發(fā)布時(shí)間：2018-06-26 20:16

  本文選題：肝硬化 + 肝硬化��； 參考：《臨床肝膽病雜志》2016年02期

【摘要】：目的探討并發(fā)糖代謝異常的男性酒精性肝硬化(ALC)與乙型肝炎肝硬化(HBC)患者的臨床特征。方法收集2008年1月-2013年9月于廣州市番禺區(qū)中心醫(yī)院住院的肝硬化患者287例,包含ALC患者74例,均為男性,其中并發(fā)糖代謝異常者54例;HBC患者213例,其中并發(fā)糖代謝異常者97例(男69例、女28例)。對(duì)并發(fā)糖代謝異常的ALC和HBC患者的臨床資料進(jìn)行分組對(duì)照研究,探討患者臨床表現(xiàn)和實(shí)驗(yàn)室檢查指標(biāo)、胰島素抵抗指數(shù)、糖代謝異常發(fā)生率及其與Child-Pugh分級(jí)的關(guān)系。計(jì)量資料組間比較采用t檢驗(yàn),計(jì)數(shù)資料組間比較采用χ2檢驗(yàn),采用Spearman進(jìn)行等級(jí)相關(guān)分析。結(jié)果 ALC男性患者糖代謝異常發(fā)生率(73.0%vs 32.4%)、肝源性糖尿病發(fā)生率(35.1%vs 14.6%)、空腹低血糖發(fā)生率(27.0%vs 10.3%)和糖耐量異常發(fā)生率(31.1%vs 14.1%)均高于HBC患者(χ2值分別為4.371、3.274、4.784、1.633,P值均0.05);Spearman相關(guān)性分析顯示,ALC和HBC男性患者糖代謝異常發(fā)生率與Child-Pugh分級(jí)呈正相關(guān)(rs=0.41,P0.05);并發(fā)糖代謝異常的ALC患者,Child-Pugh A級(jí)所占比例高于并發(fā)糖代謝異常的HBC患者;Child-Pugh C級(jí)所占比例低于并發(fā)糖代謝異常的HBC患者,差異均有統(tǒng)計(jì)學(xué)意義(χ2值分別為7.520、6.542,P值分別為0.001、0.003);并發(fā)糖代謝異常的ALC和HBC男性患者的面色晦暗、面部毛細(xì)血管擴(kuò)張、蜘蛛痣、肝大、肝腎綜合征、營(yíng)養(yǎng)不良、腹水、黃疸、肝性腦病、自發(fā)性細(xì)菌性腹膜炎和上消化道出血的發(fā)生率比較差異均有統(tǒng)計(jì)學(xué)意義(χ2值分別為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);與并發(fā)糖代謝異常的男性HBC患者相比,并發(fā)糖代謝異常的男性ALC患者的AST、TBil、平均紅細(xì)胞體積、GGT較高,白蛋白較低,差異均有統(tǒng)計(jì)學(xué)意義(t值分別為2.378、2.587、2.633、2.681、2.210,P值均0.05);并發(fā)糖代謝異常的ALC和HBC男性患者的空腹血糖水平、餐后2 h胰島素水平和胰島素抵抗指數(shù)比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為2.378、1.976、1.991,P值均0.05)。結(jié)論男性ALC和HBC患者糖代謝異常發(fā)生率隨肝功能惡化逐步升高,但二者均多以其各自病因肝硬化特征為主要表現(xiàn),糖代謝異常表現(xiàn)不明顯。對(duì)這兩種不同病因肝硬化男性患者應(yīng)及時(shí)進(jìn)行相關(guān)檢查,以明確是否存在糖代謝異常。
[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 鹵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 鹵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.
【作者單位】： 廣州市番禺區(qū)中心醫(yī)院消化內(nèi)科;
【分類(lèi)號(hào)】：R575.2;R512.62

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 鮑中英;苑曉冬;段淑紅;;肝硬化發(fā)生肝源性糖尿病的相關(guān)因素分析[J];現(xiàn)代預(yù)防醫(yī)學(xué);2011年19期

【共引文獻(xiàn)】

相關(guān)期刊論文 前2條

1 李仕雄;;糖尿病的中醫(yī)病機(jī)及恩替卡韋對(duì)慢性乙肝所致肝性糖尿病患者血糖水平及肝功能的影響[J];環(huán)球中醫(yī)藥;2014年S1期

2 豐浩田;豐義寬;田強(qiáng);李如源;;老年肝硬化并發(fā)糖尿病的臨床特點(diǎn)及相關(guān)因素Logistic分析[J];中國(guó)老年學(xué)雜志;2013年12期

【二級(jí)參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 姜麗萍;趙金滿;;肝源性糖尿病的診斷與治療[J];世界華人消化雜志;2007年06期

2 羅運(yùn)權(quán),楊甲梅,吳孟超;糖尿病增加肝硬變患者原發(fā)性肝癌發(fā)生的危險(xiǎn)性[J];新消化病學(xué)雜志;1997年12期

3 杜煒,代云龍,朱洪連,李健,董艷平;肝硬化患者的糖代謝及胰島β細(xì)胞分泌功能變化的臨床研究──附71例報(bào)告[J];新醫(yī)學(xué);2000年07期

4 丁惠國(guó);肝硬化的抗胰島素性[J];中華肝臟病雜志;1996年01期

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