Service d'Hépato-Gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
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 Res Hepatol Gastroenterol. 2024 Oct;48(8):102428. doi: 10.1016/j.clinre.2024.102428. Epub 2024 Jul 23.
The prevalence of insulin resistance (IR) and type 2 diabetes mellitus (T2DM) is higher in patients with cirrhosis, compared to control patients without liver disease. The exact mechanism for this is unknown but could include liver inflammation. In this study we investigate whether cirrhosis is the primum movens of IR or if impaired insulin sensitivity is already present in non-cirrhotic patients with chronic liver diseases.
Patients were recruited and divided into three groups: control (CTL), chronic liver disease without cirrhosis (CLD) and cirrhosis (CIR). In patients not taking pharmacological treatment for T2DM, IR was quantified using the homeostasis model assessment of insulin resistance (HOMA-IR). The proportion of patients with T2DM as well as HOMA-IR levels among different disease etiologies were recorded and compared.
532 patients were included in our study. Median glycemia and insulinemia and therefore HOMA-IR values were significantly different between the three cohorts (p-value <0.001): IR levels in CLD subjects lie between those seen in CTL and CIR subjects. The proportion of diabetic patients in the two case categories also differs (p-value = 0.027): one quarter of CLD subjects and one third of CIR patients suffer from T2DM. Finally, HOMA-IR levels vary according to disease etiology (p-value <0.001): metabolic steatosis and chronic viral hepatitis C are at greater risk than alcohol and other disease causes.
CLD is already a predisposing factor to T2DM, regardless of the presence of CIR. CIR is a factor which elicits additional increase in insulin levels. Metabolic steatosis and hepatitis C are associated with more severe IR.
与无肝脏疾病的对照患者相比，肝硬化患者的胰岛素抵抗（IR）和 2 型糖尿病（T2DM）患病率更高。其确切机制尚不清楚，但可能包括肝脏炎症。在这项研究中，我们研究了肝硬化是否是 IR 的首要原因，或者非肝硬化慢性肝病患者是否已经存在胰岛素敏感性受损。
招募患者并将其分为三组：对照组（CTL）、无肝硬化的慢性肝病（CLD）和肝硬化（CIR）。在未接受 T2DM 药物治疗的患者中，使用稳态模型评估胰岛素抵抗（HOMA-IR）来量化 IR。记录不同病因的 T2DM 患者比例以及 HOMA-IR 水平，并进行比较。
我们的研究共纳入 532 名患者。三组之间的中位血糖和胰岛素水平，因此 HOMA-IR 值存在显著差异（p 值<0.001）：CLD 患者的 IR 水平介于 CTL 和 CIR 患者之间。两种病例类别的糖尿病患者比例也不同（p 值=0.027）：四分之一的 CLD 患者和三分之一的 CIR 患者患有 T2DM。最后，HOMA-IR 水平根据疾病病因而有所不同（p 值<0.001）：代谢性脂肪变性和慢性丙型肝炎比酒精和其他疾病原因的风险更高。
无论是否存在 CIR，CLD 已经是 T2DM 的一个易感因素。CIR 是引起胰岛素水平进一步升高的一个因素。代谢性脂肪变性和丙型肝炎与更严重的 IR 相关。
