Bell David S H, Allbright Eric
Southside Endocrinology, Birmingham, Alabama 35205, USA.
Endocr Pract. 2007 May-Jun;13(3):300-12. doi: 10.4158/EP.13.3.300.
To investigate the association of diabetes and hepatobiliary disease.
We performed a MEDLINE search of the English-language literature published between January 1980 and January 2007 for studies in which diabetes was associated with liver diseases.
Through its association with the insulin resistance syndrome, type 2 diabetes is associated with nonalcoholic fatty liver disease, nonalcoholic steatohepatitis (NASH), NASH-cirrhosis, and NASH-cirrhosis-related hepatocellular carcinoma. Because of the association with insulin resistance, insulin sensitizers may slow or even arrest the progress of these diseases. Type 2 but not type 1 diabetes is associated with hepatitis C virus but not hepatitis B viral infection. This association is likely due to hepatitis C viral infection of the pancreatic beta-cells. Early detection and antiviral therapy can decelerate the development of diabetes. Type 1 diabetes is associated with hemochromatosis and autoimmune hepatitis. Because of the presence of autonomic neuropathy, cholelithiasis but not cholecystitis is more common in patients with diabetes than in the general population. Therefore, asymptomatic cholelithiasis in patients with diabetes no longer warrants a cholecystectomy. In patients with advanced liver disease of any cause, insulin resistance and diabetes have an increased frequency of occurrence and can be reversed with liver transplantation. Rarely, medications used to treat type 2 diabetes have been associated with drug-induced hepatitis.
The prevalence of hepatobiliary diseases is increased in patients with diabetes. Early recognition and treatment of these conditions can prevent, stabilize, or even reverse hepatic damage and prevent the development of hepatic carcinoma and liver failure.
研究糖尿病与肝胆疾病之间的关联。
我们对1980年1月至2007年1月发表的英文文献进行了MEDLINE检索，以查找糖尿病与肝脏疾病相关的研究。
通过与胰岛素抵抗综合征的关联，2型糖尿病与非酒精性脂肪性肝病、非酒精性脂肪性肝炎（NASH）、NASH肝硬化以及NASH肝硬化相关的肝细胞癌有关。由于与胰岛素抵抗相关，胰岛素增敏剂可能会减缓甚至阻止这些疾病的进展。2型而非1型糖尿病与丙型肝炎病毒感染相关，但与乙型肝炎病毒感染无关。这种关联可能是由于丙型肝炎病毒对胰腺β细胞的感染。早期检测和抗病毒治疗可以减缓糖尿病的发展。1型糖尿病与血色素沉着症和自身免疫性肝炎有关。由于存在自主神经病变，糖尿病患者中胆结石比胆囊炎更常见，而在普通人群中则不然。因此，糖尿病患者的无症状胆结石不再需要进行胆囊切除术。在任何原因导致的晚期肝病患者中，胰岛素抵抗和糖尿病的发生率增加，肝移植可以使其逆转。很少有用于治疗2型糖尿病的药物与药物性肝炎有关。
糖尿病患者中肝胆疾病的患病率增加。对这些疾病的早期识别和治疗可以预防、稳定甚至逆转肝损伤，并预防肝癌和肝衰竭的发生。
