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目的探讨内镜下食管静脉曲张套扎术(endoscopic variceal ligation,EVL)对乙肝肝硬化患者短期血糖的影响。方法 60例接受EVL的乙肝肝硬化患者检测糖化血红蛋白、空腹血糖,进行口服葡萄糖耐量试验(OGTT)。比较患者的临床资料,评价糖代谢异常的危险因素。根据OGTT分为糖代谢正常组和异常组,检测EVL术后即刻(0h)、术后1、2、3 h血糖值。结果年龄、性别、肝功能分级、肝功能生化指标等均不是乙肝肝硬化患者发生糖代谢异常的相关危险因素。糖代谢正常组中,EVL术后1、2、3 h与0 h血糖比较,差异均无统计学意义(P>0.05);糖代谢异常组中,EVL术后1 h血糖[(8.13±1.89)mmol/L]、2 h血糖[(8.11±1.57)mmol/L]明显高于EVL术后0 h血糖[(7.04±1.29)mmol/L],差异有统计学意义(P均<0.05)。结论乙肝肝硬化合并糖代谢异常者空腹血糖、糖化血红蛋白常在正常范围,需行OGTT明确是否有糖代谢异常。肝硬化合并糖耐量异常者EVL治疗后2 h内血糖易发生明显变化,应予以监测。
Objective To investigate the effect of endoscopic variceal ligation (EVL) on short-term blood glucose in patients with hepatitis B cirrhosis. Methods Sixty patients with cirrhosis of liver cirrhosis who underwent EVL were tested for glycosylated hemoglobin and fasting blood glucose for oral glucose tolerance test (OGTT). Compare the clinical data of patients to evaluate the risk factors of abnormal glucose metabolism. According to OGTT divided into normal glucose metabolism group and abnormal group, the blood glucose level immediately after (0h), 1,2,3 h after the operation was measured. Results Age, sex, grade of liver function and biochemical indexes of liver function were not related risk factors of abnormal glucose metabolism in patients with hepatitis B cirrhosis. In the group with normal glucose metabolism, there were no significant differences in blood glucose between 1,2,3 and 0 h after EVL (P> 0.05). In the group with abnormal glucose metabolism, the blood glucose level at 1 h after EVL [(8.13 ± 1.89 ) mmol / L] and 2 h blood glucose [(8.11 ± 1.57) mmol / L] were significantly higher than those at 0 h after EVL [(7.04 ± 1.29) mmol / L] . Conclusion In patients with hepatitis B cirrhosis complicated with abnormal glucose metabolism, fasting blood glucose and glycosylated hemoglobin are often in the normal range. OGTT should be performed to confirm whether there is abnormal glucose metabolism. Liver cirrhosis with impaired glucose tolerance within 2 h after EVL treatment of blood glucose prone to significant changes should be monitored.