不同糖代谢状态肝细胞癌患者肝肾功能指标分析

Analysis of liver and kidney function indexes of hepatocellular carcinoma patients with different glucose metabolism status

目的分析不同糖代谢状态肝细胞癌(hepatocellular carcinoma,HCC)患者的肝肾功能指标特点,为临床治疗提供思路。方法选取2016年1月1日至2016年12月31日于首都医科大学附属北京地坛医院住院的223例HCC患者为研究对象进行回顾性分析,根据不同糖代谢状态分为3组:糖代谢正常组(134例)、糖尿病前期组(34例)和糖尿病组(55例),比较各组患者的肝肾功能指标,具体包括血总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白(high-density lipoprotein,HDL)、低密度脂蛋白(low-density lipoprotein,LDL);丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、γ-谷氨酰转移酶(gamma-glutamyltransferase,GGT)、白蛋白(albumin,ALB)、总胆红素(total bilirubin,TBil)、总胆汁酸(total bile acid,TBA)、碱性磷酸酶(alkaline phosphatase,ALP);血尿素氮(blood urea nitrogen,BUN)、尿酸(uric acid,UA)、肌酐(creatinine,Cr)、钙(calcium,Ca)、血磷(phosphorus,P)。采用Pearson和Spearman法分析各指标与血糖水平的相关性。结果糖代谢正常组、糖尿病前期组和糖尿病组患者间Cr(中位数:70 mmol/L vs 63 mmol/L vs 61 mmol/L;H=8.735,P=0.013)、TG(中位数:1.0 mmol/L vs 1.6 mmol/L vs 1.2 mmol/L;H=15.395,P<0.001)、Ca(中位数:2.2 mmol/L vs 2.4 mmol/L vs 2.2 mmol/L;H=7.392,P=0.025)、P(中位数:1.0 mmol/L vs 1.2 mmol/L vs 1.0 mmol/L;H=13.088,P=0.001)、ALB(中位数:39 g/L vs 42 g/L vs 39 g/L;H=8.662,P=0.013)及GGT(中位数:54 U/L vs 38 U/L vs 86 U/L;H=9.473,P=0.009)水平差异有统计学意义(P均<0.05),其中糖尿病前期组患者TG、P和ALB水平显著高于糖代谢正常组(H=3.445,P=0.002;H=3.617,P=0.001;H=2.871,P=0.012);糖尿病组患者TG和Cr水平显著高于糖代谢正常组(H=2.658,P=0.024;H=-2.741,P=0.018);糖尿病组患者Ca、P和ALB水平显著低于糖尿病前期组(H=-2.679,P=0.022;H=-2.591,P=0.029;H=-2.476,P=0.040),GGT水平显著高于糖尿病前期组(H=3.041,P=0.007)。HCC患者TG(r=0.307,P<0.001)、P(r=0.155,P=0.021)和ALB(r=0.178,P=0.008)与血糖水平呈正相关,Cr与血糖水平呈负相关(r=-0.139,P=0.037),年龄、TC、HDL、LDL、ALT、AST、TBil、GGT、TBA、ALP、BUN、UA、Ca与血糖水平无显著相关性。结论HCC合并糖代谢异常会导致脂代谢异常,并且与肝功能损伤有相关性,积极监测及控制HCC患者的糖代谢及脂代谢紊乱,保护HCC合并糖代谢紊乱患者的肝功能,是HCC患者重要的辅助治疗方向。

Objective To analyze the biochemical characteristics of hepatocellular carcinoma(HCC)patients with different glucose metabolism status and to provide ideas for clinical treatment.Methods A total of 223 patients with HCC hospitalized in Beijing Ditan Hospital,Capital Medical University from January 1,2016 to December 31,2016 were retrospectively analyzed.The patients were divided into three groups according to different blood glucose status:normal glucose metabolism group(134 cases),prediabetic group(34 cases)and diabetic group(55 cases).The liver and kidney function indexes of each group were compared and analyzed,including blood total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL),low-density lipoprotein(LDL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyltransferase(GGT),albumin(ALB),total bilirubin(TBil),total bile acid(TBA),alkaline phosphatase(ALP),blood urea nitrogen(BUN),uric acid(UA),creatinine(Cr),calcium(Ca),blood phosphorus(P).Pearson and Spearman methods were used to analyze the correlation of each index with blood glucose level.Results There were significant differences in Cr(median:70 mmol/L vs 63 mmol/L vs 61 mmol/L;H=8.735,P=0.013),TG(median:1.0 mmol/L vs 1.6 mmol/L vs 1.2 mmol/L;H=15.395,P<0.001),Ca(median:2.2 mmol/L vs 2.4 mmol/L vs 2.2 mmol/L;H=7.392,P=0.025),P(median:1.0 mmol/L vs 1.2 mmol/L vs 1.0 mmol/L;H=13.088,P=0.001),ALB(median:39 g/L vs 42 g/L vs 39 g/L;H=8.662,P=0.013)and GGT(median:54 U/L vs 38 U/L vs 86 U/L;H=9.473,P=0.009)levels of patients in normal glucose metabolism group,prediabetic group and diabetic group(all P<0.05).TG,P and ALB levels of patients in prediabetic group were significantly higher than those in normal glucose metabolism group(H=3.445,P=0.002;H=3.617,P=0.001;H=2.871,P=0.012),TG and Cr levels of patients in diabetic group were significantly higher than those in normal glucose metabolism group(H=2.658,P=0.024;H=-2.741,P=0.018);Ca,P and ALB levels of patients in diabetic group were significantly lower than those in prediabetic group(H=-2.679,P=0.022;H=-2.591,P=0.029;H=-2.476,P=0.040),GGT level was significantly higher than that in prediabetic group(H=3.041,P=0.007).TG(r=0.307,P<0.001),P(r=0.155,P=0.021)and ALB(r=0.178,P=0.008)were positively associated with blood glucose levels,and age,TC,HDL,LDL,ALT,AST,TBil,GGT,TBA,ALP,BUN,UA,and Ca showed no correlation with blood glucose levels in patients with HCC.Conclusion HCC with abnormal glucose metabolism will lead to abnormal lipid metabolism,and it is related to liver function damage.Active monitoring and controlling the disorder of glucose metabolism and lipid metabolism in patients with HCC and protecting the liver function of HCC patients with glucose metabolism disorder is an important direction of adjuvant therapy.