García-Compeán Diego, Jáquez-Quintana Joel Omar, Lavalle-González Fernando Javier, González-González José Alberto, Muñoz-Espinosa Linda Elsa, Villarreal-Pérez Jesús Zacarías, Maldonado-Garza Héctor J
Diego García-Compeán, Joel Omar Jáquez-Quintana, José Alberto González-González, Héctor J Maldonado-Garza, Gastroenterology Service and Department of Internal Medicine, University Hospital "Dr. José E. Gonzalez" and Medical School, Universidad Autónoma de Nuevo León, Monterrey 64320, México.
World J Gastroenterol. 2014 Jun 14;20(22):7011-8. doi: 10.3748/wjg.v20.i22.7011.
To determine if subclinical abnormal glucose tolerance (SAGT) has influence on survival of non-diabetic patients with liver cirrhosis.
In total, 100 patients with compensated liver cirrhosis and normal fasting plasma glucose were included. Fasting plasma insulin (FPI) levels were measured, and oral glucose tolerance test (OGTT) was performed. According to OGTT results two groups of patients were formed: those with normal glucose tolerance (NGT) and those with SAGT. Patients were followed every three months. The mean follow-up was 932 d (range of 180-1925). Survival was analyzed by the Kaplan-Meyer method, and predictive factors of death were analyzed using the Cox proportional hazard regression model.
Of the included patients, 30 showed NGT and 70 SAGT. Groups were significantly different only in age, INR, FPI and HOMA2-IR. Patients with SAGT showed lower 5-year cumulated survival than NGT patients (31.7% vs 71.6%, P = 0.02). Differences in survival were significant only after 3 years of follow-up. SAGT, Child-Pugh B, and high Child-Pugh and Model for End-Stage Liver Disease (MELD) scores were independent predictors of death. The causes of death in 90.3% of cases were due to complications related to liver disease.
SAGT was associated with lower survival. SAGT, Child-Pugh B, and high Child-Pugh and MELD scores were independent negative predictors of survival.
确定亚临床糖耐量异常（SAGT）是否对非糖尿病肝硬化患者的生存有影响。
共纳入100例代偿期肝硬化且空腹血糖正常的患者。测量空腹血浆胰岛素（FPI）水平，并进行口服葡萄糖耐量试验（OGTT）。根据OGTT结果将患者分为两组：糖耐量正常（NGT）组和SAGT组。每三个月对患者进行随访。平均随访时间为932天（范围180 - 1925天）。采用Kaplan - Meyer法分析生存率，使用Cox比例风险回归模型分析死亡的预测因素。
在所纳入的患者中，30例表现为NGT，70例表现为SAGT。两组仅在年龄、国际标准化比值（INR）、FPI和稳态模型评估的胰岛素抵抗指数（HOMA2 - IR）方面存在显著差异。SAGT组患者的5年累积生存率低于NGT组患者（31.7%对71.6%，P = 0.02）。仅在随访3年后生存率差异才显著。SAGT、Child - Pugh B级以及高Child - Pugh和终末期肝病模型（MELD）评分是死亡的独立预测因素。90.3%的病例死亡原因是与肝病相关的并发症。
SAGT与较低的生存率相关。SAGT、Child - Pugh B级以及高Child - Pugh和MELD评分是生存的独立负性预测因素。
