肝源性糖尿病1例并文献复习  

Hepatogenous diabetes: a case report and literature review

作　　者：宋丽媛 荆菁[1] 马小莉[1] 于民民[1] 赵蕙琛 刘元涛 SONG Liyuan;JING Jing;MA Xiaoli;YU Minmin;ZHAO Huichen;LIU Yuantao(Endocrinology Department of Qingdao Municipal Hospital,Qingdao 266071,China)

机构地区：[1]青岛市市立医院内分泌科,山东青岛266071 [2]山东大学齐鲁医院(青岛)内分泌科

出　　处：《青岛大学学报（医学版）》2024年第2期310-312,共3页Journal of Qingdao University(Medical Sciences)

基　　金：青岛市创新领军人才项目(16-8-3-24-zhc)。

摘　　要：目的探讨肝源性糖尿病的发病机制、诊断及治疗。方法回顾分析1例肝源性糖尿病的病历资料,并复习相关文献。结果病人为中年男性,血糖升高8年,血糖控制不佳2月余。既往有乙型肝炎肝硬化病史20余年。否认糖尿病家族史,有乙型肝炎家族史。临床表现和实验室检查提示存在肝功能损害,血清C肽释放试验提示分泌高峰延迟及高峰值偏低。病人未应用引起糖代谢紊乱的药物,排除其他原因引起的继发性高糖血症。综合上述考虑病人诊断为肝源性糖尿病。病人行糖尿病饮食,应用抗乙肝病毒、利格列汀联合胰岛素强化治疗方案,血糖控制平稳。结论目前肝源性糖尿病的诊断尚无统一标准,需综合病人的病史、临床表现和实验室证据来诊断。肝源性糖尿病主要由胰岛β细胞功能障碍及胰岛素抵抗引起,其治疗应采取以治疗肝脏原发疾病为基础,兼顾饮食、运动、降糖药物使用等多方面的个体化综合治疗。Objective To investigate the pathogenesis,diagnosis,and treatment of hepatogenous diabetes.Methods A retrospective analysis was performed for the medical records of a case of hepatogenous diabetes,and a literature review was performed.Results The middle-aged male patient had elevated blood glucose for 8 years and poor blood glucose control for more than 2 months,with a history of hepatitis B cirrhosis for more than 20 years.He denied the family history of diabetes and had a family history of hepatitis B.Clinical manifestation and laboratory tests showedliver function damage,and the serum C-peptide release test showed delayed peak secretion and a relatively low peak value.The patient did not use drugs causing glucose metabolism disorders,and secondary hyperglycemia caused by other causes was excluded.Therefore,the patient was diagnosed with hepatogenous diabetes and was given diabetic diet and the treatment regimen of anti-hepatitis B virus drugs,linagliptin,and insulin intensive treatment,which helped to achieve stable blood glucose control.ConclusionAt present,there is no unified standard for the diagnosis of hepatogenous diabetes,and diagnosis should be made through a comprehensive analysis of medical history,clinical manifestations,and laboratory evidence.Hepatogenous diabetes is mainly caused by pancreaticβcell dysfunction and insulin resis-tance,and an individualized comprehensive treatment regimen based on the treatment of primary liver diseases should be adopted,with considerations to diet,exercise,and hypoglycemic drugs.

关 键 词：糖尿病 乙型肝炎 肝硬化 病例报告 

分 类 号：R587.1[医药卫生—内分泌]