摘要
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.
出处
《中国基层医药》
CAS
2015年第2期244-247,共4页
Chinese Journal of Primary Medicine and Pharmacy
关键词
乙型肝炎
肝硬化
肝功能试验
葡萄糖代谢障碍
胰岛素抵抗
胰岛素分泌细胞
Hepatitis B
Liver cirrhosis
Liver function tests
Glucose metabolism disorders
Insulin resistance
Insulin-secreting cells