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目的探讨肝病伴肝源性糖代谢异常的临床特点,提高诊治水平。方法分别对8例慢性乙型肝炎伴肝源性糖代谢异常患者及65例肝硬化伴肝源性糖代谢异常患者进行相关分析。结果(1)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(20.13%对3.22%,P<0.05;23.49%对1.07%,P<0.01)。(2)慢性乙型肝炎及肝硬化伴肝源性IGT或DM患者均无糖尿病症状,少有并发症,死亡原因多为原发肝病。(3)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<0.01)。(4)加强原发肝病治疗将有利于纠正血糖,同时对肝源性糖代谢异常及时诊断及治疗,也有利于原发肝病恢复。结论肝病继发糖代谢异常患者多发生于肝硬化患者,且以肝功能损害较重者为主,多无糖尿病症状;慢性乙型肝炎伴肝源性DM患者胰岛β细胞分泌胰岛素的功能增强,而肝硬化伴肝源性DM患者则减弱。加强原发肝病治疗将有利于纠正血糖,同时对肝源性糖代谢异常及时诊断及治疗,也有利于原发肝病恢复。
Objective To investigate the clinical features of hepatopathy with abnormal hepatic glucose metabolism and to improve the diagnosis and treatment. Methods Eight patients with chronic hepatitis B with abnormal hepatic glucose metabolism and 65 patients with liver cirrhosis with abnormal hepatic glucose metabolism were analyzed. Results (1) The incidence of hepatic glucose tolerance (IGT) and liver-derived diabetes mellitus (DM) in patients with cirrhosis was significantly higher than that of patients with chronic hepatitis B (20.13% vs 3.22%, P <0.05; 23.49% vs. 1.07% , P <0.01). (2) Patients with chronic hepatitis B and liver cirrhosis with liver-derived IGT or DM have no symptoms of diabetes and few complications. Most of the causes of death are primary liver disease. (3) The levels of FPG and PPG in patients with liver-derived DM were significantly higher than those in patients with liver-derived IGT (P <0.05), while the levels of FINS, PINS, FCP and PCP were lower than those in patients with liver-derived IGT , P <0.01). (4) to strengthen the treatment of primary liver disease will be conducive to correcting blood sugar, while liver abnormal glucose metabolism in time diagnosis and treatment, but also conducive to the recovery of primary liver disease. Conclusions Patients with abnormal hepatic glucose metabolism often occur in patients with liver cirrhosis and are characterized by severe hepatic dysfunction with no symptoms of diabetes. In patients with chronic hepatitis B and liver-derived DM, insulin secretion by pancreatic β-cells is enhanced, Cirrhosis with liver-derived DM patients weakened. To strengthen the treatment of primary liver disease will help correct blood sugar, liver cancer at the same time abnormalities in glucose metabolism and timely diagnosis and treatment, but also conducive to the recovery of primary liver disease.