Iovanescu V F, Streba C T, Ionescu M, Constantinescu A F, Vere C C, Rogoveanu I, Moța E
University of Medicine and Pharmacy of Craiova, Craiova, Romania.
Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
J Med Life. 2015 Oct-Dec;8(4):483-7.
Chronic viral liver disease is often associated with other conditions. Diabetes mellitus (DM) is frequently reported in this context and may play a role in the progression of the liver disease to hepatocellular carcinoma (HCC). Renal disease is also an important extrahepatic manifestation of hepatitis viral infection and its presence is associated with poor prognosis and management issues.
Our study had multiple purposes: to determine the frequency of the association between chronic viral liver disease and diabetes mellitus, evaluate the potential of diabetes mellitus as a risk factor for HCC and assess an eventual renal involvement.
We included in our study a number of 246 patients with chronic liver disease, from whom 136 were diagnosed with chronic viral hepatitis and 110 with viral liver cirrhosis. These patients were assessed by using a clinical examination and a series of tests, including serum transaminase levels, serum bilirubin, serum albumin, markers of cholestasis, fasting plasma glucose levels, serum creatinine, urea, albuminuria, Addis-Hamburger test, electrophoresis of urinary proteins, abdominal ultrasound and, in some cases, CT examination. We obtained the following results: diabetes mellitus is often associated with chronic liver disease of viral etiology, having been identified in 18.29% of the patients in our study. Age above 60 in patients with chronic hepatitis (p=0.013<0.05) and presence of hepatitis C virus were particularly correlated with the presence of diabetes mellitus. Renal disease was present in 13.4% of the patients with chronic liver disease and it was especially associated with liver cirrhosis and hepatitis C virus. The most common form of renal injury was glomerulonephritis. Acute kidney injury was diagnosed only in cirrhotic patients as hepatorenal syndrome, occurring in 7.27% of the subjects, while chronic kidney disease was identified only in two cases of chronic viral hepatitis. Four patients in our study were diagnosed with HCC and none of them presented diabetes mellitus.
Our study revealed that there is a significant association between diabetes mellitus and chronic viral liver disease induced by hepatitis C virus. Glomerulonephritis was the most common type of renal disease in both hepatitis patients and in those with cirrhosis. Glomerular injury was strongly correlated with the presence of hepatitis C virus than with hepatitis B virus. A connection between diabetes mellitus and hepatocellular carcinoma could not be established.
慢性病毒性肝病常与其他病症相关。糖尿病（DM）在此背景下屡有报道，且可能在肝病进展为肝细胞癌（HCC）过程中起作用。肾病也是病毒性肝炎感染的重要肝外表现，其存在与预后不良及管理问题相关。
我们的研究有多个目的：确定慢性病毒性肝病与糖尿病之间关联的频率，评估糖尿病作为肝细胞癌风险因素的可能性，并评估是否存在肾脏受累情况。
我们的研究纳入了246例慢性肝病患者，其中136例被诊断为慢性病毒性肝炎，110例为病毒性肝硬化。通过临床检查和一系列检测对这些患者进行评估，包括血清转氨酶水平、血清胆红素、血清白蛋白、胆汁淤积标志物、空腹血糖水平、血清肌酐、尿素、蛋白尿、艾迪斯 - 汉堡试验、尿蛋白电泳、腹部超声，部分病例还进行了CT检查。我们得到以下结果：糖尿病常与病毒性病因的慢性肝病相关，在我们研究的患者中占18.29%。慢性肝炎患者年龄超过60岁（p = 0.013<0.05）以及丙型肝炎病毒的存在与糖尿病的存在尤其相关。13.4%的慢性肝病患者存在肾病，且尤其与肝硬化和丙型肝炎病毒相关。最常见的肾损伤形式是肾小球肾炎。急性肾损伤仅在肝硬化患者中诊断为肝肾综合征，发生率为7.27%的受试者，而慢性肾病仅在两例慢性病毒性肝炎患者中发现。我们研究中有4例患者被诊断为肝细胞癌，且他们均未患糖尿病。
我们的研究表明，糖尿病与丙型肝炎病毒引起的慢性病毒性肝病之间存在显著关联。肾小球肾炎是肝炎患者和肝硬化患者中最常见的肾病类型。肾小球损伤与丙型肝炎病毒的存在比与乙型肝炎病毒的存在相关性更强。无法确立糖尿病与肝细胞癌之间的联系。
