence of liver cirrhosis （24.0% vs 3.3%, P〈 0.01）, liver cancer （6.0% vs 0.5%,P〈 0.01） and hypertension （29.0% vs 2.1%, P〈 0.01） in CHC ＋ DM group was significantly high than those in CHC group. （3）CHC patients combined with diabetes mellitus have a positive correlation with age and severity （P 〈 0.01 ）. The proportion of moderate and severe in CHC ＋ DM group was significantly high than that in CHC group （P 〈 0.01 ）. The incidence of patients older than 50 years old in CHC ＋ DM group was exceed that in CHC group. （3） Multi-regression analysis showed that age, ALT, GGT, liver cirrhosis, hypertension and insulin resistance index have a positive correlation with CHC patients combined with diabetes mellitus （P 〈 0.05）. [Conclusion] Age （〉 50 years old）, ALT, GGT, liver cirrhosis, hypertension, HOMA-IR, and liver cancer are intimately correlated with CHC patients combined with diabetes mellitus.