乙肝病毒相关的慢性肝病患者胰岛素抵抗指数测定的临床意义  

Determination of insulin resistance index and its clinical significance in chronic liver disease related to hepatitis B virus

作　　者：李冰昱[1] 王福生[2] 张纪元[2] 刘慧霞[1] 

机构地区：[1]中南大学湘雅医院老年干部医疗科,长沙410008 [2]解放军第302医院传染病研究所生物工程室

出　　处：《解放军医学杂志》2009年第3期259-261,共3页Medical Journal of Chinese People's Liberation Army

基　　金：国家重点基础研究发展计划(973计划)资助项目(2007CB512800);国家自然科学基金青年科学基金资助项目(30801039)

摘　　要：目的探讨胰岛素抵抗指数(HOMA-IR)在不同临床类型慢性乙型肝炎患者中的变化及其在肝源性糖尿病发生的早期预警中的作用。方法选取临床确诊的80例慢性乙型肝炎(CHB)患者,66例乙型肝炎肝硬化(LC)患者和30例慢性乙型重型肝炎(CSHB)患者,另外选取30例健康人作为健康对照(HC)。所有研究对象(既往无糖尿病史)均通过检测空腹血糖(FPG)及口服葡萄糖耐量试验(OGTT)以排除糖耐量异常及糖尿病,并检测FPG以及空腹胰岛素水平(FINS)以计算HOMA-IR值。结果从HC、CHB、LC至CSHB患者,FINS和HOMA-IR均逐渐升高,其中CHB患者(10.58±6.48,2.35±1.55)较HC组患者(8.06±2.14,1.68±1.53)明显升高(P<0.01),而显著低于LC患者(12.73±5.88,2.91±1.41)和CSHB患者(18.30±14.17,4.35±3.17,P<0.05)。按照CHB的临床分度,重度CHB患者的FINS与HOMA-IR均显著高于中度CHB患者(P<0.05)。FPG在CHB患者与HC组之间以及CHB不同临床分度的患者内部均无明显差异(P>0.05),但LC和CSHB患者的FPG较HC组显著升高(P<0.05)。在不同Child-Pugh分级的LC患者中,Child-C级患者的FPG值要明显高于Child-A级(P<0.01)。结论HOMA-IR可作为预测肝源性糖尿病发生的重要指标。Objective To investigate the role of insulin resistance index （HOMA-IR） in premonishing hepatogenous diabetes subsequent to chronic liver disease related to hepatitis B virus. Methods Fasting plasma glucose （FPG） and fasting serum insulin （FINS） were measured in 176 patients, including 80 patients with chronic hepatitis B （CHB）, 66 patients with liver cirrhosis （LC） and 30 patients with chronic severe hepatitis B （CSHB）. In addition 30 healthy subjects served as control （group HC）. None of the subjects in the study had a history of diabetes. FPG and FINS were measured in all the subjects to exclude impaired glucose tolerance and diabetes. Then HOMA-IR was calculated. Results Among the HC and CHB, LC and CSHB patients, both FINS and HOMA-IR levels gradually elevated. FINS and HOMA-IR in CHB patients （10. 58±6. 48, 2. 35±1.55） were significantly higher than those in group HC （8. 06±2. 14,1. 68±1.53）, while lower than those in LC （12. 73±5. 88, 2. 91±1.41） and CSHB （18. 30±14. 17, 4. 35±3. 17） patients （P〈0. 05）. Among CHB patients, no significant difference in FINS and HOMA-IR was found between the patients with mild or moderate disease （P〉0. 05）, while the values of FINS and HOMA-IR were significantly higher in severe patients than those in moderate patients （P〈0. 05）. There was no significant difference in FPG between CHB patients and group HC and among CHB patients （P〉0.05）, while the values of FPG were significantly higher in LC and CSHB patients than those in group HC （P〈0. 05）. Among the LC patients with different Child-Pugh scores, FPG in Child-C group was significantly higher than that in Child-A （P〈0. 01）. Conclusion The insulin resistance index may be used as an important predictor of hepatogenous diabetes in the patients with chronic liver disease related to hepatitis B virus.

关 键 词：肝炎 乙型 慢性 葡糖耐量试验 胰岛素抵抗 

分 类 号：R512.6[医药卫生—内科学] R587.1[医药卫生—临床医学]