肝硬化患者糖脂代谢水平及其对疾病恶化的影响

The levels of glucose and lipid metabolism in patients with liver cirrhosis and its effect on disease progression

[目的]研究肝硬化患者糖脂代谢水平及其对疾病恶化的影响。[方法]选取我院在2015年5月~2016年5月收治的68例肝硬化患者的临床资料进行回顾性分析。所有患者按照Child-Pugh评分标准分为3组,观察3组患者血脂、血糖水平以及糖尿病的发生率,然后根据患者糖尿病发病情况将患者分成2组,观察2组患者肝肾功能、血脂水平以及并发症发生情况。[结果]在本组研究的患者中,患糖尿病有13例(19.12%),B组与C组糖尿病患病率为[(29.17%)、(36.36%)],明显高于A组[(6.06%),(P<0.05)]。空腹血糖受损有15例(22.06%),3组患者空腹血糖受损率比较差异无统计学意义[(21.21%)、(20.83%)、(27.27%)]。3组患者的空腹血糖[(5.50±1.26)mmol/L、(5.57±1.34)mmol/L、(5.61±1.46)mmol/L]以及TG[(1.21±0.67)mmol/L、(1.25±0.57)mmol/L、(1.14±0.45)mmol/L]随着病情的加重而降低,但是3组患者比较差异无统计学意义,TC随着病情的加重而降低,3组比较差异有统计学意义[(4.67±1.24)mmol/L、(3.86±1.14)mmol/L、(2.96±1.02)mmol/L,(P<0.05)];糖尿病组患者的年龄(54.67±11.04)岁,显著高于无糖尿病组[(47.16±10.48)岁,(P<0.05)];糖尿病饮酒者比无糖尿病更高[(54.55%vs.18.18%),(P<0.05)];糖尿病组患者ALB水平为(39.48±8.47)g/L,显著高于无糖尿病组患者[(31.04±5.78)g/L,(P<0.05)],糖尿病组与无糖尿病组在性别、TC、TG、TBil、PT、ALT、AST、BUN、CR方面比较差异无统计学意义;糖尿病组患者消化道出血、腹水、肝性脑病发病率为[(23.08%)、(46.15%)、(27.27%)],显著高于无糖尿病组的发病率[(3.64%)、(18.18%)、(3.51%),(P<0.05)]。[结论]肝硬化会提高患者发生糖代谢异常的发生率,而发生糖尿病后会加重肝硬化患者的病情。

[Objective]To investigate the levels of glucose and lipid metabolism in patients with liver cirrhosis and its effect on disease progression.[Methods]68patients with liver cirrhosis admitted in our hospital from May 2015 to May 2016 were retrospectively analyzed.All patients were divided into three groups in accordance with the Child-Pugh standard.The blood lipid,blood glucose level and the incidence of diabetes of three groups were observed.The patients were divided into two groups according to the diabetes and the liver and kidney function,blood lipid level and complications of the two groups were observed and compared.[Results]Among the patients in this study,there were 13 patients with diabetes mellitus accounting for 19.12%.The diabetes prevalence of B group and C group（29.17% and 36.36%）were significantly higher than that in A group（6.06%）（P〈0.05）.There were 15 cases of impaired fasting glucose（22.06%）and there was no difference among the three groups（21.21%,20.83%,27.27%）.The levels of fasting blood glucose among the three groups[（5.50±1.26）mmol/L,（5.57±1.34）mmol/L,（5.61±1.46）mmol/L]and TG[（1.21±0.67）mol/L,（1.25±0.57）mmol/L,（1.14±0.45）mmol/L]decreased with the aggrava-tion of the disease,but there was no difference among three groups.With the aggravation of the disease,the levels of TC reduced and the levels between the three groups were significantly different[（4.67±1.24）mmol/L,（3.86±1.14）mmol/L,（2.96±1.02）mmol/L]（P〈0.05）.The age of diabetes group were significantly higher than that in group without diabetes[（54.67±11.04）vs.（47.16±10.48）]（P〈0.05）.The proporiton of drinkers in diabetes group was higher than that in group without diabetes（54.55% vs.18.18%）（P〈0.05）.The level of ALB in patients with diabetic group was significantly higher than that in patients with diabetes mellitus group[（39.48±8.47）g/L vs.（31.04±5.78）g/L]（P〈0.05）.The gender,TC,TG,TBil,PT,ALT,AST,BUN and CR between diabetes group and non diabetes group were not significantly different.The gastrointestinal bleeding,ascites,hepatic encephalopathy incidence[（23.08%）,（46.15%）,（27.27%）]were significantly higher than those in non diabetes group[（3.64%）,（18.18%）,（3.51%）]（P〈0.05）.[Conclusion]Liver cirrhosis can increase the incidence of abnormal glucose metabolism in patients with diabetes,and the occurrence of diabetes will aggravate the condition of patients with liver cirrhosis.