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目的探讨肝病伴糖代谢异常的临床特点及其可能机制。方法分别对29例慢性乙型肝炎伴糖代谢异常患者及62例乙型肝炎后肝硬化伴糖代谢异常患者进行相关分析。结果 (1)乙型肝炎后肝硬化患者中肝源性糖耐量减低(IGT)及肝源性糖尿病(DM)发生率高于慢性乙型肝炎患者(20．53％对 3．82％,P<0．05;24．11％对1．64％,P<0．01)。(2)慢性乙型肝炎及乙型肝炎后肝硬化伴肝源性IGT或DM 患者均无糖尿病症状,而19例慢性乙型肝炎伴原发性D M者中12例有症状,12例乙型肝炎后肝硬化伴原发性DM者中6例有症状。(3)慢性乙型肝炎伴肝源性IGT或DM者,空腹血糖(FPG)、餐后血糖(PPG)水平均低于伴原发性DM者(P<0．05);但前者葡萄糖负荷后胰岛素(PINS)及C肽(PCP)分泌水平高于后者(P<0．05)。(4)乙型肝炎后肝硬化伴肝源性DM与伴原发性DM患者的FPG、PPG水平差异均无统计学意义,伴肝源性DM患者空腹胰岛素(FINS)、PINS、空腹C肽(FCP)及PCP水平高于伴原发性DM患者(P<0．05),但两者的PINS／FINS、PCP／FCP值差异无统计学意义,且小于5;伴肝源性DM患者其FPG、 PPG水平均显著高于伴肝源性IGT者(P<0．05),FINS、PINS及FCP、PCP水平均低于肝源性IGT患者(P<0．05,P<0．0 1)。结论肝病继发糖代谢异常者多发生于肝硬化患者,且以肝功能损害较重者为主,多无症状;慢性乙型肝炎伴肝源性D M患者胰岛β细胞分泌胰岛素的功能增强,而乙型肝炎后肝硬化伴肝源性DM患者则减弱。
Objective To investigate the clinical features and possible mechanisms of liver disease with abnormal glucose metabolism. Methods 29 cases of chronic hepatitis B patients with abnormal glucose metabolism and 62 cases of post-hepatitis B cirrhosis with abnormal glucose metabolism were analyzed. Results (1) The incidence of hepatic glucose tolerance (IGT) and hepatic diabetes mellitus (DM) in patients with posthepatitic cirrhosis was higher than that in patients with chronic hepatitis B (20.53% vs 3.82%, P <0.05; 24.11% vs 1.64%, P <0.01). (2) No symptoms of diabetes were found in chronic hepatitis B and post-hepatitis B cirrhosis with liver-derived IGT or DM, while 12 of 19 chronic hepatitis B with primary DM were symptomatic and 12 Posthepatitis cirrhosis with primary DM in 6 cases of symptoms. (3) The levels of fasting blood glucose (FPG) and postprandial blood glucose (PPG) in patients with chronic hepatitis B and hepatic IGT or DM were lower than those with primary DM (P <0.05) Postprandial insulin (PINS) and C peptide (PCP) secretion levels were higher than the latter (P <0.05). (4) There was no significant difference in FPG and PPG levels between patients with posthepatitic cirrhosis with liver-derived DM and those with primary DM, with fasting insulin (FINS), PINS, fasting C-peptide (FCP) and PCP levels were higher than those with primary DM (P <0.05), but there was no significant difference between the two groups in the values of PINS / FINS and PCP / FCP The levels of FPG and PPG were significantly higher than those with hepatic IGT (P <0.05). The levels of FINS, PINS, FCP and PCP were lower than those of patients with hepatic IGT (P <0.05, P <0. 0 1). Conclusions Patients with abnormal hepatic glucose metabolism often occur in patients with cirrhosis and are characterized by severe liver damage, mostly asymptomatic. In patients with chronic hepatitis B and liver-derived DM, insulin secretion by pancreatic β-cells is enhanced, Hepatitis B cirrhosis with liver-derived DM patients weakened.