慢性乙型肝炎与肝硬化所致肝源性糖尿病患者肝纤四项与胰岛素抵抗的相关性分析  

Analysis of the relationship between insulin resistance and liver fibrosis markers in the patients with hepatogenic diabetes caused by chronic hepatitis B and liver cirrhosis

作　　者：李冰昱[1,2] 周少雄[1,2] 谢伟贤[1,2] 薛耀明[1,2] 曾科学[3] 

机构地区：[1]南方医科大学附属佛山医院 [2]广东省佛山市第二人民医院,528000 [3]广州中医药大学附属广东第二中医院,510095

出　　处：《实用医学杂志》2013年第17期2803-2805,共3页The Journal of Practical Medicine

基　　金：广东省卫生厅医学科研基金项目(编号:B2010304)

摘　　要：目的:探讨慢性乙型肝炎与肝硬化所致肝源性糖尿病(HD)患者肝纤四项与胰岛素抵抗的相关性。方法:选取慢性乙型肝炎患者(A组)76例,乙型肝炎肝硬化患者(B组)86例。测量体重、身高、肝功能、肝炎标志物(HBsAg、HBeAg)、糖脂代谢、肝纤四项、糖化血红蛋白、空腹血糖、餐后2 h血糖及空腹胰岛素水平。计算体质量指数和胰岛素抵抗指数。结果:HD患者共65例,B组患者的HD发生率(50.0%)较A组(28.9%)明显升高,两组间差异有统计学意义(P<0.01)。三型胶原为慢性乙型肝炎与肝硬化患者发生胰岛素抵抗的独立危险因素;在C组患者中,层黏蛋白和四型胶原与餐后2 h血糖呈显著正相关(P<0.01)。结论:在慢性乙型肝炎患者中,肝纤四项促进了胰岛素抵抗的发展,并最终导致HD的发生;同时,高血糖也可参与、促进肝硬化的发生发展,并进一步加重肝脏损伤。Objective To investigate the relationship between insulin resistance and liver fibrosis markers in the patients with hepatogenic diabetes （HD） caused by chronic hepatitis B and liver fibrosis. Methods 76 patients with chronic hepatitis B were selected into group A, 86 patients with liver cirrhosis of HBV were selected into group B. Biochemical assay was used to determine body weight, height, liver-function, HBsAg, HBeAg, glucose and lipid metabolism, liver fibrosis markers, hemoglobin, fasting insulin, fasting glucose and posting glucose. Body mass index and index of insulin resistance （HOMA-IR） were calculated. Results 65 patients with HD, the incidence of HD in group B patients （50.0%） was significantly higher compared with group A （28.9%） （P 〈 0.01 ）. PC-III is the independent risk factor of insulin resistance （IR） occurrence in the patients with chronic hepatitis B and liver fibrosis. Hyaluronic acid （HA） and HBeAg-positive patients are risk factors of liver cirrhosis patients with IR. In HD patients, laminin （LN） and IV collagen （IV-C） were significantly positively related to PPG （P 〈 0.010）. Conclusions In patients with chronic hepatitis B, liver fibrosis promote the development of IR, and eventually lead to occurrence of HD. Meanwhile, high blood sugar can also be involved in promoting cirrhosis occurrence and development, and further aggravate liver injury.

关 键 词：肝炎 乙型 慢性 肝硬化 肝源性糖尿病 胰岛素抵抗 

分 类 号：R512.62[医药卫生—内科学]