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目的:探讨肝源性糖尿病的临床特点及其治疗,以提高对该病的诊疗水平。方法:120例肝源性糖尿病(HD)患者,其中46例行OGTT试验,检测了血糖、胰岛素、C肽、胰岛素敏感指数(ISI),HOMA-IR及空腹血糖、空腹胰岛素(FPG/FINS)评估胰岛素抵抗,并与50例2型糖尿病(T2DM)患者进行对比分析。结果:21例(17.5%)HD患者有三多一少糖尿病典型症状。OGTT结果显示HD组空腹血糖低于T2DM组(P<0.05);胰岛素+C肽释放试验显示T2DM组和HD组胰岛素分泌呈高峰延迟型,HD患者各时段胰岛素及C肽水平高于T2DM患者(P<0.05,P<0.01)。HD组的FPG/FINS及HOMA-IR低于HD组,ISI高于HD组,差异均有统计学意义(P<0.05)。经治疗后血糖大部分控制在正常或接近正常水平,9例病例均死于肝病并发症。结论:胰岛素抵抗可能是肝源性糖尿病重要的发病机制。肝源性糖尿病以餐后高血糖为特征,临床症状不典型,短期不良预后主要与原发慢性肝病有关。
Objective: To investigate the clinical features and treatment of liver-derived diabetes in order to improve the diagnosis and treatment of the disease. Methods: OGTT was used in 46 of 120 patients with liver-derived diabetes (HD). Blood glucose, insulin, C-peptide, insulin sensitivity index (ISI), HOMA-IR, fasting blood glucose, fasting insulin (FPG / FINS) Insulin resistance was assessed and compared with 50 patients with type 2 diabetes mellitus (T2DM). Results: Twenty-one patients (17.5%) had typical symptoms of more than three diabetes. The results of OGTT showed that the fasting blood glucose in HD group was lower than that in T2DM group (P <0.05). The insulin + C peptide release test showed that the insulin secretion in T2DM group and HD group showed peak delay type. The levels of insulin and C peptide in HD group were higher than those in T2DM group P <0.05, P <0.01). FPG / FINS and HOMA-IR in HD group were lower than HD group, and ISI was higher than HD group (P <0.05). After treatment most of the control of blood glucose at normal or near normal levels, 9 cases died of liver complications. Conclusion: Insulin resistance may be an important pathogenesis of liver-derived diabetes. Hepatic diabetes is characterized by postprandial hyperglycemia, clinical symptoms are not typical, short-term adverse prognosis and primary chronic liver disease.