Gastroenterology Service and Department of Internal Medicine, University Hospital Dr. José E. González and Medical School, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
Ann Hepatol. 2012 Mar-Apr;11(2):240-8.
To define the prevalence and clinical characteristics of glucose metabolism disorders (GMD) in patients with compensated liver cirrhosis (LC).
Fasting plasma glucose (FPG) levels were measured to 130 patients with clinically stable LC. Oral glucose tolerance tests (OGTT) and fasting plasma insulin determinations were performed to patients with normal FPG. Insulin resistance (IR) was calculated with HOMA2-IR index. GMD were classified according to FPG and OGTT tests results and to the chronologic relation between diagnosis of diabetes mellitus (DM) and LC as follows: type-2 DM (T2DM), hepatogenous diabetes (HD) and impaired glucose tolerance. Patients from all groups were compared.
The prevalence of GMD were as follows: T2DM in 25 patients (19.2%, 95% CI 12.5-25.9), HD in 28 (21.5%, 95% CI 14.5-28.5) and IGT in 36 (38.5%, 95% CI 30.1-46.7). The total of patients with GMD was 79.2% (95% CI 72.3-86.1). In 41% of cases GMD were subclinical and 48.7% of patients had IR. Patients with T2DM had a higher number of variables with significant differences compared with the other groups (more marked compared to the patients without GMD). The only differences between the patients with T2DM and HD were hypercreatininemia: 1.14 ± 0.53 vs. 0.84 ± 0.22 mg/dL (p = 0.005) and family history of DM: 8 (32%) vs. 2 (7%) (p = 0.02).
Almost 80% of patients with compensated LC had GMD. Half of them were subclinical. The patients with T2DM had marked clinical differences compared to patients from the other groups, particularly renal impairment.
定义代偿性肝硬化（LC）患者中葡萄糖代谢紊乱（GMD）的患病率和临床特征。
对 130 例临床稳定的 LC 患者进行空腹血糖（FPG）水平测量。对 FPG 正常的患者进行口服葡萄糖耐量试验（OGTT）和空腹血浆胰岛素测定。使用 HOMA2-IR 指数计算胰岛素抵抗（IR）。根据 FPG 和 OGTT 试验结果以及糖尿病（DM）和 LC 诊断之间的时间关系对 GMD 进行分类，如下：2 型糖尿病（T2DM）、肝源性糖尿病（HD）和糖耐量受损。对所有组的患者进行比较。
GMD 的患病率如下：T2DM 患者 25 例（19.2%，95%CI 12.5-25.9），HD 患者 28 例（21.5%，95%CI 14.5-28.5）和 IGT 患者 36 例（38.5%，95%CI 30.1-46.7）。GMD 患者总数为 79.2%（95%CI 72.3-86.1）。41%的患者存在亚临床 GMD，48.7%的患者存在 IR。与其他组相比，T2DM 患者有更多变量存在显著差异（与无 GMD 的患者相比更为明显）。T2DM 患者与 HD 患者仅有的两个区别是血肌酸酐升高：1.14±0.53 与 0.84±0.22mg/dL（p=0.005）和 DM 家族史：8（32%）与 2（7%）（p=0.02）。
近 80%的代偿性 LC 患者存在 GMD。其中一半为亚临床。与其他组的患者相比，T2DM 患者的临床差异更为显著，尤其是肾功能损害。
