不同Child-Pugh分级的慢性乙型肝炎合并肝硬化患者糖代谢和胰岛素分泌情况及与炎症反应相关性研究  

Study on the Relationship between Glucose Metabolism,Insulin Secretion and Inflammatory Reaction in Patients with Chronic Hepatitis B Complicated with Cirrhosis and Different Child-Pugh Grades

作　　者：易爱芬 高明[2] YI Ai-fen;GAO Ming(The Fourth Department of Liver,Anyang Fifth People’s Hospital,Anyang,Henan,455000,China)

机构地区：[1]安阳市第五人民医院肝四科,河南安阳455000 [2]郑州大学第一附属医院肿瘤科,河南郑州450000

出　　处：《黑龙江医学》2023年第6期663-665,共3页Heilongjiang Medical Journal

摘　　要：目的:分析在不同Child-Pugh分级的慢性乙型肝炎伴肝硬化患者中糖代谢同胰岛素分泌、炎症反应之间关联性,对改善疾病预后的意义。方法:选取2019年2月—2020年2月安阳市第五人民医院实施慢性乙肝伴肝硬化治疗的150例患者作为研究对象。根据Child-Pugh分级不同,将其分成A级(50例)、B级(50例)以及C级(50例)。回顾性分析全部患者临床资料,主要有乙型肝炎病毒DNA载量、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、空腹血糖、C肽水平、血浆胰岛素、胰岛素抵抗指数、胰岛素分泌功能、中性粒细胞/淋巴细胞比值、白细胞介素-6、肿瘤坏死因子-α、谷草转氨酶以及谷丙转氨酶。比较三组患者临床资料以及糖耐量试验后2 h有关临床指标。结果:三组患者在白细胞介素-6水平、肿瘤坏死因子-α水平、血浆胰岛素水平、胰岛素抵抗指数、胰岛素分泌功能以及中性粒细胞/淋巴细胞比值方面对比,差异有统计学意义(t=111.610、63.140、49.110、12.530、146.030,P<0.05)。糖耐量试验后2 h三组患者在血浆胰岛素、血糖、白细胞介素-6、肿瘤坏死因子-α以及中性粒细胞/淋巴细胞比值方面对比,差异有统计学意义(t=23.510、31.890、54.170、45.680、181.490,P<0.05)。Child-Pugh分级同糖耐量试验后血糖、胰岛素以及中性粒细胞/淋巴细胞比值水平呈正相关,差异有统计学意义(r=0.449、0.642、0.675,P<0.05)。结论:慢性乙型肝炎伴肝硬化患者会有糖代谢异常以及胰岛素抵抗情况存在,并且伴随肝损伤程度的加重,糖代谢异常以及胰岛素抵抗情况更加明显,另外炎症反应在两者之间可能发挥介导作用。Objective:To analyze the association between glucose metabolism and insulin secretion and inflammatory response in patients with chronic hepatitis B with cirrhosis of different Child-Pugh classifications,with positive implications for improving disease prognosis.Methods:150 patients who underwent chronic hepatitis B with cirrhosis treatment in the hospital from February 2019 to February 2020 were selected for the study,and they were classified into grade A,grade B,and grade C according to different Child-Pugh classifications,with 50 cases in each.The clinical data of all patients were retrospectively analyzed,including hepatitis B virus DNA load,triglycerides,total cholesterol,HDL,LDL,fasting glucose,C-peptide level,plasma insulin,insulin resistance index,insulin secretory function,neutrophil/lymphocyte ratio,interleukin-6,tumor necrosis factor-α,glutathione transaminase,and glutathione transaminase.The clinical data of the three groups of patients were compared,as well as the relevant clinical indicators 2 h after the glucose tolerance test.Results:The differences in interleukin-6 levels,tumor necrosis factor-αlevels,plasma insulin levels,insulin resistance index,insulin secretory function,and neutrophil/lymphocyte ratio were statistically significant among the three groups of patients(t=111.610,63.140,49.110,12.530,146.030,P<0.05).The differences in plasma insulin,glucose,interleukin-6,tumor necrosis factor-α,and neutrophil/lymphocyte ratio at 2 h after the glucose tolerance test were statistically significant in the three groups(t=23.510,31.890,54.170,45.680,181.490,P<0.05).Child-Pugh classification was positively correlated with glucose,insulin,and neutrophil/lymphocyte ratio levels after the glucose tolerance test,with statistically significant differences(r=0.449,0.642,0.675,P<0.05).Conclusion:Patients with chronic hepatitis B with cirrhosis have abnormal glucose metabolism and insulin resistance,which become more pronounced with increasing liver damage,and inflammatory responses may play a mediating rol

关 键 词：炎症反应 胰岛素 肝硬化 慢性乙型肝炎 糖代谢 

分 类 号：R657.3[医药卫生—外科学]