Ishikawa Tsuyoshi, Shiratsuki Shogo, Matsuda Takashi, Iwamoto Takuya, Takami Taro, Uchida Koichi, Terai Shuji, Yamasaki Takahiro, Sakaida Isao
Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 7558505, Japan,
J Gastroenterol. 2014 Sep;49(9):1333-41. doi: 10.1007/s00535-013-0893-z. Epub 2013 Oct 5.
Liver cirrhosis (LC) is often complicated by hyperinsulinemia due to insulin resistance (IR), which is considered to be closely related to shunt formation and impaired liver function. This study evaluates whether balloon-occluded retrograde transvenous obliteration (B-RTO) can affect glucose and insulin metabolism in patients with LC.
Twenty-five cirrhotic patients (mean age = 69.6 years; female/male = 12/13; hepatitis C virus/alcohol/nonalcoholic steatohepatitis = 14/6/5; Child-Pugh's class A/B = 10/15) with gastric varices and/or hepatic encephalopathy caused by portosystemic shunts (PSS) due to portal hypertension (PH) underwent B-RTO at our hospital. Testing was performed before and at 1 month after the procedure.
Shunt occlusion resulted in a decrease in extrahepatic collateral blood flow and an increase in portal venous flow, as well as a dramatic improvement in hepatic function markers. In addition, B-RTO significantly decreased homeostasis model assessment (HOMA) of IR without a statistical decline of HOMA of β-cell function. The 75-g oral glucose tolerance test (75-OGTT) revealed that occlusion of PSS reduced both fasting immunoreactive insulin (IRI) levels and the area under the curve for IRI. However, no significant change in preprandial or postprandial plasma glucose levels was observed. Furthermore, according to the criteria of the American Diabetes Association, B-RTO led to an improved 75-OGTT profile in 58.3 % of patients who had impaired glucose tolerance or diabetes mellitus before the procedure.
Shunt occlusion improves IR-related hyperinsulinemia through increased portal venous flow, ameliorated liver function, and consequent augmented hepatic insulin clearance in cirrhotic patients with PH.
肝硬化（LC）常因胰岛素抵抗（IR）而并发高胰岛素血症，这被认为与分流形成和肝功能受损密切相关。本研究评估球囊闭塞逆行静脉闭塞术（B-RTO）是否会影响LC患者的葡萄糖和胰岛素代谢。
25例因门静脉高压（PH）导致门体分流（PSS）引起胃静脉曲张和/或肝性脑病的肝硬化患者（平均年龄=69.6岁；女性/男性=12/13；丙型肝炎病毒/酒精/非酒精性脂肪性肝炎=14/6/5；Child-Pugh分级A/B=10/15）在我院接受了B-RTO治疗。在手术前和术后1个月进行检测。
分流闭塞导致肝外侧支血流减少和门静脉血流增加，以及肝功能指标显著改善。此外，B-RTO显著降低了IR的稳态模型评估（HOMA），而β细胞功能的HOMA无统计学下降。75克口服葡萄糖耐量试验（75-OGTT）显示，PSS闭塞降低了空腹免疫反应性胰岛素（IRI）水平和IRI曲线下面积。然而，未观察到餐前或餐后血浆葡萄糖水平有显著变化。此外，根据美国糖尿病协会的标准，B-RTO使58.3%术前糖耐量受损或患有糖尿病的患者的75-OGTT曲线得到改善。
对于患有PH的肝硬化患者，分流闭塞通过增加门静脉血流、改善肝功能以及随之增强肝脏胰岛素清除率，改善了与IR相关的高胰岛素血症。
