肝源性糖尿病的研究现状

肝源性糖尿病(hepatogenous d iabetes)是继发于慢性肝实质损害的糖尿病,1999年在日本糖尿病会议上将其归类为2型糖尿病的一种〔1〕。严重肝病导致的糖耐量异常,是影响患者预后的一个重要因素,除已明确其发病机制为胰岛素抵抗、胰岛素分泌代谢异常、升糖激素增多、乙丙型肝炎病     

肝源性糖尿病的研究进展

肝源性糖尿病是指慢性肝病肝实质损害导致糖耐量减低，部分患者最终发展成糖尿病。多数学者认为约50％～80％慢性肝病患者有糖耐量减退，其中20％～30％最终发展为糖尿病。而正常人群糖尿病发病率仅为0．6％，我国各型肝炎、肝硬化的发病率较高，由慢性肝炎和肝硬化引起的糖耐量减退或糖尿病并不少见，及时诊断和正确治疗异常的糖代谢对于有效治疗各种慢性肝病和改善患者预后均十分重要。     

肝源性糖尿病的临床研究

目的探讨研究观察肝源性糖尿病的临床特征、治疗及预后。方法该文对自2000年4月—2014年7月住院的88例肝源性糖尿病诊断、治疗、预后进行总结分析。结果 82例病人经抗病毒、保肝、对症、营养支持及生活方式管理等;血糖控制理想,死亡6例没有一例因糖尿病而发症死亡。结论肝源性糖尿病以高血糖和葡萄糖耐量减低为特征,经过治疗原发肝病及积极控制血糖可以有效缓解病情。     

肝源性糖尿病发病机制的研究现状

1906年Naunyn等人首先提出肝源性糖尿病,慢性肝病时糖代谢异常多表现为糖耐量减低,部分患者最终发展成糖尿病（MD）,这种继发于肝实质损害发生的MD称肝源性或肝性糖尿病（hepatogenous diabetes or Hepatogenic diabetes简称HD）。慢性肝病（如肝硬化）患者大约80％出现糖耐量异常,20％～30％患者直接发展成MD。其发病机制极其复杂尚未阐明,目前认为外周组织的胰岛素抵抗与肝细胞损伤是HD的主要发生机制,现就近年的研究进展综述如下：     

肝源性糖尿病与肝病合并糖尿病的临床分析

糖尿病和肝病两者常互为因果,并存于同一患者.其中一部分糖尿病是由肝脏疾病引起的,这种继发于慢性肝实质损害的糖尿病称为"肝源性糖尿病";     

肝源性糖尿病诊断治疗探讨

肝源性糖尿病是糖尿病的一种特殊类型，对其诊治应引起重视，本报道31例的诊治体会，以供参考。     

肝源性糖尿病临床研究进展

肝脏是人体内重要的物质与能量代谢器官，对血糖的调节代谢起着十分重要的作用。因此无论哪种肝脏疾病，一旦造成肝细胞广泛损伤，均可能导机体的糖代谢紊乱。出现葡萄糖耐量异常或血糖增高现象，由于该类型糖尿病与原发胰岛病变所致的糖尿病不同，有学者称之为“肝源性糖尿病”（Hepatogenic Diabetes，HD），意指继发于肝脏实质损害的糖尿病。[第一段]     

肝硬化并发肝源性糖尿病58例治疗体会

目的探讨肝硬化患者中肝源性糖尿病发病情况及治疗效果。方法予58例肝源性糖尿病住院患者饮食运动疗法、胰岛素治疗后观察其病情转归。结果采用饮食运动疗法、胰岛素治疗后血糖达理想控制者44例(75.8%),较好控制者9例(15.6%),控制差者5例(8.6%)。结论肝硬化患者中肝源性糖尿病患病率高,经积极综合治疗可取得满意疗效。     

肝源性糖尿病的诊断与治疗

肝源性糖尿病是指继发于肝实质损害的糖尿病,临床表现以高血糖,葡萄糖耐量减低为特征,其发病率与感染的肝炎病毒类型有关.研究表明肝源性糖尿病患者多存在胰岛素抵抗,血清胰岛素样生长因子(IGF-1)降低及生长激素(GH)水平增高.在诊断与治疗方面与2型糖尿病有所不同,要兼顾肝损害和糖尿病两个方面,本文就此方面加以论述.     

恩替卡韦治疗乙型肝炎肝硬化合并肝源性糖尿病的临床观察

目的观察恩替卡韦治疗肝源性糖尿病（HD）的临床疗效。方法回顾性分析72例患者的临床资料,按是否应用恩替卡韦抗病毒治疗分为治疗组和对照组各36例。所有患者均给予糖尿病饮食及综合护肝、对症、支持治疗。治疗组给予恩替卡韦0.5 mg,口服,1次/d,观察52周的治疗效果。检测治疗前后患者血清HBV DNA水平,肝功能（ALT、AST、TBil、Alb）,血糖,糖化血红蛋白等指标。两组间计量资料比较应用t检验,计数资料比较采用χ2检验。结果治疗52周后,治疗组有29例患者（80.56%）出现病毒学应答,26例（72.22%）肝功能恢复和糖尿病控制;对照组有7例患者（19.44%）出现病毒学应答,16例患者（44.44%）肝功能恢复和糖尿病控制。两组病毒学应答率及糖尿病控制率差异有统计学意义（χ2=18.00,P〈0.01;χ2=5.774,P〈0.05）;治疗组肝功能、血糖等指标较治疗前明显好转,差异有统计学意义（P〈0.05）,治疗组患者的糖化血红蛋白、空腹血糖均低于对照组,差异有统计学意义（P〈0.01）。结论恩替卡韦治疗HBV DNA阳性的乙型肝炎肝硬化伴HD,不但能有效抑制病毒DNA复制,促进肝功能恢复,也能有效控制HD。     

Clinical implications of hepatogenous diabetes in liver cirrhosis

BACKGROUND: Hepatogenous diabetes is a common complication of liver cirrhosis. The aim of the present study was to examine the clinical and therapeutic implications and the prognostic significance of hepatogenous diabetes in patients with liver cirrhosis. METHODS: The prospective cohort study was conducted in 52 patients with histologically confirmed liver cirrhosis (44% Child A, 37% Child B, 19% Child C). The examination included a history, determination of basal C-peptide and glycosylated hemoglobin (HbA(1c)) and, in some cases, a 3 h oral glucose tolerance test with 100 g glucose. Patients were also examined for signs of diabetic retinopathy and information on the further course of illness was obtained. RESULTS: Seventy-one percent of patients with liver cirrhosis had manifest diabetes, 25% had impaired glucose tolerance and only 4% had normal glucose tolerance. In most cases, the hepatogenous diabetes was clinically asymptomatic. Sixteen percent of patients with hepatogenous diabetes had a family history of diabetes; only 8% had retinopathic complications. Within 5.6 +/- 4.5 years after diagnosis of liver cirrhosis, 52% of the diabetics had died, mainly of complications of the cirrhosis. There were no diabetes-associated or cardiovascular deaths. CONCLUSIONS: Hepatogenous diabetes differs from type 2 diabetes in that there is less often a positive family history and that the cardiovascular and retinopathic risk is low. The prognosis of cirrhotic patients with diabetes is more likely to be negatively affected by the underlying hepatic disease and its complications than by the diabetes. Antihyperglycemic treatment of hepatogenous diabetes should always be carefully weighed up in each individual case.     

恩替卡韦治疗乙型肝炎肝硬化伴肝源性糖尿病患者对肝纤维化指标的影响

目的观察恩替卡韦治疗肝源性糖尿病对肝纤维化指标的影响。方法选择2008年6月至2013年8月青岛市传染病医院收治的乙型肝炎肝硬化伴肝源性糖尿病患者98例,分为治疗组和对照组各49例,所有患者均给予糖尿病饮食及综合护肝、对症、支持治疗。治疗组给予恩替卡韦0.5 mg,1次/d,口服,52周后观察血清肝纤维化及Fibro Scan检测的肝硬度(LSM)值的差异。计量资料两组间比较采用t检验,计数资料组间比较采用χ2检验。结果治疗52周后治疗组血清肝纤维化的4项指标、层黏连蛋白、Ⅳ型胶原、透明质酸、Ⅲ型前胶原蛋白较对照组差异有统计学意义(t=2.71,P0.01;t=3.53,P0.01;t=2.34,P0.05;t=2.28,P0.05)。两组病毒学应答率和糖尿病控制率差异均有统计学意义(χ2值分别为12.69,7.14,P值均0.01)。LSM值降低显著(t=3.22,P0.01),同时肝功能指标(TBil、ALT、Alb)和空腹血糖等指标较对照组好转,差异有统计学意义(t=5.53,P0.01;t=4.73,P0.01;t=2.42,P0.05;t=16.01,P0.01)。结论恩替卡韦治疗HBV DNA阳性的乙型肝炎肝硬化伴肝源性,能有效降低其血清肝纤维化指标及LSM值,亦能有效改善HBV DNA复制、血糖、肝功能等指标,具有较好的临床效果。     

Pharmacological treatment of diabetes in older people

The pharmacological management of diabetes in older people is complex and challenging. It requires a comprehensive understanding of the individual beyond the diabetes itself. Through the ageing years, the older individual presents with diabetes‐related and non‐related comorbidities and complications, develops functional limitations and psychological issues, and may lack social support and access to care. A disturbance in these categories, known as the four geriatric domains, will negatively affect diabetes self‐management and self‐efficacy, leading to poor outcomes and complications. Furthermore, older people with diabetes may be more interested in the management of other chronic conditions such as pain or impaired mobility, and diabetes may be lower in their list of priorities. Proper education must be provided to the older individual and caregivers, with continuous monitoring and counselling, especially when pharmacological interventions offer risks of side effects, adverse reactions and interactions with other medications. Informed shared medical decisions will help to improve adherence to the regimen; however, such discussions ought to be based on the best evidence available, which is unfortunately limited in this age group. We performed a review focused on pharmacological agents and summarize current evidence on their use for the treatment of diabetes in older people. We encourage clinicians to investigate and incorporate the four geriatrics domains in the selection and monitoring of these agents.     

2型糖尿病患者血清高同型半胱氨酸水平变化与血管病变的关系

目的:探讨2型糖尿病(T2DM)患者血清中同型半胱氨酸(homocysteine,Hcy)的水平与血管并发症的关系及临床意义。方法:将112例T2DM患者依据病情分为2组:无血管并发症组(50例)和T2DM并发血管病变组(62例);以40例健康体检者作为对照组。采用酶联免疫吸附试验法检测血清中Hcy浓度。结果:血清Hcy水平在T2DM并发血管病变组、单纯T2DM组及对照组分别为(36.24±6.78)μmol/L、(22.36±7.45)μmol/L、(10.36±3.58)μmol/L,差异有统计学意义(P<0.05)。结论:高Hcy血症与T2DM血管病变关系密切。     

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。     

The changing world demography of type 2 diabetes

In recent years it has been estimated that the current global prevalence of type 2 diabetes amounts to about 150 million patients. Projections suggest that by the year 2025 the number of prevalent patients in the world will reach approximately 300 million. It is assumed that the increase in the number of patients will be most pronounced in nations currently undergoing socio-economic development including increasing urbanization. The technique used to provide these estimates is based on results from available, contemporary survey results, combined with expected future trends in demographic indicators. We suggest that the currently available methods for the estimation of the future global burden of type 2 diabetes mellitus yield underestimates. Further modifications and validity tests of the modelling techniques are necessary in order to develop a reliable instrument to globally monitor the effects of the struggle against the diabetes problem.     

Safe and effective treatment of diabetes mellitus associated with chronic liver diseases with an alpha-glucosidase inhibitor, acarbose

Glucose intolerance and diabetes mellitus are both prevalent in patients with chronic liver diseases. We examined the efficacy and systemic safety of therapy with an alpha-glucosidase inhibitor, acarbose, in diabetes mellitus associated with chronic liver diseases. Twenty patients with chronic hepatitis or liver cirrhosis and overt diabetes mellitus received acarbose (taken orally) for 8 weeks. The initial dosage of acarbose was 50mg three times daily, taken before meals; this was increased to 100mg three times daily after 2 weeks. The mean fasting plasma glucose level was 173.7±18.6mg/dl (mean±SE) at entry, and was significantly decreased to 132.9±7.5mg/dl (P<0.05) after 8 weeks of acarbose treatment. The improved glycemic control was reflected by a significant decrease in glycosylated hemoglobin (HbA1c) from 7.2±0.3% at entry to 6.3±0.2% (P<0.05) after 8 weeks. Serum levels of both aspartate and alanine aminotransferases fluctuated during acarbose treatment, probably due to the natural course of chronic liver diseases, but the mean values had decreased after 8 weeks of treatment. Plasma ammonia levels increased, from 61.3±10.7μg/dl to 71.1±9.6μg/dl after 8 weeks of acarbose treatment but the increase was not significant. Clinically significant elevation of plasma ammonia concentration was seen in 2 cirrhotic patients (121 and 124μg/dl); this was asymptomatic and gradually returned to the normal range despite continuous acarbose treatment in one patient, and was reversed after the withdrawal of acarbose with the concomitant administration of lactulose in the other patient. No other blood tests results, including albumin, cholinesterase, and prothrombin time, or lipid profile and nutritional status, in terms of rapid turnover proteins, prealbumin, retinol binding protein, and transferrin, were altered throughout the study period. These results indicate that diabetes mellitus associated with chronic liver diseases may be safely and effectively treated with acarbose. However, clinicians must be aware of the possibility of hyperammonemia when they prescribe acarbose for patients with diabetes mellitus and advanced liver cirrhosis.     

肝源性糖尿病临床特征分析

目的 探讨肝源性糖尿病的临床特征及其可能机制,以提高对该病的认识和诊治水平。方法回顾性分析102例肝源性糖尿病患者,并与原发性2型糖尿病进行对比分析。结果102例肝源性糖尿病患者中17％有口干、多饮、多食、多尿等典型糖尿病症状;空腹血糖为（7.8±2．6）mmol／L,餐后2h血糖（12．7±3．0）mmol／L;口服葡萄糖耐量试验（OGTT）显示,肝源性糖尿病患者的空腹血糖水平显著低于原发性2型糖尿病（P〈0．01）,余各时段血糖两组差异无统计学意义;胰岛素＋C肽释放试验显示,两组胰岛素分泌均呈高峰延迟型,但肝源性糖尿病患者各时段胰岛素及C肽分泌水平均高于原发性2型糖尿病（P〈0．05）。经饮食控制、应用胰岛素或口服降糖药治疗后血糖大多能控制在正常或接近正常水平。102例肝源性糖尿病患者中仅5例伴糖尿病并发症,4例死亡病例死因均为慢性肝病并发症。结论肝源性糖尿病临床症状不典型,以餐后高血糖为特征,应用胰岛素治疗效果较好,短期不良预后主要与原发慢性肝病有关。胰岛素抵抗可能是其重要的发病机制。