肝硬化患者的胰岛素抵抗及生长抑素对肝硬化血糖及胰岛素影响的探讨

Insulin resistance and the effect of somatostatin on the level of serum insulin and glucose in patients with cirrhosis

目的 本研究旨在明确肝硬化患者是否存在胰岛素抵抗 (IR)及生长抑素类似物善宁是否对肝硬化患者糖代谢有影响 ,并探讨肝硬化患者IR的发生机制及治疗对策。方法 正常对照组 2 9例 ,肝硬化组 34例 ,空腹血糖正常。两组之间自然情况比较无显著性差别。肝硬化组中有 19例接受了善宁治疗。结果 肝硬化组空腹血糖与正常对照组比较无明显差别 (P >0 .0 5 ) ;餐后 2小时血糖高于对照组 (P<0 .0 5 ) ;空腹及餐后 2小时胰岛素水平高于正常对照组 (P <0 .0 1)、胰岛素敏感性指数明显低于正常组 (P <0 .0 1) ,19例接受了善宁治疗的肝硬化患者治疗前后 ,血糖比较无明显差别 (P >0 .0 5 ) ;胰岛素水平相对下降 (P >0 .0 5 ) ;胰岛素敏感性指数相对升高 (P >0 .0 5 ) ,但经统计学处理 ,无显著性差别 (经t检验 )。结论 肝硬化患者存在糖代谢的异常 ,表现为明显的高胰岛素血症和胰岛素抵抗 ;生长抑素类似物 善宁对肝硬化患者的血胰岛素及血糖水平的影响无统计学意义。

Objective To study insulin resistance and the effect of somatostatin on the level of serum insulin and glucose in patients with cirrhosis.Methods 34 cirrhotic patients and 29 healthy control subjects were studied. None of the cirrhotic patients had a family history of type 1 or type 2 diabetes or other major organ disease excepted cirrhosis. The effects of a 12h infusion of octreotide in 19 cirrhosis patients were compared controls during fasting and postprandial conditions. Insulin and glucose were measured. Insulin resistance was calculated using the Matthews and Liguangwei method.Results Fasting blood glucose levels were similar in the patients with cirrhosis and the control group. The level of fasting blood insulin and the level of blood glucose and blood insulin at 2h after meal in cirrhosis were higher than those in healthy control subjects. Insulin-sensitivity index in the cirrhosis was lower than those in healthy control subjects. No significant change could be seen in the level of serum insulin and glucose in cirrhosis patients during somatostatin treatment.Conclusion The results clearly document that most cirrhotic patients exhibit increased peripheral plasma insulin levels and severe insulin resistance. The effects of somatostatin on the insulin and glucose in patients with cirrhosis not reach statistical significance.