慢性乙型肝病肝源性糖尿病临床特征分析

目的探讨慢性乙型肝病肝源性糖尿病的临床特征及其可能机制,以提高对该病的诊治水平。方法回顾性分析126例慢性乙型肝病肝源性糖尿病（肝源性糖尿病）患者的临床资料,并与179例（慢性乙型肝病伴发2型糖尿病）患者进行对比分析。结果 126例肝源性糖尿病中107例血清HBV-DNA〉103copies/mL,92例是慢性乙型肝炎肝硬化患者;126例肝源性糖尿病患者与179例慢性乙型肝病伴发2型糖尿病患者相比人体质量指数（BMI）、血清总胆固醇（TC）、三酰甘油（TG）、白蛋白和凝血酶原活动度（PTA）均呈低水平,无慢性乙型肝病伴发2型糖尿病多饮、多食、多尿症状和酮尿酸中毒、心、脑、肾等血管疾病,空腹血糖（6.82±2.42）mmol/L,显著低于慢性乙型肝病伴发型糖尿病（9.50±2.34）mmol/L]（P〈0.01）;空腹和餐后2 h血清胰岛素和C肽水平均明显高于慢性乙型肝病伴发2型糖尿病患者（P〈0.05）。在抗病毒治疗、改善肝功能、抗纤维化基础治疗的基础上,经控制饮食,应用胰岛素联合胰岛素增敏剂可有效控制血糖。结论肝源性糖尿病临床表现主要是肝功能损害的症状,而慢性乙型肝病伴发2型糖尿病的临床表现不典型,以餐后高血糖为特征;HBV感染引起肝脏、胰岛损伤及其引发的胰岛素抵抗可能是肝源性糖尿病重要的发病机制,抗病毒治疗和积极应用胰岛素效果较好。

Analysis of clinical features of chronic liver diseases B with hepatogenous diabetes

Objective To investigate the clinical features and the possible etiology of hepatogenous diabetes.Methods Retrospective analyzed of 126 patients with hepatogenous diabetes and compared with those of chronic liver diseases B with type 2 diabetes mellitus.Results Serum HBV-DNA titer in 107 patients with hepatogenous diabetes was higher than 103 copies/mL.Bady mass index,serum triglyceride,total cholesterol,albumen and prothombin activily level was lower between than hepagetonous diabetes and T2DM.The patients with hepatogenous diabetes showed not play clipsia,Polyphagia,polyuria and retoacidosis,angiopath of heart and brain.The patients with hepatogenous diabetes showed a much lower of fasting plazma glucose (6.82±2.42) mmol/L than that of T2DM (9.50±2.34) mmol/L](P < 0.01).Serum insulin and C-peptia level of fasting and postprandial of patints with hepatogenous diabetes was higher than that T2DM.After the threatment of anti-virus together with the using of insulin and diet control,most patients showed normal or near normal level of blood glucose.Conclusion The hepatogenous diabetes is clinically asymptomatic,and is characterized by higher postprandial plasma glucose.The anti-rirus and insulin treatment together is effective for the patients with hepatogenous diabetes.Insulin resistance cansed chronic hepatic and pancreatic injury with HBV infection may play a key role in the etrology of the hepatogenous diabetes.