Department of Internal Medicine, Wonju College of Medicine, Wonju Christian Hospital, Yonsei University, 162, Ilsan-dong, Wonju, Republic of Korea.
Dig Dis Sci. 2013 Nov;58(11):3335-41. doi: 10.1007/s10620-013-2802-y. Epub 2013 Aug 4.
The clinical impact and complications of hepatogenous diabetes (HD) on cirrhosis have not been elucidated. This study aimed to evaluate the relationship of HD with portal hypertension (PHT) and variceal hemorrhage and to assess the prevalence of HD.
From July 2007 to December 2009, 75-g oral glucose tolerance test and insulin resistance (IR) were evaluated for 195 consecutive cirrhotic liver patients (M:F = 164:1, 53.0 ± 10.2 years) who had no history of diabetes mellitus. IR was calculated using the homeostasis model of assessment-insulin resistance (HOMA-IR) formula. Endoscopy for varices, hepatic venous pressure gradient (HVPG), and serologic tests were also conducted.
HD was observed in 55.4 % (108/194) of the patients. Among them, 62.0 % required OGTT for diagnosis because they did not show an abnormal fasting plasma glucose level. The presence of HD showed a significant correlation with high Child-Pugh's score, variceal hemorrhage, and HVPG (p = 0.004, 0.002, and 0.019, respectively). In multivariate analysis, Child-Pugh's score (OR 1.43, 95 % CI 1.005-2.038) and HVPG (OR 1.15, 95 % CI 1.003-2.547) had significant relationships with HD. Patients with recent variceal hemorrhages (within 6 months) exhibited significantly higher glucose levels at 120 min in OGTT compared to patients without hemorrhages (p = 0.042). However, there was no difference in fasting glucose levels. The 120-min glucose level and HOMA-IR score were significantly and linearly correlated with HVPG (r (2) = 0.189, p < 0.001 and r (2) = 0.033, p = 0.011, respectively).
HD and IR have significant relationships with PHT and variceal hemorrhage. Postprandial hyperglycemia in particular had a significant relationship with variceal hemorrhage.
肝源性糖尿病（HD）对肝硬化的临床影响和并发症尚未阐明。本研究旨在评估 HD 与门脉高压（PHT）和静脉曲张出血的关系，并评估 HD 的患病率。
2007 年 7 月至 2009 年 12 月，对 195 例连续肝硬化患者（男：女=164：1，53.0±10.2 岁）进行 75g 口服葡萄糖耐量试验和胰岛素抵抗（IR）评估，这些患者均无糖尿病病史。采用稳态模型评估胰岛素抵抗（HOMA-IR）公式计算 IR。还进行了胃镜检查、肝静脉压力梯度（HVPG）和血清学检查。
194 例患者中有 55.4%（108/194）存在 HD。其中，62.0%的患者需要 OGTT 进行诊断，因为他们的空腹血糖水平正常。HD 的存在与高 Child-Pugh 评分、静脉曲张出血和 HVPG 显著相关（p=0.004、0.002 和 0.019）。在多变量分析中，Child-Pugh 评分（OR 1.43，95%CI 1.005-2.038）和 HVPG（OR 1.15，95%CI 1.003-2.547）与 HD 有显著关系。有近期静脉曲张出血（6 个月内）的患者在 OGTT 120 分钟时的血糖水平明显高于无出血的患者（p=0.042）。然而，空腹血糖水平没有差异。120 分钟血糖水平和 HOMA-IR 评分与 HVPG 呈显著线性相关（r(2)=0.189，p<0.001 和 r(2)=0.033，p=0.011）。
HD 和 IR 与 PHT 和静脉曲张出血有显著关系。餐后高血糖与静脉曲张出血有显著关系。
