肝硬化并发肝源性糖尿病68例临床分析

目的探讨肝硬化合并肝源性糖尿病临床特点。方法对肝源性糖尿病68例患者临床表现特点、糖尿病病情与肝功能分级的关系、胰岛素抵抗与肝功能分级的关系、治疗方法进行回顾性分析。结果肝源性糖尿病发生率高达37％，糖尿病的病情与肝功能分级之间有一定关系（P〈0．01），血清胰岛素水平显著增高，胰岛素敏感性指数（ISI）下降，予胰岛素治疗，血糖控制良好。结论肝源性糖尿病是肝硬化常见的并发症，症状多不典型，糖尿病轻重与肝损害程度有关，首选胰岛素治疗。     

肝硬化并发肝源性糖尿病41例临床分析

目的探讨肝硬化并发肝源性糖尿病的临床特点及治疗方法。方法对41例肝硬化并发肝源性糖尿病患者的临床特点、治疗方法及预后进行回顾性分析。结果肝硬化并发肝源性糖尿病以肝硬化的症状为主,很少出现糖尿病症状,血糖以餐后血糖升高为著。治疗上经控制饮食、保肝治疗后血糖好转,必要时胰岛素治疗。结论肝硬化并发肝源性糖尿病,临床表现不典型,以餐后高血糖为特征,肝源性糖尿病的治疗需要采取综合治疗措施,但应及早使用胰岛素,大部分患者的血糖随肝功能的改善而改善。     

肝硬化伴肝源性糖尿病临床分析

目的分析肝硬化伴肝源性糖尿病的临床特征。方法回顾性分析45例肝硬化伴肝源性糖尿病患者的临床资料。结果 45例患者中,乙型肝炎肝硬化31例（68.9%）;空腹血糖7.3±2.9mmol/L,餐后2h血糖16.2±4.7mmol/L,空腹血糖水平与Child-Pugh分级呈正相关（Spearman等级相关系数rs=0.48,P〈0.01）;通过饮食控制、口服α葡萄糖苷酶抑制剂或皮下注射胰岛素,大部分患者血糖控制在正常水平或接近正常水平;7例死亡病例均死于肝硬化并发症。结论肝硬化伴肝源性糖尿病患者的糖尿病症状多不典型,以餐后高血糖为特征,血糖水平与肝功能的损害程度密切相关,应用胰岛素治疗效果较好,不良预后主要与肝硬化相关。     

肝源性糖尿病125例临床分析

探讨肝源性糖尿病的临床特征,实验室检查,治疗方法,以提高诊治水平.回顾性分析125例肝源性糖尿病病例.临床表现以肝病症状为主,糖尿病症状少见;丙型肝炎肝硬化较乙型肝炎肝硬化,酒精性肝病糖尿病发生率高;血糖以餐后高血糖为著,血糖程度与肝功能损害程度呈正相关;治疗上控制饮食、保肝治疗后血糖好转,必要时胰岛素治疗.肝源性糖尿病以餐后高血糖为特征;血糖随肝功能好转可恢复.     

肝源性糖尿病胰岛素代谢异常的临床分析

目的探讨肝源性糖尿病胰岛素代谢的临床特点及可能机制。方法对31例肝源性糖尿病与2型糖尿病患者均行OGTY试验,均检测血糖、胰岛素、C肽水平,并计算胰岛素敏感指数、胰岛素抵抗指数。结果肝源性糖尿病患者胰岛素敏感性高于2型糖尿病患者（P〈0．05）,胰岛素抵抗指数低于2型糖尿病患者（P〈0．05）。结论肝源性糖尿病患者血糖水平与肝功能受损程度有一定关系,需降糖治疗时,应首先采用胰岛素治疗。     

肝硬化和肝源性糖尿病临床关系分析

目的探讨肝硬化和肝源性糖尿病的临床关系。方法选取2016年度该院收治的45例肝硬化合并糖尿病患者作为研究组,同时选取同期收治的45例肝硬化未合并糖尿病患者作为对照组,并比较不同组患者肝功能分级、临床表现和并发症。结果研究组患者出现多饮多食多尿的现象明显高于对照组(P0.05),研究组患者恶心呕吐、黑便、腹水、腹胀、脾肿大和乏力等现象与对照组患者比较差异无统计学意义(P0.05);研究组患者肝功能A级明显低于对照组(P0.05),肝功能B级患者者明显高于对照组(P0.05),但肝功能C级两者差异无统计学意义(P0.05);研究组患者自发性腹膜炎、肝肾综合征和肝性脑病发生率均明显高于对照组(P0.05)。结论肝源性糖尿病与肝硬化疾病具有密切相关性,肝硬化合并肝源性糖尿病患者其临床症状表现多样且复杂,临床上需对原发疾病进行积极治疗,同时严格控制血糖水平。     

肝功能损害与肝源性糖尿病的关系

目的探讨肝硬化肝功能损害程度与肝源性糖尿病的关系及其发生机制及治疗特点。方法根据肝功能Child分级及有无并发症进行分组测血糖．了解肝功能的受损程度与血糖的关系。结果肝功能处于ChildC级者平均血糖明显高于ChildA级、ChildB级者：肝硬化发生并发症者血糖水平明显高于无并发症者。结论肝硬化患者易发生糖代谢紊乱，发生机制可能与胰岛素抵抗有关，血糖水平与肝功能受损程度呈平行关系，对于合并严重肝功能异常且血糖升高明显者，宜加用胰岛素治疗。     

乙型肝炎肝硬化合并肝源性糖尿病的治疗

目的 探讨肝源性糖尿病与乙型肝炎肝硬化的关系及治疗。方法 186例肝硬化患者根据临床表现、肝功能检测、病毒学标志物、B超、空腹及餐后2小时血糖、糖耐量试验，33例存在糖耐量减低，48例诊断为肝源性糖尿病，在保肝、抗病毒、退黄等综合治疗的同时给予控制饮食、皮下注射胰岛素治疗。结果 48例糖尿病患者中，血糖得到良好控制35例，控制不良8例，病情恶化合并消化道出血死亡2例，合并肝性脑病死亡2例，合并肝肾综合征死亡1例。结论肝源性糖尿病临床表现不典型者多见，乙型肝炎肝硬化患者应定期复查血糖，肝源性糖尿病治疗重点在于积极抗病毒，治疗原发病，改善肝功能，对于合并糖尿病肝功能破坏严重者，应及早给予胰岛素治疗。     

肝硬化合并肝源性糖尿病49例临床分析

目的探讨肝硬化合并肝源性糖尿病的临床特点、发病机制及诊治方法。方法回顾性分析符合诊断标准的49例肝硬化合并肝源性糖尿病患者的临床资料,主要包括临床特点、诊治方法及预后等。结果 49例患者以肝病症状为主,包括乏力、食欲减退、腹胀等,合并有糖尿病并发症者较少;治疗上以休息、饮食控制、营养支持、抗病毒、保肝及预防并发症等对症支持治疗为主,同时酌情给予口服降糖药或胰岛素进行降血糖治疗;本组49例患者经积极治疗后35例(占71.4%)肝功能逐渐好转、症状得到明显改善、血糖水平得到有效控制,自动出院5例(占10.2%),转上级医院治疗4例(占8.2%),死亡5例(占10.2%),死因为上消化道出血者2例、多脏器功能衰竭者2例、肝性脑病1例。结论肝硬化合并肝源性糖尿病患者临床表现不典型,确诊后应采取综合治疗方法进行干预,多数患者经治疗后肝功能、血糖水平均能获得明显改善。     

肝源性糖尿病临床特征及治疗

目的研究探讨肝源性糖尿病临床特征及治疗方法。方法对58例肝源性糖尿病患者的临床表现、肝功能及血糖检测结果进行探讨分析(实验组),并从同期患者中随机抽取58例原发性2型糖尿病患者作为对照组。两组患者均实施了胰岛素、C肽释放及OGTT测定。结果所有肝源性糖尿病患者均出现了不同程度的腹胀、乏力、纳差等典型的肝病特征,但只有4例出现"三多一少"等糖尿病典型症状。肝源性糖尿病患者空腹血糖含量的平均值为(6.9±2.5)mmol/L,饮食后2 h血糖含量的平均值为(12.9±2.7)mmol/L。OGTT结果的比较表明肝源性糖尿病患者在空腹时血糖水平比原发性2型糖尿病低,且两组间差异具有统计学意义(P0.05),但用餐后1、2、3 h两组患者血糖水平无显著性差异。胰岛素释放结果及C肽释放水平的比较表明,肝源性糖尿病患者在任何时间段均比对照组高,且两组间差异具有统计学意义(P0.05)。结论肝源性糖尿病的临床症状表现不典型,主要特征为饮食后高血糖,治疗该病的首选药物为胰岛素。     

Hospital Cirrhosis Volume and Readmission in Patients with Cirrhosis in California

Background

Patients with cirrhosis are at high readmission risk. Using a large statewide database, we evaluated the effect of hospital cirrhosis-related patient volume on 30-day readmissions in patients with cirrhosis.

Methods

We conducted a retrospective study of the Healthcare Cost and Utilization Project State Inpatient Database for adult patients with cirrhosis, as defined by International Classification of Diseases, Ninth Revision (ICD-9) codes, hospitalized in California between 2009 and 2011. Multivariable logistic regression analysis was performed to evaluate the effect of hospital volume on 30-day readmissions.

Results

A total of 69,612 patients with cirrhosis were identified in 405 hospitals; 24,062 patients were discharged from the top 10% of hospitals (N = 41) by cirrhosis volume, and 45,550 patients in the bottom 90% (N = 364). Compared with higher-volume centers, lower-volume hospitals cared for patients with similar average Quan–Charlson–Deyo (QCD) comorbidity scores (6.54 vs. 6.68), similar proportion of hepatitis B and fatty liver disease, lower proportion of hepatitis C (34.8 vs. 41.5%) but greater proportion of alcoholic liver disease (53.1 vs. 47.4%). Multivariable logistic regression analysis demonstrated admission to a lower-volume hospital did not predict 30-day readmission (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.92–1.01) after adjusting for sociodemographics, QCD score, cirrhosis severity, and hospital characteristics. Instead, liver transplant center status significantly decreased the risk of readmission (OR 0.87, 95% CI 0.80–0.94). Ascites, hepatic encephalopathy, hepatocellular carcinoma, higher QCD, and presence of alcoholic liver disease and hepatitis C were also independent predictors.

Conclusions

Readmissions within 30 days were common among patients with cirrhosis hospitalized in California. While hospital cirrhosis volume did not predict 30-day readmissions, liver transplant center status was protective of readmissions. Medically complicated patients with cirrhosis at hospitals without liver transplant centers may benefit from additional support to prevent readmission.

     

Anti-HCV-Positive Cirrhosis Associated with Schistosomiasis

Hepatosplenic schistosomiasis is occasionally associated with cirrhosis and progressive hepatic decompensation. The aim of the present study was to determine the prevalence of antibody to hepatitis C virus in patients with schistosomiasis and cirrhosis. The prevalence of anti-HCV was studied in 12 consecutive cases of schistosomiasis associated with biopsy proven cirrhosis. All patients had a past history of schistosomiasis and high liters of schistosomal antibodies in serum (1:32 to 1:4096). Five of the 12 patients had hepatic catheterization and were found to have sinusoidal involvement with corrected sinusoidal pressures ranging from 19 to 23 mm Hg. Four had ascites, six had pedal edema, and eight had peripheral signs of chronic liver disease in the form of palmar erythema, spider nevi, and/or gynecomastia. Ten of the 12 cases (83%) were repeatedly positive for anti-HCV/ELISA. These results suggest that when patients with schistosomiasis develop cirrhosis, associated hepatitis C virus infection should be suspected.     

Cirrhosis in children with celiac disease

BACKGROUND: Liver involvement represents an extra-intestinal feature of celiac disease (CD) and shows a clinical spectrum varying from nonspecific reactive hepatitis to cirrhosis. Here we report the association of cirrhosis with CD in 5 children. PATIENTS AND METHODS: The mean age of the patients was 9.4 +/- 2.8 years. Viral, metabolic, and autoimmune etiology of liver disease was ruled out. Intestinal and liver biopsies were performed to confirm the histologic diagnosis in all subjects. RESULTS: Three of the patients had chronic diarrhea and hepatosplenomegaly in whom diagnoses of CD and cirrhosis were established at presentation simultaneously. In the other 2 patients, CD was diagnosed following an initial diagnosis of cirrhosis. At diagnosis, alanine aminotransferase (range, 64-271 IU/L) and aspartate aminotransferase (range, 90-225 IU/L) values were elevated. After 1 to 5 years of a gluten-free diet (GFD), normalization of serum aminotransferase levels and clinical improvement were observed in 3 patients with strict GFD. The other 2 patients without improvement of the liver disease had poor dietary compliance. CONCLUSION: CD may be associated with severe hepatic damage in children and strict GFD may have beneficial effect on the course of liver disease. Serologic screening of CD should be included in differential diagnosis of chronic liver disease of unknown origin.     

Ethical Issues in Patients with Cirrhosis

Purpose of Review

To briefly summarize topical ethical issues in patients with cirrhosis.

Recent Findings

The “four quadrants” framework is ideally suited to address ethical issues in patients with cirrhosis. The presence of hepatic encephalopathy complicates any ethical analysis and stresses the importance of advanced directives and end of life planning, both of which appear to be poorly applied. Organ allocation in liver transplantation (LT) based on survival benefit, a “not unreasonable standard” to assess live donor LT (LDLT) in patients removed from the wait list, LT in patients with acute alcoholic hepatitis, and LT in undocumented immigrants are supported by sound ethical principles.

Summary

Significant ethical issues remain challenging and unresolved for patients with cirrhosis. Further research must be done to assess how frequently ethical problems occur in individual patients. Clear, detailed policies, based on strong ethical platforms, must be developed to further address these significant ethical challenges.

     

肝硬化患者胆结石的发病率

本文回顾性总结近10年来住院肝硬化患者526例与非肝硬化者405例胆结石的发病情况,结果表明肝硬化组与非肝硬化组胆结石的发病率分别为11.22％和3.95％。两组比较差异显著(P<0.01)。其中胆色素结石占61.9％。其原因可能与肝脏对胆红素代谢异常和慢性溶血有关。肝硬化患者伴有黄疸为62.5％,但仅有25.4％的患者发现肝内外胆管结石。提示黄疸常常由于肝细胞损害所致。肝硬化伴胆结石无症状占66％,可能与胆囊结石发生率高有关。     

Ulcerative Colitis Associated with Primary Biliary Cirrhosis

Primary biliary cirrhosis and ulcerative colitisare two diseases with many features of autoimmunity.Thirteen cases of coexistence of the two diseases havebeen reported in the literature so far. Patients are usually younger and more often males thanthe ordinary primary biliary cirrhosis patient, whilethe colitis is mild and easily controllable. In ahomogeneous population of 550,000 inhabitants of the island of Crete, 412 cases of ulcerativecolitis and 82 individuals with primary biliarycirrhosis or autoimmune cholangitis have beenidentified. In two cases, coexistence of the twodiseases was found. Immunological screening for AMA positivity in150 ulcerative colitis sera disclosed no further cases.Prevalence of primary biliary cirrhosis in ulcerativecolitis patients seems at least 30 times higher than in the general population in our area. Apossible immunological link between the two diseases isdiscussed.