乙型肝炎肝硬化胰岛β细胞功能与肝功能等因素分析

Relationship between pancreatic beta cell function and liver function in hepatitis B cirrhosis

目的 探讨不同糖代谢状态下慢性乙型肝炎肝硬化患者发生胰岛素抵抗、胰岛β细胞功能与肝功能状况的关系及相关因素.方法 入选247例乙型肝炎肝硬化患者,根据其空腹血糖及75 g口服糖耐量试验2h血糖（2 h PG）测定值分为肝硬化糖代谢正常组（A组,47例）、肝硬化糖耐量减退组（B组,103例）、肝硬化合并糖尿病组（C组,97例）,测量各组空腹血糖（FBG）及餐后2h血糖、C肽、胰岛素、糖化血红蛋白（HbA1c）、胰岛β细胞功能指数（HBCI）、胰岛素敏感指数（ISI）、乙型肝炎病毒载量.结果 乙型肝炎后肝硬化患者合并糖代谢异常者占81.0％,其中肝源性糖尿病占39.3％.A、B、C三组2 hPG[（6.29±3.78） mmol/L、（10.56±4.26） mmol/L、（17.34±5.9） mmol/L]、FBG[（4.72±2.15） mmol/L、（5.68±2.81） mmol/L、（9.82 ±5.1） mmol/L]、HbA1c[（4.5±1.2）％、（10.56±4.26）％、（9.5±3.0）％]、乙型肝炎病毒载量[（3.78±0.52）、（4.82±0.61）、（6.02 ±0.63）]比较,A组各项观察指标均较其他两组低,差异均有统计学意义（F=93.23、41.35、84.93、237.2,均P＜0.05）.C、B、A组空腹胰岛素[（15.65±4.17）、（26.53土7.22）、（30.18±3.23） mU/L]、餐后胰岛素[（45.28±10.22） mU/L、（106.8±20.74） mU/L、（141.68±20.25） mU/L]、餐后C肽[（5.96 ±4.82） mU/L、（9.86±5.46） mU/L、（9.54±6.42） mU/L]以及ISI[（-5.96±0.61）、（-4.92 ±0.42）、（-5.03 ±0.51）]比较,C组各值均低于A和B组,差异均有统计学意义（均P＜0.05）.三组患者HBCI分别为（5.66±0.64）、（5.32±1.01）、（4.30±1.53）,呈依次降低,且差异有统计学意义（F=27.55,P＜0.05）.C组患者Child-Pugh C级的例数较其他两组多（χ^2=48.6,P＜0.01）.结论 乙型肝炎肝硬化患者存在高胰岛素血症、胰岛素抵抗、胰岛β细胞分泌功能下降,与患者肝功能状况相关.

Objective To investigate the relationship between pancreatic beta cell function and liver function in hepatitis B cirrhosis with different glucose metabolism status.Methods A total of 247 patients with hepatitis B cirrhosis were included and divided into 3 groups according to measurement of fasting blood glucose （FBG）,and 2h blood glucose in 75g oral glucose tolerance test（2hPG）,normal glucose metabolic status group（group A,n =47）,glucose tolerance impairment group（group B,n =103） and diabetes mellitus group（group C,n =97）.Data of fasting and 2h postprandial blood glucose,C-peptide,insulin and glycosylated hemoglobin （HbA1c）,pancreatic beta cell function index（HBCI）,insulin sensitivity index （ISI）,hepatitis B virus load were collected and analyzed.Results Abnormal glucose metabolism was observed in 81% patients with hepatitis B cirrhosis,while hepatogenic diabetes accounted for 39.3%.2 hPG[（6.29 ± 3.78） mmol/L,（10.56 ± 4.26） mmol/L,（17.34 ± 5.9） mmol/L],FBG [（4.72 ±2.15）mmot/L,（5.68 ±2.81） mmol/L,（9.82 ±5.1） mmol/L],HbA1c [（4.5 ± 1.2）% （10.56 ±4.26） % （9.5 ± 3.0） %],HBV-DNA [（3.78 ± 0.52）,（4.82 ± 0.61）,（6.02 ± 0.63）] were compared in group A,group B and C.2hPG,FBG,HbA1c and HBV viral loads in group A were significantly lower than group B and group C （F =93.23,41.35,84.93,237.2,P 〈 0.05）.Fasting insulin [（15.65 ± 4.17） mU/L,（26.53 ± 7.22） mU/L,（30.18 ± 3.23） mU/L],postprandial insulin [（45.28 ± 10.22） mU/L,（106.8 ± 20.74） mU/L,（141.68 ±20.25） mU/L],postprandial C peptide [（5.96 ± 4.82） mU/L,（9.86 ± 5.46） mU/L,（9.54 ± 6.42） mU/L] and ISI [（-5.96 ± 0.61）,（-4.92 ± 0.42）,（-5.03 ± 0.51）] were compared in group C,group B and A,those values in group C were lower than group A and B,the defferences were stastistically significant （P 〈 0.05）.HBCI in three groups were （5.66 ± 0.64）,（5.32 ± 1.01）,（4.30 ± 1.53）,respectively,the defferences were stastistically significant（F =27.55,P 〈0.05）.Patients in group C with Child-Pugh C score was much more than group A and B,the defference was stastistically significant （χ^2=48.6,P 〈 0.01）.Conclusion Hyperinsulinemia,increased insulin resistance and decreased insulin secretion exist in hepatitis B cirrhosis patients,and they are closely related to liver function.