肝硬化合并糖尿病患者发生低血糖症的临床分析  

A clinical analysis of hypoglycemia in patients with liver cirrhosis and diabetes mellitus

作　　者：赵娟[1] 惠威[1] 窦爱华[1] 魏琳琳[1] 刘梅[1] 董桂芳[1] 徐斌[1] ZHAO Juan;HUI Wei;DOU Aihua(Department of Hepatology and Endocrinology, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China)

机构地区：[1]首都医科大学附属北京佑安医院肝病内分泌科

出　　处：《临床肝胆病杂志》2020年第2期329-332,共4页Journal of Clinical Hepatology

基　　金：中国初级卫生保健基金会-佑安肝病艾滋病基金;2018年度院内中青年人才孵育项目(YNKTQN20180208)

摘　　要：目的 探讨肝硬化合并糖尿病患者发生低血糖的原因及临床指标的特点。方法 选取首都医科大学附属北京佑安医院2017年1月-2019年6月收治的肝硬化合并糖尿病患者共50例为研究对象,其中发生1次低血糖的25例为试验组,未发生低血糖的25例为对照组。对两组患者肝肾功能、空腹血糖、糖化血红蛋白及Child-Pugh分级进行评估,并分析低血糖发生的时间段及可能原因。计量资料两组比较采用独立样本t检验或Mann-Whitney U检验,计数资料两组间比较采用χ2检验。结果 试验组空腹血糖明显低于对照组[6.10(3.45~8.96)mmol/L vs 8.12(6.18±12.59)mmol/L, Z=-2.687, P=0.007],ChE明显低于对照组[3009.00(1788.50~4493.50)U/L vs 4936.00(4051.00~6740.50)U/L, Z=-3.095, P=0.002],Alb明显低于对照组[(32.02±7.07)g/L vs (35.89±5.49)g/L, t=2.161,P=0.036],糖化血红蛋白明显低于对照组[(6.97±1.64)mmol/L vs (8.04±1.78)mmol/L,t=2.047,P=0.047]。试验组Child-Pugh分级以B级(36%)及C级(36%)为主,对照组以A级(56%)及B级(40%)为主,两组Child-Pugh分级差异有统计学意义(χ^2=8.786,P=0.012)。肝硬化合并糖尿病患者大部分低血糖发生在晨起空腹及白天,原因以胰岛素过多(44%)及进食或热量补充不足(40%)为主,部分患者有空腹无症状性低血糖(16%)。结论 临床上应重视肝硬化合并糖尿病患者的血糖监测及管理,减少低血糖事件的发生。Objective To investigate the causes of hypoglycemia and the features of clinical indices in patients with liver cirrhosis and diabetes mellitus. Methods A total of 50 patients with liver cirrhosis and diabetes mellitus who were admitted to Beijing YouAn Hospital, Capital Medical University, from January 2017 to June 2019 were enrolled as subjects, among whom 25 patients with one hypoglycemic event were enrolled as experimental group and 25 patients without hypoglycemia were enrolled as control group. Hepatic and renal function, fasting blood glucose, glycosylated hemoglobin, and Child-Pugh class were evaluated for both groups, and the time period and possible causes of hypoglycemia were analyzed. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Results Compared with the control group, the experimental group had significantly lower levels of fasting blood glucose [6.10(3.45~8.96) mmol/L vs 8.12(6.18~12.59)mmol/L, Z=-2.687, P=0.007], cholinesterase [3009.00(1788.50~4439.50)U/L vs 4936.00(4051.00~6740.50)U/L, Z=-3.095, P=0.002], albumin (32.02±7.07 g/L vs 35.89±5.49 g/L, t=2.161, P=0.036), and glycosylated hemoglobin (6.97±1.64 mmol/L vs 8.04±1.78 mmol/L, t=2.047, P=0.047). Among the patients in the experimental group, 36% had Child-Pugh class B cirrhosis and 36% had Child-Pugh class C cirrhosis, and among the patients in the control group, 56% had Child-Pugh class A cirrhosis and 40% had Child-Pugh class B cirrhosis;there was a significant difference in Child-Pugh class between the two groups (χ^2=8.786, P=0.012). Most of the patients with liver cirrhosis and diabetes mellitus experienced hypoglycemia in the fasting state in the morning and in the daytime, with the main causes of excessive insulin (44%) and insufficient food intake or calorie supplementation (40%), and some patients experienced fasting asymptomatic hypoglycemia (16%). Conclusion Blood g

关 键 词：肝硬化 糖尿病 低血糖症 胰岛素 

分 类 号：R575.2[医药卫生—消化系统]