Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Aliment Pharmacol Ther. 2020 Aug;52(3):527-536. doi: 10.1111/apt.15915. Epub 2020 Jun 29.
Diabetes mellitus may lead to increased serum ammonia and systemic inflammation thereby promoting hepatic encephalopathy (HE).
To investigate the potential association between diabetes mellitus/glycaemic control and the presence of covert HE as well as the development of overt HE in a prospective setting.
A total of 240 patients with liver cirrhosis were included into this prospective cohort study and followed for a median of 17 months. Covert HE was diagnosed by pathological results in the Portosystemic Hepatic Encephalopathy Score. Predictors for the presence of covert HE or the development of overt HE were analysed using logistic regression or Cox-regression models.
At study inclusion, 65 patients (27.1%) presented with diabetes mellitus and covert HE was detected in 33.3%. Patients with diabetes mellitus had a more preserved liver function as compared to patients without diabetes mellitus (MELD 9 vs 10; P = 0.043). In regression analyses after adjustment for confounders, diabetes mellitus was independently associated with the presence of covert HE at study inclusion and the development of overt HE during follow-up. These associations were confirmed in separate propensity-score-weighted regression models. In subgroup analyses, patients with worse glycaemic control (HbA1c >= 6.5%) had a pronounced risk for covert HE (OR 2.264, 95% CI 1.002-5.118) and overt HE (HR 4.116, 95% CI 1.791-9.459).
Diabetes mellitus may associate with higher risk for the presence of covert HE and the development of overt HE in patients with liver cirrhosis. Adequate glycaemic control may be a potential target to attenuate this important complication.
糖尿病可能导致血清氨和全身炎症增加，从而促进肝性脑病（HE）。
在前瞻性研究中，研究糖尿病/血糖控制与隐匿性肝性脑病（HE）的存在以及显性 HE 的发生之间的潜在关联。
这项前瞻性队列研究共纳入 240 例肝硬化患者，中位随访时间为 17 个月。通过门体系统肝性脑病评分的病理结果诊断隐匿性 HE。使用逻辑回归或 Cox 回归模型分析预测隐匿性 HE 存在或显性 HE 发展的因素。
在研究纳入时，65 例患者（27.1%）患有糖尿病，33.3%的患者存在隐匿性 HE。与无糖尿病的患者相比，患有糖尿病的患者肝功能保存得更好（MELD 9 分比 10 分；P=0.043）。在调整混杂因素后的回归分析中，糖尿病与研究纳入时隐匿性 HE 的存在以及随访期间显性 HE 的发展独立相关。在单独的倾向评分加权回归模型中也证实了这些关联。在亚组分析中，血糖控制较差（HbA1c>=6.5%）的患者存在隐匿性 HE（OR 2.264，95%CI 1.002-5.118）和显性 HE（HR 4.116，95%CI 1.791-9.459）的风险明显增加。
糖尿病可能与肝硬化患者隐匿性 HE 的存在和显性 HE 的发生风险增加相关。适当的血糖控制可能是减轻这一重要并发症的潜在目标。
