乙肝肝硬化合并肝源性糖尿病临床特点及相关因素分析

Clinical Characteristics and Risk Factors of Diabetes in Liver Cirrhosis

【目的】探讨乙肝肝硬化合并肝源性糖尿病（HD）的临床特征及相关危险因素。【方法】回顾性分析2011-2014年本院收治的226例乙肝肝硬化患者临床资料，统计 HD 发生情况、生化指标，分析其相关危险因素。【结果】HD 组病程显著高于非 HD 组（ P ＜0．05）；HD 组血清总胆固醇（TC）、凝血酶原国际标准化比值（INR）水平均高于非 HD 组，白蛋白水平低于非 HD 组，差异均具有统计学意义（ P ＜0．05）；肝功能Child‐Pugh 分级 C 级 HD 发生率明显高于 A 、B 级，三级间比较差异有统计学意义（ P ＜0．01），C 级 HD 组患者显著高于非 HD 组患者（ P ＜0．01）。 HD 组患者上消化道出血、原发性腹膜炎并发症发生率较高，与非HD 组相比较有显著差异（ P ＜0．05）。 其他并发症的发生比例无明显差异（ P ＞0．05）。 经 Logistic 回归分析结果显示，病程、上消化道出血、原发性腹膜炎、肝功能 Child‐Pugh 分级 C 级对乙肝肝硬化继发 HD 有显著影响（ P ＜0．05）。 【结论】乙肝肝硬化继发 HD 患者临床症状不典型，以餐后血糖升高为主，病程、肝功能Child‐Pugh 分级 C 级、消化道出血、原发性腹膜炎是乙肝肝硬化继发 HD 的独立危险因素，临床上应引起重视。

[Objective] To explore the clinical characteristics and risk factors of hepatogenous diabetes in hepatitis B liver cirrhotics .[Methods] Retrospective analysis was conducted for 226 cases of hepatitis B liver cirrhosis from 2011 to 2014 .And the occurrence ,biochemical indicators ,clinical manifestations ,complications and prognosis of hepatogenous diabetes were statistically analyzed .[Results] The morbidity of hepatoge‐nous diabetes in hepatitis B liver cirrhosis patients was 27 .4% .And the courses of cirrhosis was 9 .65 ± 5 .360 years for diabetic group and 4 .88 ± 2 .918 years for non‐diabetic group （ P 〈 0 .05） .The morbidity of diabetics with Child‐Pugh C grade was 63 .08% .There were less typical diabetic symptoms ,normal or slight elevation of fasting plasma glucose and obviously elevated postprandial plasma glucose in hepatitis B liver cirrhotics .Di‐abetic group was more susceptible to upper gastrointestinal hemorrhage and idiopathic peritonitis than non‐dia‐betic group .Logistic regression analysis showed that the courses ,upper gastrointestinal hemorrhage ,idio‐pathic peritonitis and Child‐Pugh C grade were associated with hepatogenous diabetes .[Conclusion] The clini‐cal symptoms of hepatogenous diabetes are non‐typical in hepatitis B liver cirrhotics .The dependent risk fac‐tors for hepatogenous diabetes in cirrhosis are elevated level of postprandial plasma glucose ,disease course , Child‐Pugh C grade ,gastrointestinal hemorrhage and idiopathic peritonitis .And more clinical attention should be paid to hepatogenous diabetes .