非传统糖代谢指标在慢性乙型肝炎及乙型肝炎后肝硬化患者中的临床应用

Clinical application of nontraditional glycemic markers in patients with hepatitis B and post-hepatitis B cirrhosis

目的评估非传统糖代谢指标糖化清蛋白(GA)、果糖胺(FA)、1,5-脱水葡萄糖醇(1,5-AG)在慢性乙型肝炎(CHB)及乙型肝炎后肝硬化(PHBC)患者中的临床应用价值。方法选择86例CHB患者(CHB组)、51例PHBC患者(PHBC组),以及458例健康对照者(健康对照组)为研究对象,比较3组研究对象相关指标的差异。采用Spearman相关分析评估非传统糖代谢指标与肝功能指标之间的关系。结果CHB组和PHBC组GA、FA水平均显著高于健康对照组(U=194.1、263.9、124.2、120.1,P<0.001)。且PHBC组的GA水平显著高于CHB组(U=-69.9,P=0.021)。CHB组与健康对照组的1,5-AG水平差异无统计学意义(U=12.4,P=0.540),而PHBC组1,5-AG水平显著低于健康对照组(U=-68.2,P=0.007)。无论是健康对照组、CHB组还是PHBC组,GA水平与清蛋白(ALB)水平均无相关性(P>0.05)。结论GA和FA不能反映CHB及PHBC患者的糖代谢水平,而GA可作为评估肝病患者过度糖基化的指标之一。在CHB患者中,1,5-AG仍可用于评估糖代谢水平,但当患者发展为肝硬化时,不能将其作为反映糖代谢情况的指标。

Objective To value the glycated albumin(GA),fructosamine(FA)and 1,5-anhydroglucitol(1,5-AG)in assessment of chronic hepatitis B(CHB)and post-hepatitic cirrhosis(PHBC)patients.Methods This study enrolled 86 CHB patients(CHB group)and 51 PHBC patients(PHBC group),and 458 healthy subjects(control group).The differences of the indicators between CHB,PHBC,and control group were compared.The relationship between glycemic markers and liver function markers were conducted by Spearman analysis.Results Levels of GA and FA of CHB and PHBC group were significantly higher than those of control group(U=194.1,263.9,124.2,120.1,P<0.001).While the GA of PHBC group was significantly higher than that of CHB group(U=-69.9,P=0.021).There was no difference between CHB group and control group in 1,5-AG(U=12.4,P=0.540),while 1,5-AG of PHBC group was significantly lower than that of control group(U=-68.2,P=0.007).GA level had no correlations with albumin(ALB)level no matter in control,CHB or PHBC group(P>0.05).Conclusion GA and FA cannot reflected the level of glucose metabolism in CHB and PHBC patients.GA can be used as one of the indicators assessing of potential liver disease over-glycation.In CHB patients,1,5-AG can still be used to assess the level of glucose metabolism,but it cannot be used as a glucose metabolism indicator when patients develop to liver cirrhosis.