肝硬化患者糖代谢、血清胰岛素及胰高血糖素的变化

目的观察肝硬化患者糖代谢变化,探讨其可能机制与肝储备功能的关系。方法 46例肝硬化患者进行口服糖耐量试验、胰岛素释放试验及胰高血糖素的测定,并与同期住院36例非肝病患者进行比较。结果肝硬化组和对照组空腹血糖均正常,分别为（5.0±2.8）mmol/L和（4.9±1.9）mmol/L（P〉0.05）;餐后2h,肝硬化组血糖为（10.4±5.2）mmol/L,对照组血糖为（7.8±2.2）mmol/L,肝硬化组血糖升高更为明显（P〈0.05）。两组空腹血清胰岛素均正常,分别为（17.2±6.3）Um/L和（10.2±7.0）Um/L（P〉0.05）;餐后2h,肝硬化组胰岛素为（55.9±11.2）Um/L,对照组胰岛素为（35.7±12.2）Um/L,肝硬化组胰岛素升高更为明显（P〈0.05）。肝硬化患者胰高血糖素较对照组明显增高,分别为（256.14±76.1）ng/L和（67.9±26.6）ng/L（P〈0.05）。结论肝硬化患者糖代谢异常,且随肝功损害加重,胰高血糖素增高,提示胰岛素抵抗参与其发生过程。

The changes of glycometabolism,serum insulin and glucagons levels in the patients with hepatocirrhosis

Objective To study the changes of glycometabolism,serum insulin and glucagons levels in hepatocirrhotic patients and to discuss its possible pathogenesis and relationship with the hepatic reserve capacity in hepatocirrhosis.Methods Forty-six hepatocirrhosis and 38 non-liver diseases in-patients as control were selected in this study.The oral glucose tolerance test（OGTT）,serum insulin and glucagon levels were determined.Results The serum fasting glucose levels were normal in hepatocirrhosis（5.0±2.8 mmol/L） and control group（4.9±1.9 mmol/L）.The serum levels of postprandial glucose were increased in both groups.However,the elevated level was significantly higher in hepatocirrhosis group（10.4±5.2 mmol/L） than that in control group（7.8±2.2 mmol/L）.The serum levels of fasting insulin were normal in both groups（17.2±6.3 Um/L and 10.2±7.0 Um/L,respectively）.The serum postprandial insulin increased in the two groups,but increased serum level of postprandial insulin was significantly higher,in hepatocirrhosis group（55.9±11.2 Um/L） than that in control group（35.7±12.2 Um/L）.The serum level of glucagon in patients with hepatocirrhosis（5.1±2.7mmol/L） was significantly higher than that in non-liver diseases group（4.9±1.8 mmol/L）.Conclusion The patients with hepatocirrhosis had abnormal glycometabolism,it increasing with live function deterioration according to Child＇s grade.Insulin resistance may involve abnormal glycometa-bolism in patient with hepatocirrhosis since abnormally high concentration of serum glucagon was found in these patients.