肝硬化患者口服葡萄糖耐量试验临床意义及研究进展

Clinical implications of oral glucose tolerance test in cirrhotic patients with hepatogenous diabetes

肝脏和骨骼肌维持糖代谢。随着慢性肝病进展为肝硬化,肝功能恶化会导致糖代谢异常。因此,肝硬化患者常常伴有糖耐量异常和胰岛素抵抗,早期以餐后高血糖和高胰岛素血症为特征。一般而言,即使应用传统的空腹血糖或糖化血红蛋白水平标准,肝硬化伴有糖代谢异常患者往往被低估,因为他们中的多数表现出较低的空腹血糖水平或糖化血红蛋白水平,掩盖了其糖耐量减低的实情。因此,推荐使用口服葡萄糖耐量试验来评估出现空腹血糖正常的餐后高血糖患者。

The liver and skeletal muscles are responsible for maintaining glucose metabolism. As chronic liver disease progresses to cirrhosis,the liver disfunction leads to the deterioration of glucose metabolism. Consequently,impaired glucose tolerance(IGT) and insulin resistance(IR) are often observed in patients with liver cirrhosis. In early stage,the cirrhotics with hepatogenous diabetes is characterized by marked postprandial hyperglycemia and hyperinsulinemia. Generally,it is possible to underestimate IGT when using either the conventional fasting plasma glucose (FPG) criterion or hemoglobin A1c (HbA1c) levels because many of these patients show lower FPG or HbA1c levels,which might mask their IGT. In this circumstances,the oral glucose tolerance test is recommended to properly evaluate patients with normal FPG levels.