肝性糖尿病临床特点浅析

目的 探讨肝硬化并发肝性糖尿病患者的临床特点、治疗及预后。方法 回顾性研究42例肝硬化患者，详细记录病史并随访，实验室检查评价肝功能、血糖和糖尿病并发症。比较肝功能损害程度与血糖的关系。结果 肝硬化患者中有32％有糖尿病表现，12％有糖耐量异常，56％糖耐量正常，大部分无临床症状。肝性糖尿病患者中1例（9％）有糖尿病家族史，1例并发糖尿病视网膜病变。肝功能C级患者的血糖比B级明显升高，其中白蛋白水平差异更显著（P〈0.05）。在诊断肝硬化5年内，23％肝性糖尿病患者因肝硬化并发症而死亡。结论 肝性糖尿病临床表现不典型，其降糖治疗应根据患者具体情况而定，发生心血管和视网膜病变的危险性较低，预后受肝病并发症影响更大。

Clinical implications of hepatogenous diabetes in liver cirrhosis

Objective] The aim of the present study was to examine the clinical and therapeutic complications and the prognostic significance of hepatogenous diabetes in patients with liver cirrhosis. Methods] 42 patients with liver cirrhosis were examined of history and laboratory tests. Compared the relationship between hepatic function and blood glucose. Results] 42% of patients with liver cirrhosis had manifest diabetes, 12% had impaired glucose tolerance and 56% had normal glucose tolerance. In most cases, the hepatogenous diabetes was clinically asymptomatic. 9% of patients with hepatogenous diabetes had a family history of diabetes; only one had retinopathic complications. Within five years after diagnosis of liver cirrhosis, 23% of the diabetics had died, mainly of complications of the cirrhosis. Conclusions] Antihyperglycemic treatment should always be carefully weighed up in each individual case. 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.