Kingston M E, Ali M A, Atiyeh M, Donnelly R J
Gastroenterology. 1984 Sep;87(3):688-94.
One hundred consecutive patients with nonautoimmune chronic active hepatitis (51% HBsAg-positive), 50 patients with cirrhosis (38% HBsAg-positive), 25 patients with chronic persistent hepatitis, and 118 patients with hepatoma who were seen at this hospital were reviewed to determine the prevalence and characteristics of glucose intolerance and diabetes in these conditions. Diabetes (fasting serum glucose greater than 7.8 mmol/L, 140 mg/dl on two separate occasions) was present in 8% of patients with chronic persistent hepatitis and mild chronic active hepatitis, 44% of patients with severe chronic active hepatitis, 40% of patients with cirrhosis, and 15% of patients with hepatoma, compared with 7% of all other patients aged 35 yr or over, undergoing liver biopsy. Compared with this high prevalence of diabetes in liver disease, only 3% of diabetic patients referred to the hospital diabetic clinic had chronic hepatitis or cirrhosis. Glucose tolerance was similar in chronic active hepatitis and cirrhosis and was characterized initially by basal hyperinsulinemia, normal basal glucose levels but elevated serum glucose following glucose loading, and evidence of insulin resistance. We suggest that the high prevalence of diabetes in chronic active hepatitis and cirrhosis in Saudi Arabia is due to the insulin resistance of chronic liver disease acting over many years in a population with a high genetic predisposition to diabetes.
对在本院就诊的100例非自身免疫性慢性活动性肝炎患者（51% HBsAg阳性）、50例肝硬化患者（38% HBsAg阳性）、25例慢性持续性肝炎患者和118例肝癌患者进行了回顾，以确定这些疾病中葡萄糖耐量异常和糖尿病的患病率及特征。与所有其他接受肝活检的35岁及以上患者中的7%相比，糖尿病（空腹血清葡萄糖大于7.8 mmol/L，两次独立测量均大于140 mg/dl）在慢性持续性肝炎和轻度慢性活动性肝炎患者中占8%，在重度慢性活动性肝炎患者中占44%，在肝硬化患者中占40%，在肝癌患者中占15%。与肝病中糖尿病的高患病率相比，转诊至医院糖尿病门诊的糖尿病患者中只有3%患有慢性肝炎或肝硬化。慢性活动性肝炎和肝硬化患者的葡萄糖耐量相似，其特征最初为基础高胰岛素血症、基础血糖水平正常但葡萄糖负荷后血清葡萄糖升高以及存在胰岛素抵抗。我们认为，沙特阿拉伯慢性活动性肝炎和肝硬化中糖尿病的高患病率是由于慢性肝病的胰岛素抵抗在对糖尿病具有高度遗传易感性的人群中作用多年所致。
