Kwon S Y, Kim S S, Kwon O S, Kwon K A, Chung M G, Park D K, Kim Y S, Koo Y S, Kim Y K, Choi D J, Kim J H
Gil MerDepartment of Internal Medicine, Division of Gastroenterology and Hepatology, Gachon Medical School, Gil Medical Centre, 1198 Guwal-dong, Namdong-gu, Inchon 405-760, Korea.
Diabet Med. 2005 Nov;22(11):1530-5. doi: 10.1111/j.1464-5491.2005.01687.x.
Diabetes mellitus (DM) is frequently observed in patients with cirrhosis, particularly that due to hepatitis C virus (HCV) infection. However, no studies have focused on the clinical significance of glycaemic control in cirrhotic patients because of their short life expectancy and poor hepatic function. The aim of this study was to evaluate the prognostic impact of glycaemic control in patients with hepatitis B virus (HBV) and HCV-related cirrhosis and DM.
A total of 434 patients with HCV-related (HCV group, n = 88) or HBV-related (HBV group, n = 346) cirrhosis were studied retrospectively. We determined the prevalence of DM and treatment methods for hyperglycaemia and status of glycaemic control, and the patients' outcome.
The prevalence of DM was 43.2% (38/88) in the HCV group and 19.7% (68/346) in the HBV group. Patients in the HCV group were older with a female preponderance. DM was detected before the diagnosis of cirrhosis or simultaneously in 92% and 79% in the HCV and HBV groups, respectively. Most patients were treated with insulin or oral hypoglycaemic agents. However, blood glucose levels were maintained within the normal range in 34.2% of the HCV group and in 23.5% of the HBV group. Forty-six patients died during the observation period in both groups. Hepatic failure was the most common cause of death, and sepsis and variceal bleeding were more frequent in the HCV group than in the HBV group. Multivariate analysis showed that Child-Pugh class was the most important factor for survival in both groups. In the HCV group, the status of glycaemic control was a significant independent factor of survival (P = 0.018). In the HBV group, age and the development of spontaneous bacterial peritonitis were significant.
DM is more frequent in patients with HCV-related cirrhosis than in patients with HBV. Strict control of blood glucose levels could improve survival in HCV patients. A precise assessment of the risks and benefits of glycaemic control is required to reduce the mortality and morbidity of patients with cirrhosis and DM.
糖尿病（DM）在肝硬化患者中较为常见，尤其是丙型肝炎病毒（HCV）感染所致的肝硬化患者。然而，由于肝硬化患者预期寿命短且肝功能差，尚无研究关注血糖控制在这类患者中的临床意义。本研究旨在评估血糖控制对乙型肝炎病毒（HBV）和HCV相关肝硬化合并DM患者预后的影响。
回顾性研究了434例HCV相关（HCV组，n = 88）或HBV相关（HBV组，n = 346）肝硬化患者。我们确定了DM的患病率、高血糖的治疗方法和血糖控制状况以及患者的结局。
HCV组DM患病率为43.2%（38/88），HBV组为19.7%（68/346）。HCV组患者年龄较大，女性居多。HCV组和HBV组分别有92%和79%的患者在肝硬化诊断前或同时被检测出患有DM。大多数患者接受胰岛素或口服降糖药治疗。然而，HCV组34.2%的患者和HBV组23.5%的患者血糖水平维持在正常范围内。两组在观察期内共有46例患者死亡。肝衰竭是最常见的死亡原因，HCV组败血症和静脉曲张出血比HBV组更频繁。多因素分析显示，Child-Pugh分级是两组生存的最重要因素。在HCV组，血糖控制状况是生存的显著独立因素（P = 0.018）。在HBV组，年龄和自发性细菌性腹膜炎的发生是显著因素。
HCV相关肝硬化患者中DM比HBV相关肝硬化患者更常见。严格控制血糖水平可改善HCV患者的生存率。需要精确评估血糖控制的风险和益处，以降低肝硬化合并DM患者的死亡率和发病率。
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