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【摘要】：目的探讨肝病合并糖尿病患者中胰岛素抵抗的特点，并寻找导致胰岛素抵抗的可能途径。方法选取2017年9月-2018年3月北京佑安医院收治的肝病合并2型糖尿病患者67例，分析在慢性肝炎及肝硬化阶段胰岛B细胞分泌功能和胰岛素抵抗情况，并检测rs2943650位点是否变异，分析该位点变异与不同程度肝损伤的胰岛素抵抗的关系。计量资料组间比较采用t检验或Kruskal Wallis H秩和检验，计数资料组间比较采用χ2检验。结果慢性肝炎合并2型糖尿病患者胰岛B细胞的分泌功能与肝硬化合并2型糖尿病患者比较差异无统计学意义（52.72±34.56 vs 52.35±36.59，t=0.24，P=0.99），胰岛素抵抗指数在二者间差异具有统计学意义（1.33±0.62 vs 2.08±1.79，t=2.27，P=0.02）。rs2943650位点变异组胰岛素抵抗与未变异组比较差异有统计学意义（t=211，P=0.04）；rs2943650变异和未变异在肝脏疾病的不同阶段存在明显差异（χ2=6.73，P=0.01），rs2943650位点变异在肝硬化患者中更多见。结论慢性肝病合并糖尿病患者中，随着肝损伤的加重，胰岛B细胞功能下降不明显，而胰岛素抵抗明显增加，rs2943650位点变异与胰岛素抵抗明显相关，其变异加重导致胰岛素抵抗，并且随着肝损伤加重而明显增加，可能是肝病合并糖尿病导致胰岛素抵抗的重要途径。
【Abstract】：ObjectiveTo investigate the features of insulin resistance in patients with liver disease and diabetes and possible pathways leading to insulin resistance. MethodsA total of 67 patients with liver disease and type 2 diabetes who were admitted to Beijing You’an Hospital from September 2017 to March 2018 were enrolled. The insulin secretory function of pancreas islet B cells and insulin resistance in the stages of chronic hepatitis and liver cirrhosis were analyzed. The presence or absence rs2943650 mutation was detected, and the association between rs2943650 mutation and insulin resistance in different degrees of liver injury was analyzed. The t-test or the rank sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThere was no significant difference in the secretory function of pancreas islet B cells between the patients with chronic hepatitis and type 2 diabetes and those with liver cirrhosis and type 2 diabetes (52.72±34.56 vs 52.35±36.59, t=0.24, P=0.99), while there was a significant difference in insulin resistance index (1.33±0.62 vs 2.08±1.79, t=2.27, P=0.02). There was a significant difference in insulin resistance between the patients with rs2943650 mutation and those without such mutation (t=2.11, P=0.04). There was a significant difference in the presence or absence of rs2943650 mutation between different stages of liver disease (χ2=6.73, P=0.01), and rs2943650 mutation was more common in patients with liver cirrhosis. ConclusionIn patients with chronic liver disease and diabetes, there is no significant reduction in the function of pancreas islet B cells with the increase in the degree of liver injury, while there is a significant increase in insulin resistance. The rs2943650 mutation is significantly associated with insulin resistance and increases significantly with the aggravation of liver injury, and therefore, it may be an important pathway for insulin resistance induced by liver disease and diabetes.
【关键字】：肝疾病； 糖尿病， 2型； 胰岛素抵抗
【Key words】：liver diseases; diabetes mellitus, type 2; insulin resistance
【引证本文】：DOU AH, HUI W, LIU M, et al. Relationship between mutation of rs2943650 locus and insulin resistance at different stages of chronic liver disease complicated with type 2 diabetes mellitus［J］. J Clin Hepatol, 2018, 34(11): 2379-2382. （in Chinese) 窦爱华， 惠威， 刘梅，等. 慢性肝病合并2型糖尿病的rs2943650位点变异及胰岛素抵抗之间的关系［J］. 临床肝胆病杂志, 2018, 34(11): 2379-2382.