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目的探讨慢性乙型病毒性肝炎合并慢性胆囊炎与糖尿病的关联性,并为慢性乙型病毒性肝炎合并慢性胆囊炎的治疗提供借鉴。方法选取住院的轻、中度慢性乙型病毒性肝炎396例为研究对象。查空腹血糖、餐后2 h血糖,糖耐量试验筛查糖尿病;做肝胆B超或CT筛查慢性胆囊炎,统计并比较有糖尿病者和无糖尿病者慢性胆囊炎的发生率。以同时合并慢性胆囊炎和糖尿病(或糖耐量异常)者72例为治疗Ⅰ组,单纯合并慢性胆囊炎者119例为治疗Ⅱ组。两组治疗方法相同,比较治疗效果。治疗Ⅰ组无效者,加胰岛素治疗,观察疗效。结果慢性胆囊炎发生率,有糖尿病者100.0%(72/72),无糖尿病者36.7%(119/324),两者比较差异有统计学意义(P<0.01)。分组治疗,治疗Ⅰ组肝功能复常率及总有效率显著低于治疗Ⅱ组(P<0.01);胆道声像改善总有效率亦显著低于治疗Ⅱ组(P<0.01)。治疗Ⅰ组肝功能治疗无效者,加胰岛素治疗后,总有效率为68.3%。结论慢性乙型病毒性肝炎合并慢性胆囊炎与糖尿病密切相关,且糖尿病的存在直接影响到肝功能及胆道病变的治疗效果,但可通过胰岛素治疗获得良好预后。慢性乙型病毒性肝炎合并慢性胆囊炎时,排查糖尿病尤为重要。
Objective To investigate the association between chronic hepatitis B and chronic cholecystitis and diabetes mellitus, and provide references for the treatment of chronic hepatitis B and chronic cholecystitis. Methods 396 cases of mild and moderate chronic hepatitis B were selected as the research object. Check fasting blood glucose, 2 h postprandial blood glucose, glucose tolerance test screening of diabetes; do hepatobiliary B ultrasound or CT screening of chronic cholecystitis, statistics and comparison with diabetes and non-diabetic patients with chronic cholecystitis incidence. 72 patients with chronic cholecystitis and diabetes mellitus (or impaired glucose tolerance) were treated with Group Ⅰ, and 119 with simple cholecystitis were treated with Group Ⅱ. The same treatment of two groups, the treatment effect. Treatment of ineffective group Ⅰ, plus insulin therapy, observe the effect. Results The incidence of chronic cholecystitis was 100.0% (72/72) in patients with diabetes and 36.7% (119/324) in patients without diabetes, the difference was statistically significant (P <0.01). Group therapy, treatment group Ⅰ liver function recovery rate and total effective rate was significantly lower than the treatment group Ⅱ (P <0.01); biliary ultrasound was also significantly lower than the total effective rate of treatment group Ⅱ (P <0.01). Treatment group Ⅰ liver function fails, plus insulin therapy, the total effective rate was 68.3%. Conclusion Chronic hepatitis B and chronic cholecystitis are closely related to diabetes mellitus, and the presence of diabetes has a direct effect on the treatment of liver function and biliary lesions. However, good prognosis can be obtained through insulin therapy. Chronic hepatitis B with chronic cholecystitis, the investigation of diabetes is particularly important.