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,P<0.05);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。
Objective To investigate the clinical features of male patients with alcoholic liver cirrhosis （ ALC ） or hepatitis B cirrhosis （HBC） complicated by abnormal glucose metabolism. Methods A total of 287 patients with liver cirrhosis who were admitted to Guangzhou Panyu Central Hospital from January 2008 to September 2013 were selected. Among these patients, 74 had ALC and were all male, inclu- ding 54 with abnormal glucose metabolism; the other 213 had HBC, including 97 with abnormal glucose metabolism （69 male patients and 28 female patients）. A controlled study was performed for the clinical data of ALC and HBC patients with abnormal glucose metabolism, to investigate the association of patients＇ clinical manifestations with the indices for laboratory examination, insulin resistance index, incidence rate of abnormal glucose metabolism, and Child - Pugh class. The t - test was applied for comparison of continuous data between groups, the chi - square test was applied for comparison of categorical data between groups, and the Spearman rank correlation was applied for correlation analysis. Results Compared with HBC patients, ALC patients had significantly higher incidence rates of abnormal glucose metabolism （73.0% vs 32.4% ）, hepatogenous diabetes （35.1% vs 14.6% ）, fasting hypoglycemia （27.0% vs 10.3% ）, and impaired glucose toler- ance （31.1% vs 14.1% ） （X2 = 4.371, 3. 274, 4. 784, and 1. 633, all P 〈 0.05）. The Spearman correlation analysis showed that in ALC and HBC patients, the incidence rate of abnormal glucose metabolism was positively correlated with Child - Pugh class （rs = 0.41, P 〈 0. 05 ）. Compared with the HBC patients with abnormal glucose metabolism, the ALC patients with abnormal glucose metabolism had a sig- nificantly higher incidence rate of Child - Pugh class A （X2 = 7. 520, P = 0.001 ） , and a significantly lower incidence rate of Child - Pugh class C （x2 = 6. 542, P = 0. 003）. There were significant differences in the incidence rates of dim complexion, telangiectasia of the face, spider angioma, hepatomegaly, hepatorenal syndrome, malnutrition, ascites, jaundice, hepatic encephalopathy, spontaneous bacterial peri- tonitis, and upper gastrointestinal bleeding between the ALC and HBC patients with abnormal glucose metabolism （X2 = 3. 785, 2. 651, 1. 974, 3. 316, 3.771,5. 843, 7.251,5. 214, 5. 778, 2. 966, and 6.312, all P 〈 0.05 ）. Compared with the HBC patients with abnormal glucose metabolism, the ALC patients with abnormal glucose metabolism had significantly higher levels of aspartate aminotransferase and total bilirubin, a significantly greater mean corpuscular volume, a significantly higher level of gamma - glutamyl transpeptidase, and a significant- ly lower level of albumin （t = 4. 775, 7. 887, 5. 143, 6. 124, and 5. 210, all P 〈 0.05 ）. There were significant differences in the fasting blood glucose level, insulin level 2 hours after meal, and insulin resistance index between the ALC and HBC patients with abnormal glucose metabolism （t = 2. 770, 6.331, and 3. 770, all P 〈 0.05 ）. Conclusion The male patients with ALC or HBC gradually develop abnormal glucose metabolism with the deterioration of liver function, with individual etiology and features of liver cirrhosis, and the manifestations of abnormal glucose metabolism are not obvious. Related examinations should be performed for these male patients with liver cirrhosis of various causes, to confirm the existence of abnormal glucose metabolism.
出处
《临床肝胆病杂志》
CAS
2016年第2期296-300,共5页
Journal of Clinical Hepatology
关键词
肝硬化
肝硬化
酒精性
肝炎
乙型
葡萄糖代谢障碍
liver cirrhosis
liver cirrhosis, alcoholic
hepatitis B
glucose metabolism disorders
