肝源性糖尿病的临床特点及治疗策略

肝脏是重要的能量物质代谢器官,参与并调节糖、脂肪、蛋白质等的代谢。当肝脏因多种病因导致慢性肝炎、肝硬化,并引起不同程度的肝损害时,易诱发糖代谢紊乱,甚至出现葡萄糖耐量减退或糖尿病,这种继发于慢性肝实质损害的糖尿病称为肝源性糖尿病（hepatogenous diabetes,HD）。不同于2型糖尿病,其发病机制更为复杂,病情更为隐匿,有资料报道,肝硬化并发糖尿病时,糖尿病可加重肝功能损害,使肝硬化进展,肝性脑病、自发性腹膜炎、肝肾综合征等并发症并不少见,因此临床医生应根据肝源性糖尿病的特点及发病机制,及早给予个体化综合治疗,改善和保护肝功能,降低高血糖,缓解症状,最大限度地减轻由糖尿病所致的肝病进展及糖尿病急、慢性并发症的发生,提高患者生存质量、延长生存期。

Clinical features and therapeutic strategies for hepatogenous diabetes

Liver,which plays important role in the metabolism of saccharide,lipid,protein and so on,has long been recognized as an essential energy metabolic organ for human beings.Glucose metabolic disorders or even more,glucose tolerance decreases and diabetes may be induced in patients with variaty of chronic liver demage,espicially with liver cirrhosis.This type of diabetes,which occurring secondary to chronic hepatic parenchymal damage,is named as hepatogenous diabetes(HD).Different from type Ⅱ diabetes mellitus,HD has a much more complex pathogenesis and may be subclinical.Reports said that diabetes will aggravate and intensify liver damage in cirrhosis,which in turn leading to a high morbidity of complications like hepatic encephalopathy,spontaneous bacterial peritonitis and hepatorenal syndromes.Therefore,clinician shall design individualized treatment by improving liver functions,reducing hyperglycemia and relieving the symptoms to control progression of liver disease,acute and chronic complications of HD,which will finally improve patients’ life quality and prolonging their life-time.