肝硬化患者胰岛素抵抗与血栓调节蛋白水平的关系

目的探讨肝硬化患者胰岛素抵抗（IR）与血栓调节蛋白（TM）水平的关系。方法选择111例肝硬化患者,其中肝功能Child-Pugh分级A级21例,B级47例,C级43例。检测其血清空腹胰岛素（FINS）、血糖（FPG）和TM,并计算胰岛素敏感性指数（ISI）。结果与Child-Pugh分级A、B级肝硬化患者比较,C级患者的血清FINS、TM明显升高,ISI明显降低（P均〈0.01）。肝硬化患者的Child-Pugh分级与FINS、TM水平呈正相关（r分别为0.523、0.372,P均〈0.01）,与ISI呈负相关（r=-0.536,P〈0.01）;TM水平与FINS呈正相关（r=0.298,P〈0.01）,与ISI呈负相关（r=-0.272,P〈0.01）。结论肝硬化患者存在高胰岛素血症、IR及TM升高,其血清FINS、ISI、TM均与Child-Pugh分级相关;检测以上指标有助于判断患者的肝功能损害程度。

Relationship between the insulin resistance and thrombomodulin in liver cirrhosis patients

Objective To investigate the relationship between the insulin resistance and thrombomodulin（TM） in liver cirrhosis patients.Methods According to Child-Pugh classification,111 patients with liver cirrhosis were divided into Child-Pugh class A（21 cases）,Child-Pugh class B（47 cases） and class C（43 cases）.Fasting insulin（FINS）,fasting plasma glucose（FPG） and TM levels were detected,and insulin sensitivity index（ISI） were calculated.Results FINS and TM levels in Child-Pugh class C were higher significantly than those in Child-Pugh class A and B,the ISI were lower.There were significant positive correlation among Child-Pugh class,FINS level;TM level（r=0.523,0.372,P0.01）,and negatively correlated with ISI（r=-0.536,P0.01）,TM level was positively correlated with FINS（r=0.298,P0.01）,and negtively correlated with ISI（r=-0.272,P0.01）.Conclusions Liver cirrhosis patients have hyperinsulinemia,insulin resistance and high TM level,and the changes of FINS,ISI and TM are relative to Child-Pugh classication and may show the degree of liver function disorder.