内镜下食管静脉曲张套扎术对乙肝肝硬化患者短期血糖的影响

发布时间：2018-08-18 12:40

【摘要】：背景肝脏是人体内葡萄糖代谢的重要器官，它的各种病理改变均能影响其对糖类物质的代谢，甚至出现糖耐量异常及糖尿病。有研究发现，约有80%的慢性肝病患者存在糖耐量异常，其中约35%最终发展为糖尿病，而正常人群糖尿病发病率仅为10%左右。肝硬化则是各种慢性肝脏疾病病发展的晚期阶段，主要表现包括肝功能减退及门静脉高压，门静脉高压表现有脾大、腹水的形成及食管胃底静脉曲张。而食管静脉曲张极易发生破裂导致上消化道大出血，是肝硬化门脉高压后最严重的并发症，病死率高，约达30%左右，是造成肝硬化患者死亡的首要原因。及时有效的胃镜下食管静脉曲张套扎术治疗，能够有效提高疾病检出率，大大减少患者出血的风险。但有报告指出，经胃镜下食管静脉曲张套扎治疗后，会引起门静脉压力增高，那么，其对血糖，尤其是短期血糖是否造成影响，鲜有文献报道。本文通过前瞻性设计研究，分析北京军区总医院全军肝病治疗中心肝硬化患者胃镜食管静脉曲张套扎治疗前后肝功能的变化，并追踪观察其治疗后的短期连续血糖，了解其变化趋势，以期为肝硬化患者尤其是伴糖代谢异常患者的临床诊治提供参考。目的观察胃镜下食管静脉曲张套扎治疗对乙肝肝硬化患者短期血糖的影响。方法选取2013年7月至2013年11月间，因肝硬化于我院住院治疗的患者作为本次的研究对象，均接受食管静脉曲张套扎治疗，共计60例。按照口服葡萄糖耐量试验(Oral glucosetolerance test，OGTT)分为糖代谢正常组和异常组。检测糖化血红蛋白(Glycosylated hemoglobin，HbA1c)，，术前1天、术后1天肝功能值。检测行内镜下食管曲张静脉套扎术(Endoscopic variceal ligation，EVL)后0h、1h、2h、3h指血糖值（空腹状态）。结果 (1)肝硬化患者是否发生糖代谢异常与年龄、性别、有无腹水等均无明显关系。 (2)糖代谢正常组中，丙氨酸氨基转移酶(Alanine aminotransferase，ALT)、总胆红素(Total bilirubin，TBIL)、直接胆红素(Direct bilirubin，DBIL)存在显著性差异(P0.05)。糖代谢异常组中，血清白蛋白(Albumin，ALB)、DBIL较治疗前存在显著性差异(P0.05)。 (3)糖代谢正常组治疗后各时间点较治疗后0h无明显显著性差异(P0.05)。糖代谢异常组1h、2h血糖与治疗后0h存在显著性差异(P0.05)。结论 (1)肝硬化患者糖代谢异常发生率高，但检出率低。目前除空腹血浆葡萄糖(Fastingplasma glucose，FPG)、HbA1c外，OGTT试验应作为诊断肝硬化患者是否存在糖代谢异常的常规检查项目。 (2)胃镜下食管静脉曲张套扎治疗可能对肝硬化患者肝功能造成应激性损害，加强术前术后保肝治疗，可减少因治疗带来的肝脏二次损伤。 (3)胃镜下食管静脉曲张套扎治疗对肝硬化伴糖代谢异常患者的术后短期血糖变化有一定影响，及时监测短期连续血糖变化，特别是肝硬化合并糖代谢异常者治疗后2小时内血糖易发生明显变化，合理监控调节血糖，有助于减少治疗风险。
[Abstract]:background
Liver is an important organ of glucose metabolism in human body. Its various pathological changes can affect its metabolism of carbohydrates, even abnormal glucose tolerance and diabetes mellitus. Cirrhosis is the late stage of the development of various chronic liver diseases, mainly manifested as hypofunction of the liver and portal hypertension, portal hypertension with splenomegaly, ascites and esophagogastric varices. Serious complications, high mortality, about 30%, are the leading causes of death in patients with cirrhosis. Effective and timely endoscopic variceal ligation can effectively improve the detection rate of disease, greatly reducing the risk of bleeding. But some reports have pointed out that gastroscopic variceal ligation can cause portal stillness. In this paper, we analyzed the changes of liver function in patients with liver cirrhosis before and after gastroscopic esophageal variceal ligation in the PLA Liver Disease Treatment Center of Beijing Military Region General Hospital by prospective design study, and followed up the changes of liver function after treatment. To understand the change trend of blood glucose, so as to provide reference for the diagnosis and treatment of patients with cirrhosis, especially those with abnormal glucose metabolism.
objective
Objective To observe the effect of endoscopic variceal ligation on short-term blood sugar in patients with hepatitis B cirrhosis.
Method
From July 2013 to November 2013, 60 patients with liver cirrhosis who were hospitalized in our hospital received esophageal variceal ligation. They were divided into normal glucose metabolism group and abnormal glucose metabolism group according to oral glucose tolerance test (OGTT).
Glycosylated hemoglobin (HbA1c) was measured at 1 day before operation and 1 day after operation. Blood glucose (fasting state) was measured at 0, 1, 2 and 3 hours after endoscopic variceal ligation (EVL).
Result
(1) whether there is abnormal glucose metabolism in cirrhosis patients is not related to age, sex, ascites and so on.
(2) Alanine aminotransferase (ALT), total bilirubin (TBIL), direct bilirubin (DBIL) were significantly different in the normal glucose metabolism group (P 0.05). In the abnormal glucose metabolism group, serum albumin (ALB), DBIL were significantly different (P 0.05).
(3) There was no significant difference (P 0.05) at each time point after treatment between the normal glucose metabolism group and the 0 h after treatment. There was significant difference (P 0.05) between the abnormal glucose metabolism group and the 0 h after treatment.
conclusion
(1) The incidence of abnormal glucose metabolism in patients with liver cirrhosis is high, but the detection rate is low. At present, besides fasting plasma glucose (FPG) and HbA1c, OGTT test should be used as a routine examination item for the diagnosis of abnormal glucose metabolism in patients with liver cirrhosis.
(2) Endoscopic esophageal variceal ligation may cause stress damage to liver function in patients with liver cirrhosis. Strengthening hepatoprotective therapy before and after operation can reduce the secondary liver injury caused by treatment.
(3) Endoscopic esophageal variceal ligation has a certain effect on the short-term blood glucose changes in patients with cirrhosis and abnormal glucose metabolism. Monitoring the short-term continuous blood glucose changes in time, especially in patients with cirrhosis and abnormal glucose metabolism within 2 hours after treatment, can help reduce the risk of treatment.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.62;R575

【相似文献】