酒精性肝硬化与乙型肝炎肝硬化并发糖代谢异常男性患者的临床特征对比分析

张文洁; 陈绮丹; 万瑜; 邓辉

doi:10.3969/j.issn.1001-5256.2016.02.020

酒精性肝硬化与乙型肝炎肝硬化并发糖代谢异常男性患者的临床特征对比分析

DOI: 10.3969/j.issn.1001-5256.2016.02.020

广州市番禺区中心医院消化内科

详细信息

中图分类号: R575.2;R512.62
计量
- 文章访问数: 2120
- HTML全文浏览量: 15
- PDF下载量: 476
- 被引次数: 0
出版历程
- 收稿日期: 2015-04-07
- 出版日期: 2016-02-20

Clinical features of male patients with alcoholic liver cirrhosis or hepatitis B cirrhosis complicated by abnormal glucose metabolism

Department of Gastroenterology,Panyu Central Hospital

摘要

摘要: 目的探讨并发糖代谢异常的男性酒精性肝硬化（ALC）与乙型肝炎肝硬化（HBC）患者的临床特征。方法收集2008年1月-2013年9月于广州市番禺区中心医院住院的肝硬化患者287例,包含ALC患者74例,均为男性,其中并发糖代谢异常者54例;HBC患者213例,其中并发糖代谢异常者97例（男69例、女28例）。对并发糖代谢异常的ALC和HBC患者的临床资料进行分组对照研究,探讨患者临床表现和实验室检查指标、胰岛素抵抗指数、糖代谢异常发生率及其与Child-Pugh分级的关系。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,采用Spearman进行等级相关分析。结果 ALC男性患者糖代谢异常发生率（73.0%vs 32.4%）、肝源性糖尿病发生率（35.1%vs 14.6%）、空腹低血糖发生率（27.0%vs 10.3%）和糖耐量异常发生率（31.1%vs 14.1%）均高于HBC患者（χ2值分别为4.371、3.274、4.784、1.633,P值均<0.05）;Spearman相关性分析显示,ALC和HBC男性患者糖代谢异常发生率与Child-Pugh分级呈正相关（rs=...
- 肝硬化 /
- 肝硬化,酒精性 /
- 肝炎,乙型 /
- 葡萄糖代谢障碍
Abstract: Objective To investigate the clinical features of male patients with alcoholic liver cirrhosis( ALC) or hepatitis B cirrhosis( HBC) complicated by abnormal glucose metabolism. Methods A total of 287 patients with liver cirrhosis who were admitted to Guangzhou Panyu Central Hospital from January 2008 to September 2013 were selected. Among these patients,74 had ALC and were all male,including 54 with abnormal glucose metabolism; the other 213 had HBC,including 97 with abnormal glucose metabolism( 69 male patients and28 female patients). A controlled study was performed for the clinical data of ALC and HBC patients with abnormal glucose metabolism,to investigate the association of patients' clinical manifestations with the indices for laboratory examination,insulin resistance index,incidence rate of abnormal glucose metabolism,and Child- Pugh class. The t- test was applied for comparison of continuous data between groups,the chi- square test was applied for comparison of categorical data between groups,and the Spearman rank correlation was applied for correlation analysis. Results Compared with HBC patients,ALC patients had significantly higher incidence rates of abnormal glucose metabolism( 73. 0% vs 32. 4%),hepatogenous diabetes( 35. 1% vs 14. 6%),fasting hypoglycemia( 27. 0% vs 10. 3%),and impaired glucose tolerance( 31. 1% vs 14. 1%)( χ2= 4. 371,3. 274,4. 784,and 1. 633,all P < 0. 05). The Spearman correlation analysis showed that in ALC and HBC patients,the incidence rate of abnormal glucose metabolism was positively correlated with Child- Pugh class( rs= 0. 41,P <0. 05). Compared with the HBC patients with abnormal glucose metabolism,the ALC patients with abnormal glucose metabolism had a significantly higher incidence rate of Child- Pugh class A( χ2= 7. 520,P = 0. 001),and a significantly lower incidence rate of Child- Pugh class C( χ2= 6. 542,P = 0. 003). There were significant differences in the incidence rates of dim complexion,telangiectasia of the face,spider angioma,hepatomegaly,hepatorenal syndrome,malnutrition,ascites,jaundice,hepatic encephalopathy,spontaneous bacterial peritonitis,and upper gastrointestinal bleeding between the ALC and HBC patients with abnormal glucose metabolism( χ2= 3. 785,2. 651,1. 974,3. 316,3. 771,5. 843,7. 251,5. 214,5. 778,2. 966,and 6. 312,all P < 0. 05). Compared with the HBC patients with abnormal glucose metabolism,the ALC patients with abnormal glucose metabolism had significantly higher levels of aspartate aminotransferase and total bilirubin,a significantly greater mean corpuscular volume,a significantly higher level of gamma- glutamyl transpeptidase,and a significantly lower level of albumin( t = 4. 775,7. 887,5. 143,6. 124,and 5. 210,all P < 0. 05). There were significant differences in the fasting blood glucose level,insulin level 2 hours after meal,and insulin resistance index between the ALC and HBC patients with abnormal glucose metabolism( t = 2. 770,6. 331,and 3. 770,all P < 0. 05). Conclusion The male patients with ALC or HBC gradually develop abnormal glucose metabolism with the deterioration of liver function,with individual etiology and features of liver cirrhosis,and the manifestations of abnormal glucose metabolism are not obvious. Related examinations should be performed for these male patients with liver cirrhosis of various causes,to confirm the existence of abnormal glucose metabolism.
- liver cirrhosis /
- liver cirrhosis,alcoholic /
- hepatitis B /
- glucose metabolism disorders

HTML全文

参考文献(16)

[1]GARCIA-COMPEAN D,JAQUEZ-QUINTANA JO,MALDONADO-GARZA H.Hepatogenous diabetes.Current views of an ancient problem[J].Ann Hepatol,2009,8(1):13-20.

[2]Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B(2010 version)[J].J Clin Hepatol,2011,27(1):I-XVI.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].临床肝胆病杂志,2011,27(1):I-XVI.

[3] Fatty Liver and Alcoholic Liver Disease Study Group of the Chinese Liver Disease Association,Chinese Medical Association.Guidelines for prevention and treatment of alcoholic liver disease(revised version 2010)[J].J Clin Hepatol,2010,26(3):229-232.(in Chinese)中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南(2010年修订版)[J].临床肝胆病杂志,2010,26(3):229-232.

[4]American Diabetes Association.Clinical practice recommendations2001:gestational diabetes mellitus[J].Diabetes Care,2001,24(9):s77-s79.

[5]SIBLEY D,PALMLMER JP,HIRSCH IB,et al.Visceral obesity,hepatic lipase activity and dyslipidemia in type 1 diabetes[J].J Clin Endocrinol Metab,2003,88(7):3379-3384.

[6]GARCIA-COMPEAN D,GONZALEZ-GONZALEZ JA,LAVALLE-GONZALEZ FJ,et al.Current concepts in diabetes mellitus and chronic liver disease:clinical outcomes,hepatitis C virus association,and therapy[J].Dig Dis Sci,2015.[Epub ahead of print]

[7]GARCIA-COMPEAN D,JAQUEZ-QUINTANA JO,LAVALLEGONZALEZ FJ,et al.Subclinical abnormal glucose tolerance is a predictor of death in liver cirrhosis[J].World J Gastroenterol,2014,20(22):7011-7018.

[8]BIANEHI G,MATCHESINI G,ZOLI M,et al.Prognostic significance of diabetes in patients with cirrhosis[J].Hepatology,1994,20(1):119-125.

[9]WLAZLO N,van GREEVENBROEK MM,CURVERS J,et al.Diabetes mellitus at the time of diagnosis of cirrhosis is associated with higher incidence of spontaneous bacterial peritonitis,but not with increased mortality[J].Clin Sci(Lond),2013,125(7):341-348.

[10]YANG CH,CHIU YC,CHEN CH,et al.Diabetes mellitus is associated with gastroesophageal variceal bleeding in cirrhotic patients[J].Kaohsiung J Med Sci,2014,30(10):515-520.

[11]BUTT Z,JADOON NA,SALARIA ON,et al.Diabetes mellitus and decompensated cirrhosis:risk of hepatic encephalopathy in different age groups[J].J Diabetes,2013,5(4):449-455.

[12]LING Q,DONG F,GENG L,et al.Impacts of TCF7L2 gene polymorphisms on the susceptibility of hepatogenous diabetes and hepatocellular carcinoma in cirrhotic patients[J].Gene,2013,522(2):214-218.

[13]JEON HK,KIM MY,BAIK SK,et al.Hepatogenous diabetes in cirrhosis is related to portal pressure and variceal hemorrhage[J].Dig Dis Sci,2013,58(11):3335-3341.

[14]LI JN,LAI YM,QIAN JM,et al.Trends in etiologies of chronic pancreatitis within 20 years:analysis of 636 cases[J].Chin Med J(Engl),2011,124(21):3556-3559.

[15]ZHANG XJ.Clinical analysis of the incidence of low blood sugar in patients with intensive insulin therapy[J].Modern Prevent Med,2011,38(12):2445-2446,2450.(in Chinese)张旭娟.肝源性糖尿病患者胰岛素强化治疗后低血糖发生率的临床分析[J].现代预防医学,2011,38(12):2445-2446,2450.

[16]BAO ZY,YUAN XD,DUAN SH.Analysis of risk factor of cirrhosis complicated by hepatogeous diabetes[J].Modern Prevent Med,2011,38(19):3885-3887.(in Chinese)鲍中英,苑晓东,段淑红.肝硬化发生肝源性糖尿病的相关因素分析[J].现代预防医学,2011,38(19):3885-3887.

施引文献

资源附件(0)

访问统计