Service d'Hépato-gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
Laboratory of Hepatology and Gastroenterology, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium.
Clin Sci (Lond). 2020 Aug 28;134(16):2117-2135. doi: 10.1042/CS20200022.
End-stage chronic liver diseases are often associated with insulin resistance (IR) and diabetes mellitus (DM). Indeed, to quantify insulin sensitivity the euglycemic clamp technique was utilized, allowing the following to be stated: in small groups of patients, an IR in almost all cirrhotic patients can be observed, compared with a control group. Additionally, it has been demonstrated that IR in cirrhosis is linked to a decreased peripheral (muscle) glucose uptake rather than an increased liver glucose production. The homoeostasis model of IR (HOMA-IR) technique, devised only later, was then exploited to assess this same phenomenon in a larger sample population. The research established that even in patients with preserved liver function, cirrhosis is associated with significant alterations in glucose homoeostasis levels. The purpose of the present paper is to present the current research around the affiliation of cirrhosis and IR, discuss potential mechanisms explaining the association between cirrhosis and IR (i.e. endocrine perturbation, liver inflammation, altered muscle mass and composition, altered gut microbiota and permeability), complications that can arise as well as treatment options, through a critical review of the literature surrounding this subject. This research will also be investigating the beneficial impact, if there is any, of identifying and curing IR in patients with cirrhosis.
终末期慢性肝脏疾病常伴有胰岛素抵抗（IR）和糖尿病（DM）。实际上，为了量化胰岛素敏感性，使用了正葡萄糖钳夹技术，可以得出以下结论：在小部分患者中，几乎所有肝硬化患者都存在 IR，与对照组相比。此外，已经证明肝硬化中的 IR 与外周（肌肉）葡萄糖摄取减少有关，而不是肝葡萄糖生成增加有关。随后，利用后来开发的稳态模型评估胰岛素抵抗（HOMA-IR）技术，在更大的样本人群中评估了这种现象。研究表明，即使在肝功能正常的患者中，肝硬化也与葡萄糖稳态水平的显著改变有关。本文的目的是介绍目前关于肝硬化和 IR 之间关联的研究，通过对该主题相关文献的综述，讨论解释肝硬化和 IR 之间关联的潜在机制（即内分泌紊乱、肝脏炎症、肌肉质量和组成改变、肠道微生物群和通透性改变）、可能出现的并发症以及治疗选择，并探讨如果存在的话，识别和治疗肝硬化患者的 IR 会有什么有益影响。
