肝硬化患者口服葡萄糖耐量试验的变化

目的　了解口服葡萄糖耐量试验的血糖值与肝硬化患者肝功能状况的关系。方法　 3 8例肝硬化患者按Child Pugh肝功能分级 ,分为A级 ( 10例 )、B级 ( 14例 )和C级 ( 14例 )三组。 11例健康者为对照组。抽取空腹血 2ml后 ,行糖耐量试验 ,以葡萄糖氧化酶法测定血糖浓度。结果　肝硬化各组的基础血糖浓度与对照组比较无显著差异 ,60和12 0分钟血糖浓度均显著高于对照组 (P <0 .0 0 2～ 0 .0 5 ) ,且随着肝硬化严重程度的增加 (即A级→B级→C级 ) ,血糖浓度有增高的趋势。肝硬化各组的血糖12 0 /0 值均显著高于对照组 (P <0 .0 0 1～ 0 .0 0 2 ) ,并随着肝硬化严重程度的增加而增高。 12 0分钟血糖及血糖12 0 /0 值与血清白蛋白浓度呈显著负相关 (P <0 .0 0 1) ,与血清总胆红素浓度、凝血酶原延长时间、R151CG及Child Pugh肝功能评分呈显著正相关 (P <0 .0 0 1～ 0 .0 0 5 )。结论　口服葡萄糖耐量试验的 2小时血糖值及血糖12 0 /0 值与肝硬化患者的肝功能状况密切相关 ,是反映肝硬化患者肝功能状况的良好指标 ,有一定的临床应用价值。     

口服葡萄糖耐量试验

口服葡萄糖耐量试验(OGTT)是空腹抽取静脉血，以测定空腹血糖，然后口服葡萄糖水。糖水由75克葡萄糖溶于250～300毫升水而成，体重轻者或儿童，葡萄糖量可按1．75克／公斤计算。糖水应千5分钟内服完。由开始服糖水计起，于30、60、90、120分钟，分别抽取静脉血测定血糖。     

33例肝硬化患者葡萄糖耐量试验结果分析

３３例肝硬化患者葡萄糖耐量试验结果分析秦玉彩，薄敬华，黄振国（河北医学院第二医院石家庄０５００００）肝硬化患者糖代谢障碍，常表现有葡萄糖耐量试验（糖耐量）减低，部分病人最终发展为糖尿病。由于此类病人无明显多饮、多尿故常不引人注意，只有通过糖耐量才能确...     

口服葡萄糖耐量试验临床应用的争议与共识

随着人们生活方式的改变,2型糖尿病和糖耐量受损(IGT)的发病率日益增加。流行病学资料显示有相当一部分新发的2型糖尿病患者因没有得到及时诊治而导致其并发症的发生[1],同时IGT被认为是糖尿病的独立危险因子,与心血管疾病的发生密切相关[2],早期发现并进行干预可以明显减少糖尿病的发生,因此糖尿病和IGT的早期筛查极为重要。口服葡萄糖耐量试验(OGTT)被WHO推荐为目前筛查糖尿病和IGT的标准方法,但就其在临床实践和流行病学中的地位还存在争议:美国糖尿病学会(ADA)由于其操作不便、重复性差、耗资较大,所以不推荐常规使用;国际糖尿…     

哪些患者不可做口服糖耐量试验

对于那些空腹或餐后血糖高于正常但又达不到诊断标准的病人,医生往往建议他们做口服葡萄糖耐量试验,以尽早发现糖尿病,但某些患者却不可做此检查。     

口服葡萄糖耐量试验对老年2型糖尿病早期诊断的意义

大多老年2型糖尿病(T2DM)患者一般无典型症状或只有乏力、体重下降、视力障碍、神经痛等非特异性症状，由于临床症状不典型不易早期发现，通过口服葡萄糖耐量试验(OGTF)提高老年人T2DM及糖耐量低减(IGT)的早期诊断率，防止空腹血浆葡萄糖(FPG)正常的已患有T2DM或IGT的老年人群漏诊。FPG特别是对老年患者只能是诊断T2DM的晚期指标，对具有肥胖、高血压病、高脂血症或T2DM高危家族史的中老年人，FPG正常仍不能除外DM，对有T2DM高危因素的中老年人做OGTF才有利于早期检出T2DM。     

口服葡萄糖耐量试验不同取血次数对妊娠糖尿病诊断的影响

目的分析OGTT不同取血次数对妊娠糖尿病（GDM）诊断的影响。方法对1506例50g葡萄糖负荷试验（GCT）阳性的孕妇进行3hOGTT,观察各时间点组合的10种诊断方法的灵敏度、漏诊率、总符合率、阴性预测值等指标,并与标准诊断方法相比进行一致性检验。结果1-2-3h法诊断GDM的Kappa值为0．936（P〈0．01）。结论对50gGCT阳性的孕妇行OGTT时,FPG对GDM的诊断影响最小,如需减少取血次数,可考虑取消之。     

空腹血糖未达糖尿病诊断标准患者直接进行口服葡萄糖耐量试验的异常率及安全性

目的探讨既往1年内空腹血糖检查未达糖尿病诊断标准(7 mmol/L)患者直接进行口服葡萄糖耐量试验(OGTT)糖代谢异常发生率及安全性等。方法年龄≥40岁、近1年体检空腹血糖7 mmol/L且无糖尿病症状的患者301例直接进行OGTT,收集患者一般情况及血糖、血脂等。根据OGTT结果分为:血糖正常、糖调节受损组、糖尿病3组。分析糖调节受损、糖尿病发生率,分析3组年龄、血压、血糖、血脂等差异。结果血糖正常比例为47.18%,糖调节受损比例为34.88%,糖尿病比例为17.94%。血糖正常组年龄最小,糖尿病组高血压比例最高,糖调节受损组总胆固醇及低密度脂蛋白显著比血糖正常组高(均P0.05)。空腹血糖、餐后2 h血糖、糖化血红蛋白3组比较:血糖正常组糖尿病前期组糖尿病组(均P0.05)。空腹血糖5.6 mmol/L患者OGTT筛查餐后2 h血糖204例,其中糖耐量异常21.57%,糖尿病6.37%。3组直接行OGTT均未出现糖尿病酮症、糖尿病高渗状态等需紧急降糖处理病例,也未发现恶心、反酸、胃灼痛等消化道症状。结论年龄≥40岁、近1年体检空腹血糖7 mmol/L且无糖尿病三多一少症状的患者直接进行OGTT检查具有很强的必要性及良好的安全性。     

疑似冠心病患者口服葡萄糖耐量试验和血清胰岛素水平检测的临床意义

目的观察无糖尿病病史的首次冠状动脉造影（CAG）人群的糖代谢状况,于不同糖代谢状态下分别比较组间血清胰岛素水平的差异,并探讨其临床意义。方法研究对象共184例,按照美国糖尿病协会（ADA）2003年标准调查其糖代谢状态;分析冠心病组和对照组之间以及0支、单支、多支病变组间血清胰岛素水平及其它指标的差异。结果首次CAG患者中糖代谢异常非常普遍,使用口服葡萄糖耐量试验（OGTT）可发现其中63.6%的患者存在糖代谢异常。对正常糖耐量的患者分析表明,冠心病组2h胰岛素（2hINS）水平明显高于对照组,而空腹胰岛素（FINS）在两组间无明显差异;且2hINS还与病变严重程度相关;Logistic回归表明在多因素存在的条件下,2hINS仍然与冠心病发病相关。对糖调节受损的患者进行分析也有相似的结果。而糖尿病患者中未发现冠心病组和对照组之间血清胰岛素水平的差异。结论疑似冠心病患者应积极推荐OGTT（二点法）,并加测血清胰岛素水平,不但有助于及早发现糖代谢异常,还有助于冠心病的筛查。     

5小时口服葡萄糖耐量试验在诊断餐后低血糖中的应用

目的在有或无疑似餐后低血糖症状的受试者中进行5小时口服葡萄糖耐量试验（5hOGTT）,探讨OGTT特征及其临床应用价值。方法共纳入27例有疑似餐后低血糖症状的受试者和41例无餐后低血糖症状的受试者,均行82．5g葡萄糖的5hOGTT。结果在无餐后低血糖症状的受试者中共筛查出低血糖6例。在有疑似餐后低血糖的受试者中共筛查出低血糖17例,低血糖再现率83％。诊断服糖后低血糖的人群中IGT伴发率达30％。结论与无餐后低血糖症状人群相比,有疑似餐后低血糖人群中服糖后低血糖的发生率高达63％,服糖后低血糖病例的IGT伴发率达29％。对有疑似餐后低血糖病例进行4hOGTT低血糖筛查敏感性达100％。     

血糖正常的高血压患者做葡萄糖耐量试验的临床意义

目的：探讨对空腹血糖正常的高血压患者进行葡萄糖耐量试验（OGTT）的意义。方法：选择既往无糖代谢异常病史，空腹血糖〈5．6mmol／L，确诊原发性高血压的成人患者；行OGTT2h血糖测定，如果OGTT2h血糖≥11．1mmol／L，再次行OGTT以排除糖尿病。同时观察年龄，入院时血压、体重指数、血肌酐、血尿酸、甘油三酯、高密度脂蛋白等参数的改变。结果：本组266例患者中检出糖耐量减低者（OGTT2h血糖≥7．8mmol／L）共98例（36．8％），其中确诊2型糖尿病29例（OGTT2h血糖≥11．1mmol／L），占10．9％。结论：所有空腹血糖正常的高血压患者均应进行OGTT，以发现可能的糖代谢异常，使患者能得到早期干预，更显著地降低心血管事件发生的风险。     

Subclinical abnormal glucose tolerance is a predictor of death in liver cirrhosis

AIM:To determine if subclinical abnormal glucose tolerance(SAGT)has influence on survival of non-diabetic patients with liver cirrhosis.METHODS:In total,100 patients with compensatedliver cirrhosis and normal fasting plasma glucose were included.Fasting plasma insulin(FPI)levels were measured,and oral glucose tolerance test(OGTT)was performed.According to OGTT results two groups of patients were formed:those with normal glucose tolerance(NGT)and those with SAGT.Patients were followed every three months.The mean follow-up was932 d(range of 180-1925).Survival was analyzed by the Kaplan-Meyer method,and predictive factors of death were analyzed using the Cox proportional hazard regression model.RESULTS:Of the included patients,30 showed NGT and70 SAGT.Groups were significantly different only in age,INR,FPI and HOMA2-IR.Patients with SAGT showed lower 5-year cumulated survival than NGT patients(31.7%vs 71.6%,P=0.02).Differences in survival were significant only after 3 years of follow-up.SAGT,Child-Pugh B,and high Child-Pugh and Model for EndStage Liver Disease(MELD)scores were independent predictors of death.The causes of death in 90.3%of cases were due to complications related to liver disease.CONCLUSION:SAGT was associated with lower survival.SAGT,Child-Pugh B,and high Child-Pugh and MELD scores were independent negative predictors of survival.     

Diagnostic value of fasting capillary glucose,fructosamine and glycosylated haemoglobin in detecting diabetes and other glucose tolerance abnormalities compared to oral glucose tolerance test

New diagnostic criteria for diabetes mellitus recommend lowering of the fasting plasma glucose to 7.0 mmol/l. In contrast to recommendations of the American Diabetes Association (AA). WHO recommends using the oral glucose tolerance test (OGTT) in clinical practice. In this study, based on OGTT results and WHO 1998 criteria, we determined if measuring fasting capillary glycaemia (FCG) along with fructosamine and/or glycosylated haemoglobin allows the detection of glucose tolerance abnormalities better than FCG alone. OGTT was performed in 538 patients. Serum fructosamine was determined in 480 of the patients, and glycosylated haemoglobin in 234 of the patients. According to WHO 1998 criteria, the patients were divided into groups due to glucose tolerance abnormalities. Fructosamine correlated stronger with 2-h post-load glucose concentrations than with FCG. HbA1c correlated stronger with FCG than with 2-h post-load glucose. Combined use of fructosamine and FCG predicted 2-h post-load glucose better than combined use of FCG and HbA1c. Receiver operating characteristic curve analyses showed that FCG was the best criterion in discriminating diabetes. Combined use of FCG and fructosamine slightly improved the ability to discriminate glucose tolerance abnormalities from normal glucose tolerance. FCG is the most effective predictor of 2-h post-load glucose and the best criterion for discriminating diabetes and other glucose tolerance abnormalities from normal glucose tolerance. Fructosamine is a potentially useful post-load glycaemia index. OGTT is irreplaceable in identification of patients with high post-load glycaemia. Received: 14 March 2001 / Accepted in revised form: 19 December 2001     

肝硬化合并糖尿病临床、预后和糖代谢指标的观察研究

目的 了解肝硬化合并糖尿病患者的临床特点和转归,探讨肝源性糖尿病(HD)与2型糖尿病(T2DM)患者临床和预后情况的差异.方法 收集2010年11月至2012年4月的肝硬化患者246例,分为肝硬化合并糖尿病组(72例)和肝硬化无糖尿病组(174例),肝硬化合并糖尿病组又分为HD组(33例)和T2DM组(39例).所有病例随访至死亡或研究终点.对患者临床、预后和糖代谢指标进行对比分析.部分肝硬化合并糖尿病组患者行口服葡萄糖耐量试验和胰岛素C肽释放试验.两组间均数的比较采用Student f检验.计数资料或两组间率的比较采用卡方检验.肝硬化死亡相关因素行Logistic回归分析.结果 肝硬化合并糖尿病组中酒精性肝硬化所占比例[18.1％ (13/72)]高于肝硬化无糖尿病组[6.9％(12/174)],差异有统计学意义(x2=6.946,P=0.008).HD组中有糖尿病家族史者所占比例[9.1％(3/33)]低于T2DM组[30.8％(12/39)],酒精性肝硬化者所占比例[30.3％(10/33)]高于T2DM组[7.7％(3/39)],TBil水平[(43.4±57.7)μmol/L]高于T2DM组[(22.6±13.3) μmol/L),总胆固醇水平[(3.3±1.2) mmol/L]低于T2DM组[(4.0±1.6)mmol/L],差异均有统计学意义(x2=5.093、6.177,t=2.178、2.014,P=0.024、0.013、0.033、0.048).肝硬化合并糖尿病组住院时间、Child-Pugh评分、上消化道出血发生率、肝性脑病发生率、电解质紊乱发生率、病死率均高于肝硬化无糖尿病组,差异均有统计学意义(t=2.389、2.270,x2=6.496、5.572、5.194、19.646,P均＜0.05),HD组和T2DM组间则差异均无统计学意义(P均＞0.05).HD组口服葡萄糖耐量试验各时间点(0、30、60、120、180 min)的血糖水平均低于T2DM组,差异均有统计学意义(t=3.175、2.345、3.444、3.090、3.542,P均＜0.05).HD组和T2DM组空腹胰岛素水平接近,其余各时间点(30、60、120、180 min) HD组的胰岛素水平均高于T2DM组,差异均有统计学意义(t=3.084、2.881、3.648、2.840,P均＜0.05),HD组存在明显高胰岛素血症.各时间点(0、30、60、120、180 min) HD组C肽水平均正常,T2DM组C肽水平均低于正常值.Child-Pugh分级C级是肝硬化患者死亡的独立预测因素(OR=3.056,95％ CI:1.268～7.346,P=0.013).结论 与肝硬化无糖尿病患者相比,合并糖尿病患者肝功能更差,并发症发生率和病死率更高;而肝硬化HD与T2DM患者间则无明显差异.     

Improvement in glucose tolerance after one year of follow-up in a Hindu community in Africa

Oral glucose tolerance was studied following a 75 g glucose load in 108 (82.4%) of 131 male and 110 (79.1%) of 139 female members of a Hindu subcommunity aged 15 years and over in Dar es Salaam. One year later, the glucose tolerance tests were repeated in 93 (86.1%) and 93 (84.5%) of the 108 male, and 110 of the female subjects, respectively. In the first survey, 25 (26.9%) of the 93 male and 24 (25.8%) of the 93 female subjects had impaired glucose tolerance (IGT), 6 (6.4%) and 15 (16.1%), respectively, had diabetes mellitus; and 62 (66.7%) and 54 (58.1%), respectively, had normal glucose tolerance. In the repeat survey, of the 93 male and 93 female subjects, 8 (8.6%) and 7 (7.5%) had IGT, 4 (4.3%) and 10 (10.8%) had diabetes; and 81 (87.1%) and 76 (81.7%) were normal, respectively. Of the 21 subjects diagnosed as having diabetes in the first survey, 13 (61.9%) continued to show diabetic glucose tolerance; 4 (19%) IGT and 4 (19%) had normal glucose tolerance with no gender difference. One (1.6%) of the 62 male subjects and none of the 54 females with normal glucose tolerance in the first survey progressed to IGT, while the remainder retained normal glucose tolerance. Diabetes and IGT rates in both surveys were higher for the older than the younger persons. A significant fall in mean fasting and post-75 g blood glucose levels, and in mean systolic and diastolic pressure levels was observed between the first and second surveys in both genders. There was, however, no significant difference in body mass index (BMI), serum total cholesterol and triglyceride levels between surveys, suggesting that major dietary changes had not taken place. Male subjects who showed persistent IGT had significantly lower mean level of body mass index (kg/m²) than subjects who reverted to normal, whilst for the whole group those who had persistent IGT were older. It is tempting to speculate that these changes were due to community action. However, in view of the lack of change in weight and lipids and similar results in other communities in Tanzania when retested at 1 week, further studies are needed to establish the significance of the findings.     

No deterioration of oral glucose tolerance during pregnancy in rural Tanzania.

There is still controversy concerning the reference ranges for glucose tolerance tests in pregnancy. The WHO has recommended the universal use of the 75 g oral glucose load with 2-h post-load values of greater than 6.7 mmol l-1 to be considered impaired glucose tolerance (IGT) in the non-pregnant, and equivalent to gestational diabetes in the pregnant. Some data are available for pregnant Caucasians but little information is available for other ethnic groups. Oral glucose tolerance tests (75 g) have therefore been performed in 189 pregnant women in rural Tanzania. Mean fasting blood glucose values were 4.0 mmol l-1 in non-pregnant women, and 3.7, 3.5, and 3.3 mmol l-1 in pregnant women in the first, second, and third trimesters, respectively. Two-hour OGTT values were 4.7 mmol l-1, and 4.6, 4.5, and 4.2 mmol l-1 while the upper limit of normal values (mean + 2SD) were 7.1 mmol l-1, and 6.8, 6.8, and 6.1 mmol l-1. The 2-h glucose levels are therefore close to WHO recommendations but lower than those reported for Caucasians. By contrast with reports for Caucasians, glucose tolerance did not deteriorate during pregnancy. The prevalence of diabetes and IGT was zero in the pregnant group.     

Glycosylated haemoglobin levels in patients referred for oral glucose tolerance tests

Oral glucose tolerance tests (OGTTs) were performed on 127 patients, and the results interpreted according to the WHO criteria. Glycosylated haemoglobin (GHb), assayed by affinity chromatography, was measured on the fasting blood specimen. All patients classified as diabetic were found to have GHb results greater than 9.9%. There was no overlap with the normal group, all of whom had GHb results less than 8.8%. In the diabetic patients, GHb showed good correlations with both fasting and 2-hour post-glucose blood glucoses. By contrast the non-diabetic group showed only poor correlations between GHb and the fasting and the 2-hour blood glucose concentrations. Overall, the best correlation was found between GHb and the mean of the five blood glucose results obtained during the OGTT.