酒精性肝硬化与乙型肝炎肝硬化并发糖代谢异常男性患者的临床特征对比分析

发布时间：2018-06-26 20:16

本文选题：肝硬化 + 肝硬化　；参考：《临床肝胆病杂志》2016年02期

【摘要】：目的探讨并发糖代谢异常的男性酒精性肝硬化(ALC)与乙型肝炎肝硬化(HBC)患者的临床特征。方法收集2008年1月-2013年9月于广州市番禺区中心医院住院的肝硬化患者287例,包含ALC患者74例,均为男性,其中并发糖代谢异常者54例;HBC患者213例,其中并发糖代谢异常者97例(男69例、女28例)。对并发糖代谢异常的ALC和HBC患者的临床资料进行分组对照研究,探讨患者临床表现和实验室检查指标、胰岛素抵抗指数、糖代谢异常发生率及其与Child-Pugh分级的关系。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,采用Spearman进行等级相关分析。结果 ALC男性患者糖代谢异常发生率(73.0%vs 32.4%)、肝源性糖尿病发生率(35.1%vs 14.6%)、空腹低血糖发生率(27.0%vs 10.3%)和糖耐量异常发生率(31.1%vs 14.1%)均高于HBC患者(χ2值分别为4.371、3.274、4.784、1.633,P值均0.05);Spearman相关性分析显示,ALC和HBC男性患者糖代谢异常发生率与Child-Pugh分级呈正相关(rs=0.41,P0.05);并发糖代谢异常的ALC患者,Child-Pugh A级所占比例高于并发糖代谢异常的HBC患者;Child-Pugh C级所占比例低于并发糖代谢异常的HBC患者,差异均有统计学意义(χ2值分别为7.520、6.542,P值分别为0.001、0.003);并发糖代谢异常的ALC和HBC男性患者的面色晦暗、面部毛细血管扩张、蜘蛛痣、肝大、肝肾综合征、营养不良、腹水、黄疸、肝性脑病、自发性细菌性腹膜炎和上消化道出血的发生率比较差异均有统计学意义(χ2值分别为3.785、2.651、1.974、3.316、3.771、5.843、7.251、5.214、4.726、2.966、6.312,P值均0.05);与并发糖代谢异常的男性HBC患者相比,并发糖代谢异常的男性ALC患者的AST、TBil、平均红细胞体积、GGT较高,白蛋白较低,差异均有统计学意义(t值分别为2.378、2.587、2.633、2.681、2.210,P值均0.05);并发糖代谢异常的ALC和HBC男性患者的空腹血糖水平、餐后2 h胰岛素水平和胰岛素抵抗指数比较差异均有统计学意义(t值分别为2.378、1.976、1.991,P值均0.05)。结论男性ALC和HBC患者糖代谢异常发生率随肝功能恶化逐步升高,但二者均多以其各自病因肝硬化特征为主要表现,糖代谢异常表现不明显。对这两种不同病因肝硬化男性患者应及时进行相关检查,以明确是否存在糖代谢异常。
[Abstract]:Objective to investigate the clinical features of alcoholic cirrhosis (ALC) and hepatitis B cirrhosis (HBC) complicated with abnormal glucose metabolism. Methods from January 2008 to September 2013, 287 patients with liver cirrhosis, including 74 patients with ALC, were collected from Panyu District Central Hospital of Guangzhou, including 213 patients with HBC complicated with abnormal glucose metabolism. Among them, 97 cases were complicated with abnormal glucose metabolism (69 males and 28 females). The clinical data of ALC and HBC patients with abnormal glucose metabolism were divided into two groups. The clinical manifestations, laboratory parameters, insulin resistance index, the incidence of abnormal glucose metabolism and their relationship with Child-Pugh grade were investigated. T test was used for comparison of measurement data, 蠂 2 test was used for comparison of counting data, and Spearman was used for rank correlation analysis. Results the incidence of abnormal glucose metabolism (73.0%vs 32. 4%), hepatic diabetes mellitus (35.1%vs 14. 6%), fasting hypoglycemia (27.0%vs 10. 3%) and impaired glucose tolerance (31.1%vs 14. 1%) in male patients were higher than those in patients with 73.0%vs (蠂 2 = 4. 371 卤3. 274). The results showed that the incidence of abnormal glucose metabolism in ALC and HBC male patients was positively correlated with Child-Pugh grade (Rs0.41), and the proportion of ALC patients with abnormal glucose metabolism was higher than that of HBC patients with abnormal glucose metabolism. The patient with abnormal HBC, The difference was statistically significant (蠂 ~ 2 = 7.520 ~ 6.542P = 0.001 / 0.003, respectively), the color of ALC and HBC male patients with abnormal glucose metabolism was dark, facial capillary dilatation, spider nevus, hepatomegaly, hepatorenal syndrome, malnutrition, ascites, jaundice. There were significant differences in the incidence of hepatic encephalopathy, spontaneous bacterial peritonitis and upper gastrointestinal hemorrhage (蠂 ~ 2 = 3.785U 2.651U 1.974 ~ 3.316U 3.771n 5.8437.251 ~ 5.2144.7262.966U 6.312P 0.05), compared with those of male HBC patients with abnormal glucose metabolism. The mean RBC GGT was higher and albumin was lower in male ALC patients with abnormal glucose metabolism (t = 2.378U 2.587U 2.633N 2.681U 2.210g P = 0.05), and the fasting blood glucose level in ALC and HBC patients with abnormal glucose metabolism was 0.05. There were significant differences in insulin level and insulin resistance index between 2 hours after meal (t = 2.3781.976 卤1.991g, P = 0.05). Conclusion the incidence of abnormal glucose metabolism in male patients with ALC and HBC increased gradually with the deterioration of liver function, but most of them were mainly characterized by their respective etiological characteristics, but the abnormal glucose metabolism was not obvious. Patients with cirrhosis of these two different etiologies should be examined in time to determine whether there is abnormal glucose metabolism.
【作者单位】：广州市番禺区中心医院消化内科;
【分类号】：R575.2;R512.62

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