肝硬化并糖尿病患者胰岛素抵抗及与肝功能关系探讨

Research on insulin resistance in liver cirrhosis patients complicated with diabetes mellitus and its relationship with hepatic function

关键词:  肝硬化  糖尿病  胰岛素抵抗  Child-Pugh分级

Key words:  liver cirrhosis  diabetes mellitus  insulin resistance  Child-Pugh classification

摘要:

目的　探讨肝硬化并糖尿病患者胰岛素抵抗及与肝功能间的关系，为临床治疗提供参考。方法　选择肝硬化、肝硬化并糖尿病患者各60例及无糖尿病及肝硬化的健康体检者60例为对照组，测定空腹血浆胰岛素、葡萄糖及血脂水平，计算胰岛素抵抗指数，比较其在各组间的差异，分析其与患者肝功能Child-Pugh分级间的关系。结果　肝硬化组患者血浆胰岛素水平与胰岛素抵抗指数均明显高于对照组(P<0.05)，肝硬化并糖尿病组患者血糖、血浆胰岛素水平及胰岛素抵抗指数均明显高于肝硬化组及对照组（P<0.05）。肝硬化并糖尿病组中Child-Pugh分级为C级患者的比例高于肝硬化组（P<0.05）。肝硬化及肝硬化并糖尿病患者的胰岛素抵抗指数在Child-Pugh分级为C级者高于B级，B级高于A级（P均<0.05)。肝硬化组患者血胆固醇水平高于肝硬化并糖尿病组（P<0.05)。结论　肝硬化患者体内存在高胰岛素血症与胰岛素抵抗，合并糖尿病时更加明显，且合并糖尿病的肝硬化患者肝功能状态更差，预后不佳。

Abstract:

Objective To investigate the relationship between insulin resistance and hepatic function in patients with liver cirrhosis (LC) complicated by diabetes (LC-DM). Methods 60 cases of LC, 60 cases of LC-DM and 60 normal subjects were elected to analyze fasting plasma glucose (FPG), fasting plasma insulin (FINS)，Child-Pugh classification，cholesterol，triglyceride，alpha-lipoprotein and low density lipoprotein. Homeostasis Model for Assessment of Insulin Resistance. Results All FPG, FINS and HOMA-IR in LC-DM group were higher than those in LC group and normal subjects (P<0.05). The Child-Pugh C patients in LC-DM group were more than LC group (P<0.05). The HOMA-IR in patients with Child-Pugh C was higher than Child-Pugh B and Child-Pugh A, the HOMA-IR in patients with Child-Pugh B was also higher than Child-Pugh A (P<0.05). The cholesterol in LC group was higher than LC-DM group (P<0.05). Conclusion Compared to liver cirrhosis patients without diabetes，the liver function is worse and the hyperinsulinemia and insulin resistance are more severe in liver cirrhosis patients complicated by diabetes．