摘要
目的探讨老年肝硬化合并糖尿病患者胰岛素抵抗，以及其与肝功能的关系，为临床治疗提供参考。方法选择老年肝硬化患者、老年肝硬化合并糖尿病患者、60岁及以下非老年肝硬化合并糖尿病患者及对照组各30例，测定空腹血浆胰岛素、葡萄糖，计算胰岛素抵抗指数，比较其在各组间的差异，分析其与患者肝功能Child—Pugh分级间的关系。结果老年肝硬化组患者血浆胰岛素水平与胰岛素抵抗指数分别为（9．58±3．62）mU／L、2．47±0．88，均明显高于对照组（6．03±1．99）mU／L、2．12±0．99（均P=0．000），老年肝硬化合并糖尿病组患者血糖、血浆胰岛素水平及胰岛素抵抗指数分别为（5．83±1．40）mmol／L、（15．63±6．37）mU／L、6．33±2．59，均明显高于老年肝硬化组（5．03±0．83）mmol／L、（9．58±3．62）mU／L、2．47±0．88及对照组（5．31±0．58）mmol／L、（6．03±1．99）mU／L、2．12±0．99（均P〈0．05）。老年肝硬化合并糖尿病组血糖、血浆胰岛素水平及胰岛素抵抗指数与60岁及以下非老年肝硬化合并糖尿病组患者比较差异无统计学意义（均P〉0．05）。老年肝硬化合并糖尿病组患者中Child—Pugh分级为C级患者的比例C20例（66．7％）]高于老年肝硬化组患者[11例（36．7％）]（χ2=5．406，P=0．019）；同时也高于60岁及以下非老年肝硬化合并糖尿病组中Child—PughC级患者比例（40．0％，12例），差异有统计学意义（χ2=4．286，P=0．037）。肝硬化及肝硬化合并糖尿病患者的胰岛素抵抗指数在Child—Pugh分级为c级者为7．39±2．25，高于B级胰岛素抵抗指数4．90±1．76，而Child—Pugh分级B级者胰岛素抵抗指数4．90±1．76，高于A级2．69±1．02（均P〈O．05）。结论老年肝硬化患者体内存在高胰岛素血症与胰岛素抵抗，合并糖尿病时更加明显，且合并糖尿病的老年肝硬化患者肝功能状态更差，预后不佳。
Objective To investigate the relationship between insulin resistance and hepatic function in elderly liver cirrhosis （LC）patients with diabetes （LC-DM）and to provide evidence for clinical treatment. Methods Thirty cases of elderly LC, 30 cases of elderly LC-DM, 30 younger patients （〈60 years） with LC-DM and 30 healthy subjects were enrolled. Levels of fasting plasma glucose（FPG）and fasting plasma insulin（FINS）were examined to evaluate the homeostasis model for assessment of insulin resistance （HOMA-IR）, which was used for comparison between the groups. Moreover, the relationship between HOMA-IR and the Child-Pugh classification was also analyzed. Results Patients in the elderly LC group were associated with significantly higher levels of FINS （9.58±3.62 vs. 6. 03±1.99 mU/L,P〈0.05）and HOMA-IR（2. 47±0.88 vs. 2.12±0.99,P〈 0.05） ,compared with the control group. Meanwhile,levels of FPG,FINS and HOMA-IR in the elderly LC-DM group were （5.83 ±1.40） mmol/L, （15.63 ±6.37 ） mU/L and 6.33± 2.59, respectively, significantly higher than those[（5.03±0.83）mmol/L, （9.58±3.62）mU/L,2.47±0.88]in the elderly LC group and those[（5.31 ± 0.58） mmol/L, （6.03 ± 1.99） mU/L, 2.12 ± 0.99] in the control group （all P〈0.05）. However,levels of FPG, FINS and HOMA-IR were similar between the elderly LC-DM group and the younger LC-DM group（P〈0.05）. In the elderly LC-DM group, more patients（66.7 %）had Child-Pugh C liver function compared with the elderly LC group（36.7 %）and the younger LC-DM group（40.0%）（both P〈0.05）. Of those in the LC and LC DM groups,levels of HOMA-IR were 7.39± 2.25 in patients with Child-Pugh C,which were significantly higher than those in patients with Child Pugh B function（4.90± 1.76） and with Child-Pugh A liver function（2.69 ±1.02） （both P〈 0.05）. Conclusions Hyperinsulinemia and insulin resistance are more pronounced in elderly LC-DM than in elderly LC,with poor liver function and prognosis.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2017年第11期1199-1202,共4页
Chinese Journal of Geriatrics
关键词
肝硬化
糖尿病
胰岛素抗药性
Liver cirrhosis
Diabetes mellitus
Insulin resistance
