Djiambou-Nganjeu Herbert
Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
J Transl Int Med. 2019 Apr 22;7(2):79-83. doi: 10.2478/jtim-2019-0009. eCollection 2019 Jun.
Our aim was to explore the relationship between liver cirrhosis (LC), portal hypertension (PH), and diabetes mellitus (DM). LC displayed hemodynamic alterations reflected by signs and symptoms of hypertension and hyperdynamic circulation. Portal hypertension also caused splenomegaly because of the blood flow into the spleen from the portal vessels and portal flow. The alcoholic cirrhosis displayed abnormal values (AST, ALT, AST/ALT, albumin, ammonia, bilirubin, blood platelet, erythrocytes, glucose, Hb, international normalized ratio (INR), PT, prothrombin index (PI), thymol test, white blood cell (WBC) count), which demonstrated the presence of portal hypertension, ascites, DM, infection, and coagulopathy. The evaluation of liver enzymes and other laboratories data helped to determine the severity of the condition and prognosis. Diabetes appeared to be less affecting the prognosis of patients with cirrhosis than LC itself, showing that hepatocellular failure was largely responsible for patients' mortality rather than diabetes and its complications. Patients displayed a BMI correlating obesity, although affected by concomitant diseases that commonly cause a severe weight loss. The elevated BMI in this case was accentuated by the presence of ascitic fluid, which is responsible for the increase in weight and the inaccurate BMI evaluation. Ascites affect patients' recovery from liver diseases. Obese patients with cirrhosis can be related to have a large amount of ascites and that physicians should be expecting to notice changes in their BMI pre- and postoperatively, subsequently making a prior classification as obese inappropriate. Disease severity could be assessed through the evaluation of PH stage, which was characterized by a significant depletion of WBC and as well as platelet counts.
我们的目的是探讨肝硬化（LC）、门静脉高压（PH）和糖尿病（DM）之间的关系。肝硬化表现出由高血压和高动力循环的体征和症状所反映的血流动力学改变。门静脉高压还因门静脉血管的血流和门静脉血流流入脾脏而导致脾肿大。酒精性肝硬化表现出异常值（谷草转氨酶、谷丙转氨酶、谷草转氨酶/谷丙转氨酶、白蛋白、氨、胆红素、血小板、红细胞、葡萄糖、血红蛋白、国际标准化比值（INR）、凝血酶原时间（PT）、凝血酶原指数（PI）、麝香草酚浊度试验、白细胞（WBC）计数），这些异常表明存在门静脉高压、腹水、糖尿病、感染和凝血障碍。对肝酶和其他实验室数据的评估有助于确定病情的严重程度和预后。糖尿病似乎对肝硬化患者预后的影响小于肝硬化本身，这表明肝细胞衰竭在很大程度上是患者死亡的原因，而非糖尿病及其并发症。患者的体重指数（BMI）与肥胖相关，尽管受到通常导致严重体重减轻的伴随疾病的影响。在这种情况下，腹水的存在加剧了BMI的升高，腹水导致体重增加以及BMI评估不准确。腹水影响患者从肝病中的恢复。肝硬化肥胖患者可能伴有大量腹水，医生应注意其术前和术后BMI的变化，因此术前将其归类为肥胖并不合适。疾病严重程度可通过评估门静脉高压阶段来确定，该阶段的特征是白细胞和血小板计数显著减少。
