乙型肝炎肝硬化合并糖尿病的临床特点

赵长青; 顾宏图; 邢枫; 周扬; 徐列明

乙型肝炎肝硬化合并糖尿病的临床特点

1. 上海中医药大学附属曙光医院肝硬化科
2. 上海市中医药大学肝病研究所
3. 上海中医药大学肝肾疾病病证教育部重点实验室
4. 国家中医药管理局重点研究室(慢性肝病虚损)

基金项目:

上海市重点学科建设项目(Y0302)；上海市教育委员会E-研究院建设计划项目(E03008)；国家中医药管理局中医肝胆病重点学科(2010sh)；上海市高校创新团队建设项目(第一期)；上海市教育委员会重点学科(第五期)建设项目(J50307)；

详细信息

中图分类号: R587.1;R575.2
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出版历程
- 出版日期: 2012-06-20

Clinical features of post-hepatitis B liver cirrhosis associated with diabetes mellitus

Research funding:

摘要

摘要: 目的研究乙型肝炎肝硬化合并糖尿病不同于2型糖尿病的临床特点。方法分别对乙型肝炎肝硬化合并糖尿病（肝糖组）112例和2型糖尿病（糖尿病组）106例患者进行口服葡萄糖耐量试验（OGTT）、胰岛素释放试验（IRT）、C肽释放试验（CRT）,同时检测胰高血糖素（Glu）,并分别计算胰岛素抵抗指数HOMA-IR、β细胞功能指数（HOMA-β,MBCI）等,分析比较两组之间的差异。结果在OGTT各时间点（0、30、60、120、180 min）,肝糖组的血糖均显著低于糖尿病组（P<0.001）。两组空腹时胰岛素含量无明显差异,而肝糖组在餐后30、60、120、180 min的胰岛素含量均显著高于糖尿病组（P<0.001）。在餐后60、120、180 min,肝糖组C肽值明显高于糖尿病组（P<0.01、P<0.01和P<0.05）。与糖尿病组相比,肝糖组的Glu水平明显升高（P<0.05）,异常升高人数显著增多（P<0.001）。两组间发生血糖低于正常情况有明显差异（P<0.01）。肝糖组的HOMA-IR指数较糖尿病组显著低下（P<0.01）。结...
- 肝硬化 /
- 糖尿病
Abstract: Objective To study the clinical features of post-hepatitis B liver cirrhosis (LC) that are associated with diabetes mellitus (LCDM) and distinctive from type 2 diabetes mellitus (T2DM) without HBV infection or LC.Methods One-hundred-and-six post-hepatitis B LCDM patients and 112 T2DM patients were analyzed.All patients underwent oral glucose tolerance test (OGTT) , insulin release test (IRT) , C-peptide release test (CRT) , and glucagon (Glu) test.The homeostasis model assessment of insulin resistance (HOMA-IR) index, HOMA beta cell function (HOMA-β) , and modified beta cell function index (MBCI) were calculated.Between group differences were statistically analyzed.ResultsThe OGTT glucose levels were consistently significantly lower in LCDM than in T2DM (P<0.001) .Some insulin levels (30, 60, 120, 180min) were significantly higher in LCDM (P<0.001) .The fasting and 30 min insulin levels were not significantly different.The postprandial C-peptide levels (60, 120, 180min) were significantly higher in LCDM (P<0.05) .Glu was much higher in LCDM (P<0.05) , and the percentage of patients with abnormally elevated Glu was also significantly different between the two groups (P<0.001) .Eighty-three percent of LCDM patients had normal fasting glucose, and their diabetes mellitus was diagnosed by abnormal postprandial glucose.The percentage of patients with abnormal fasting glucose was significantly lower in the LCDM group (P<0.001) .Lower than normal glucose levels were much more prevalent in the T2DM group (P<0.01) .The HOMA-IR was lower in LCDM (P<0.01) .The HOMA-β and MBCI were similar between the two groups (P>0.05) .Conclusion Post-hepatitis B LCDM has several clinical features that are distinctive from T2DM, including postprandial glucose, OGTT curve, IRT curve, CRT curve, Glu, insulin resistance index, and lower fasting glucose.The features of insulin resistance and abnormally increased Glu may be one of the main causes of DM in HBV-related cirrhotic patients.
- liver cirrhosis /
- diabetes mellitus

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