空腹血糖水平对乙型肝炎病毒相关慢加急性肝衰竭患者疾病转归的影响  

Effect of fasting plasma glucose level on the prognosis of disease in patients with HBV⁃related acute⁃on⁃chronic liver failure

作　　者：王海斌 李晖[1] 陈晓蕾[2] 刘娜[2] 李全美[2] 邹玉 李春梅[1] 甘井泉 吴长会 陈华仙 刘向 龚明 WANG Haibin*;LI Hui;CHEN Xiaolei;LIU Na;LI Quanmei;ZOU Yu;LI Chunmei;GAN Jingquan;WU Changhui;CHEN Huaxian;LIU Xiang;GONG Ming(Department of Infectious Diseases,the Affiliated Hospital of YunNan University(the Second People's Hospital of YunNan Province),Kunming 650000,China)

机构地区：[1]云南大学附属医院(云南省第二人民医院、云南省眼科医院)感染性疾病科,昆明650000 [2]昆明市第一人民医院内分泌科,昆明650000

出　　处：《实用医学杂志》2023年第18期2373-2378,共6页The Journal of Practical Medicine

基　　金：昆明市卫生科技人才“百工程”项目[编号:2020-SW(省)-09]。

摘　　要：目的 探索空腹血糖(fasting plasma glucose, FPG)对乙型肝炎病毒(hepatitis B virus, HBV)相关慢加急性肝衰竭(acute-on-chronic liver failure, ACLF)患者疾病转归的影响。方法 抽取曾于云南省某三级甲等医院感染性疾病科住院的109例HBV相关ACLF患者的临床资料进行回顾性分析,根据不同FPG水平、凝血酶原国际标准化比率(prothrombin international normalized ratio, PT-INR)分组后,运用单因素ANOVA检验、χ2检验、Spearman相关分析及二分类logistic回归分析FPG水平对HBV相关ACLF患者疾病转归的影响。结果 低FPG组HBV相关ACLF并发症(HE、低钠血症、SBP)的发生率及患者病死率高于正常FPG、高FPG组(P <0.05);中-晚期组低FPG的发生率及患者病死率均高于前-早期组(P <0.05);Child-Pugh评分、MELD评分与PT-INR间存在明显的正相关性(P <0.001);二分类logistic回归分析低FPG、正常FPG是HBV相关ACLF患者疾病进展的独立危险因素(P <0.05,OR=0.174,95%CI:0.066~0.461)。结论 低FPG增加了HBV相关ACLF患者疾病进展恶化的风险,而高FPG有可能起到了保护肝脏功能的作用。Objective To explore the effect of fasting blood glucose(FPG)on the prognosis of disease in patients with HBV-related acute-on-chronic liver failure.Methods The clinical data of 109 HBV-related ACLF patients admitted to the Department of Infectious Diseases of a tertiary a hospital in Yunnan Province were retrospectively analyzed,and grouped according to different FPG levels and prothrombin international standardized ratio(PT-INR)of prothrombin.ANOVA test,Chi-square test,Spearman correlation analysis and binary logistic regression were used to analyze the effect of FPG level on the prognosis of disease of HBV-related ACLF patients.Results The incidence and mortality of HBV-related ACLF complications(HE,hyponatremia,SBP)in low FPG group were higher than those in normal FPG and high FPG group(P<0.05).The incidence of low FPG and mortality of patients in middle-late stage group were higher than those in pre-early stage group(P<0.05).Child-Pugh score,MELD score and INR were positively correlated(P<0.001).Binary Logistic regression analysis showed that low FPG and normal FPG were independent risk factors for disease progression in HBV-related ACLF patients(OR=0.174,95%CI:0.066~0.461,P<0.05).Conclusion Low FPG increases the risk of worsening disease progression in patients with HBV-related ACLF,while high FPG may play a role in protecting liver function.

关 键 词：乙型肝炎病毒 慢加急性肝衰竭 空腹血糖 危险因素 保护性 

分 类 号：R575.3[医药卫生—消化系统] R587.1[医药卫生—内科学]