肝源性糖尿病对HBV相关慢性肝衰竭患者临床特征的影响

Impact of hepatogenous diabetes on clinical features of patients with HBV related chronic liver failure

目的:观察肝源性糖尿病(hepatogenous diabetes,HD)对乙型肝炎病毒(hepatitis B virus,HBV)相关慢性肝衰竭(chronic liver failure,CLF)患者临床特征的影响.方法:187例HBV相关CLF患者分为肝源性糖尿病组(HD组,n=65)和非肝源性糖尿病组(对照组,n=122).回顾性分析HD组及对照组间肝肾功、凝血功能、糖化血红蛋白(glycosylated hemoglobin,Hb Alc)水平、ChildPugh评分、终末期肝病模型(model for endstage liver disease,MELD)评分、并发症及24w k死亡率差异.分析H b A lc水平与H B V相关CLF患者并发症及预后的相关性.结果:H B V相关C L F患者中H D发生率为34.76%.H D组总胆红素、I N R、肌酐(creatinine,CRE)、Hb Alc水平及Child-Pugh评分、MELD评分明显高于对照组,差异有统计学意义(P<0.05).HD组患者原发性腹膜炎、肝肾综合征发生率及24 wk死亡率明显高于对照组,差异有统计学意义(P<0.05).HBV相关CLF患者Hb Alc水平与Child-Pugh评分(r2=0.17,F=14.74,P=0.021)及MELD评分正相关(r2=0.19,F=16.61,P=0.014).H b A lc水平是H B V相关C L F患者发生原发性腹膜炎(P=0.019,OR=2.27)、肝肾综合征(P=0.023,OR=1.02)及24 wk死亡(P=0.032,OR=0.85)的危险因素.结论:并发HD的HBV相关CLF患者病情更为严重,预后更差.高Hb Alc水平是HBV相关CLF患者并发症的发生和不良预后的危险因子.

AIM： To investigate the impact of hepatogenous diabetes （HD） on the clinical features of patients with hepatitis B virus （HBV） related chronic liver failure （CLF）. METHODS： One hundred and eighty-seven patients with HBV related CLF were divided into either an HD group （n = 65） or a control group （n = 122）. The liver and kidney function, HBV DNA level, coagulation function, glycosyl- ated hemoglobin Alc （HbAlc） level Child-Pugh score, model for end-stage liver disease （MELD）score, complications and mortality at 24 wk were analyzed. The correlations between HbAlc level and Child-Pugh score and MELD score were an- alyzed by linear correlation analysis. Uncondi- tional binary response logistic regression model was used to determine the correlations between HbAlc level and the incidence of complications and mortality at 24 wk. RESULTS： The incidence of HD in patients with HBV related CLF was 34.76%. The level of total bilirubin （TBIL）, international normal- ized ratio （INR）, creatinine （CRE）, HbAlc, Child-Pugh score and MELD score were sig- nificantly higher in the HD group （P 〈 0.05）. The incidence rates of spontaneous peritonitis and hepatorenal syndrome and mortality at 24 wk were also significantly higher in the HD group （P 〈 0.05）. There were positive correla- tions between the HbAlc level and Child-Pugh score （r2 = 0.17, F = 14.74, P = 0.021） and MELD score （r2 = 0.19, F = 16.61, P = 0.014） in patients with CLF. Logistic regression analysis identi- fied that high HbAlc level was related to the high incidence of spontaneous peritonitis （P = 0.019, OR = 2.27） and hepatorenal syndrome （P= 0.023, OR = 1.02） and high mortality at 24 wk （P = 0.032, OR = 0.85）. CONCLUSION： The clinical features of patients with HBV related CLF complicated with HD are more serious. High HbAlc level is a risk factor for spontaneous peritonitis, hepatorenal syndrome and worse prognosis in patients with HBV related CLF.