胰岛素强化治疗肝硬化合并糖尿病患者的疗效观察

Effect of Intensive Insulin Therapy in Patients with Liver Cirrhosis and Diabetes Mellitus

目的探讨肝硬化合并糖尿病患者应用胰岛素强化治疗后血糖及临床指标的变化特点。方法以首都医科大学附属北京佑安医院2018年11月~2021年7月收治的肝硬化合并糖尿病患者共52例为研究对象,分为代偿期肝硬化组(n=16)和失代偿期肝硬化组(n=36),在糖尿病饮食基础上进行胰岛素强化治疗。在基线及强化治疗1周后进行空腹血糖、餐后2h末梢血糖、肝功能、凝血功能和血常规等指标评估。结果代偿期肝硬化组经过胰岛素强化治疗1周后,与基线比较,lnALT、空腹血糖及餐后2h末梢血糖均明显下降(3.45±0.58IU/L vs 3.71±0.99IU/L,7.32±1.55mmol/L vs 12.29±1.93mmol/L,9.89±1.84mmol/L vs 28.30±1.45mmol/L;P均<0.05)。失代偿期肝硬化组经过胰岛素强化治疗1周后,与基线比较,lnALT、空腹血糖及餐后2h末梢血糖均明显下降(3.04±0.89IU/L vs 3.36±1.00IU/L,8.63±2.95mmol/L vs 13.76±3.04mmol/L,12.87±1.77mmol/L vs 27.98±2.14mmol/L;P均<0.05),白蛋白明显上升(32.61±4.49g/L vs 29.39±5.66g/L;P<0.05),但餐后2h末梢血糖仍高于代偿期肝硬化组(P<0.05)。两组胰岛素强化治疗前后比较,谷草转氨酶(AST)、总胆红素(TBil)、胆碱酯酶、凝血酶原活动度、白细胞计数、血红蛋白和血小板计数差异无统计学意义(P均>0.05)。结论胰岛素强化治疗能够有效降低肝硬化合并糖尿病患者血糖,对于失代偿期肝硬化患者仍需更长时间的监测及调整才能使血糖达标。

Objective To investigate the changes of blood glucose and clinical indexes in patients with cirrhosis complicated with diabetes mellitus after intensive insulin therapy.Methods A total of 52 patients with cirrhosis complicated with diabetes who were admitted to Beijing YouAn Hospital from November 2018 to July 2021 were enrolled.They were divided into two groups:compensatory cirrhosis(16 cases) and decompensated cirrhosis(36 cases).Intensive insulin therapy was given on the basis of diabetic diet.Fasting blood glucose,two-hour postprandial peripheral blood glucose and liver function were evaluated at baseline and 1 week after intensive insulin therapy.Independent sample t-test was used to compare the quantitative data conforming to normal distribution between the two groups,paired t-test was used to compare the two groups before and after treatment,and non-parametric test was used to compare the two groups when not conforming to normal distribution.Results After 1 week of intensive insulin therapy in the compensated cirrhosis group,compared with baseline,ln ALT,fasting blood glucose and 2-hour postprandial peripheral blood glucose were significantly decreased(3.45±0.58 IU/L vs 3.71±0.99 IU/L,7.32±1.55 mmol/L vs 12.29±1.93 mmol/L,9.89±1.84 mmol/L vs 28.30±1.45 mmol/L,P0.05).Conclusion Intensive insulin therapy can effectively reduce blood glucose in patients with cirrhosis complicated with diabetes,but for patients with decompensated cirrhosis,it still needs longer time to achieve blood sugar control goals.