慢性丙型肝炎患者的糖代谢异常及其危险因素

目的明确慢性丙型肝炎患者糖代谢异常(空腹血糖升高与Ⅱ型糖尿病)的发生率,探讨其临床特征及相关危险因素。方法用荧光定量聚合酶链反应(fluorogenic quantitative polymerase chain reaction,PCR)法对152例慢性丙型肝炎(chronic hepatitis C,CHC)(其中54例合并丙型肝炎性肝硬化)患者与82例慢性乙型肝炎(chronic hepatitis B,CHB)(其中30例合并乙型肝炎性肝硬化)患者进行血清丙型肝炎病毒(hepatitis Cvirus,HCV)RNA和HCV基因型的检测。将肝硬化患者按child-pugh分级标准分为child A、B、C3组。比较CHC与CHB2组患者Ⅱ型糖尿病发病率的差异,探讨HCV感染易发生糖代谢异常的相关危险因素。结果①CHC患者空腹血糖升高的发生率为24.8%,Ⅱ型糖尿病发病率为19.2%,肝硬化患者合并Ⅱ型糖尿病的发病率为25.9%;childpugh A、B、C3型患者分别为17.4%,29.2%和42.9%。②CHB患者的Ⅱ型糖尿病发生率为9.7%,肝硬化患者占6.7%,childpugh A、B、C3型患者分别为0%,0%和6.7%。③CHC患者Ⅱ型糖尿病发生率高于CHB患者,差异有统计学意义(P<0.01)。④多元回归分析表明,基因1b型、年龄、高血压、肝硬化是慢性丙型肝炎患者合并Ⅱ型糖尿病的危险因素(P<0.01)。结论CHC患者易发生糖代谢异常,是否合并Ⅱ型糖尿病与基因1b型、肝硬化、高血压和年龄相关。

Glycometabolism in Patients with Chronic Hepatitis C and Their Risk Factors

Objective To study the prevalence of abnormal glucose metabolism in patients with chronic hepatitis C and their clinical features and risk factors. Methods We retrospectively analyzed 152 patients with chronic hepatitis C(54 with liver cirrhosis) and 82 with chronic hepatitis B(30 with liver cirrhosis ). Results 1 The prevalence of impaired fasting glucose and diabetes mellitus in patients with chronic hepatitis C was 24.8% and 19.2%, respectively. The occurrence of diabetes mellitus in patients with liver cirrhosis was 25.9%, and in patients with child-pugh A, B and C the occurrence was 17.4%, 29.2%, 42.9%, respectively. 2 The prevalence of diabetes mellitus in patients with chronic hepatitis B was 9.7 %, and in liver cirrhosis(child-pugh C) was 6.7%. 3 The prevalence of type Ⅱ diabetes in patients with CHC was significantly higher than that in patients with CHB(P<0.01). 4 By Logistic regression analysis, risk factors associated with T2MD of CHC patients were genotype 1b, age, hypertensive, liver cirrohosis. Conclusion A considerable proportion of patients with CHC had abnormalities in glucose metabolism and type Ⅱ diabetes, and an increased prevalence of type Ⅱ diabetes was found associated with age, hypertension, genotype 1b and liver cirrhosis.