肝硬化胰岛素抵抗及血清生长激素水平的研究

Insulin resistance and serum growth hormone level in patients with cirrhosis

目的:研究肝硬化患者胰岛素抵抗和血清生长激素(GH)水平的关系.方法:选择肝硬化患者40例,按Child-Pugh分级将其分为ChildA级(16例)、B级(13例)和C级(11例),正常对照组22例,用放射免疫法测定空腹血清胰岛素和GH水平,并计算胰岛素敏感性指数(ISI);同时分析Child-Pugh分级与血胰岛素、ISI和GH的关系.结果:肝硬化患者的血清胰岛素(17.8±7.2U/L)和GH水平(3.7±2.2μg/L)较正常对照组(分别为10.1±3.4U/L和1.9±0.9μg/L)显著升高(分别是P<0.05和P<0.01),并随着Child-PughA,B,C分级的升高而升高;而肝硬化患者ISI显著低于正常对照组(0.017±0.010vs0.025±0.014,P<0.05),并随着Child-PughA,B,C分级的升高而降低;肝硬化C级的空腹血清胰岛素(23.6±10.1U/L)和GH水平(4.7±2.6μg/L)显著高于肝硬化A级(分别为13.8±4.5U/L和3.1±1.4μg/L)而肝硬化C级的ISI(0.012±0.007)显著低于肝硬化A级(0.019±0.011);肝硬化患者的Child-Pugh积分与胰岛素水平呈正相关(r=0.428,P<0.01),与GH水平呈正相关(r=0.376,P<0.05),与ISI呈负相关(r=-0.333,P<0.05);ISI与GH呈负相关(r=0.388,P<0.05);合并腹水、肝性脑病和肝癌的患者的血清胰岛素、GH水平较合并上消化道出血的患者显著升高(P<0.05).结论:肝硬化患者存在着高胰岛素血症、胰岛素抵抗和高GH症,他们均与肝功能的损伤程度有关.

AIM: To investigate the insulin resistance and serum growthhormone (GH) level in patients with liver cirrhosis.METHODS:Serum insulin and GH concentrations were de-tected by radioimmunoassay and insulin sensitivity index(ISI) were calculated in 40 patients with liver cirrhosis and22 healthy controls. According to Child-Pugh classification,cirrhotic patients were divided into Child A (16 cases), ChildB (13 cases) and Child C (11 cases) groups. Meanwhile thecorrelations between Child-Pugh classification and seruminsulin levels, ISI or serum GH levels were analyzed.RESULTS:The serum insulin and GH levels in cirrhosis were highersignificantly than those in healthy controls (17.8 ± 7.2 U/L vs10.1±3.4 U/L , P <0.05; 3.7±2.2 μg/L vs 1.9±0.9 μg/L,P <0.01). The ISI in patient with cirrhosis was lower sig-nificantly than that in healthy controls (0.017 ± 0.010vs 0.025 ± 0.014, P <0.05). The serum insulin and GHlevels in Child C were higher significantly than those in Child A(23.6±10.1 U/L vs 13.8±4.5 U/L, P <0.05; 4.7±2.6 μ/L vs3.1 ± 1.4 μg/L, P <0.05). There were significant positivecorrelation between Child-Pugh degree and serum insulinlevel (r =0.428, P <0.01) and between Child-Pugh degreeand serum GH level(r =0.376,P <0.05), and negative cor-relation between Child-Pugh degree and ISI(r =-0.333,P <0.05) and between ISI and GH (r =0.388, P <0.05 ).CONCLUSIONS:There are hyperinsulinemia, insulin resis-tance and high serum GH level in patients with cirrhosis,and the levels of serum insulin, ISI and GH are closed cor- related with Child-Pugh classification and may reflect com-promised hepatic function.