Farinati F, Rinaldi M, Del Prato S, Lana S, De Maria N, Paleari D, Marafin C, Naccarato R
Department of Gastroenterology, Padua University, Italy.
Ital J Gastroenterol Hepatol. 1997 Oct;29(5):427-33.
Following a hyperosmolar diabetic coma in a cirrhotic patient with hepatocellular carcinoma undergoing transcatheter arterial chemo-embolization, we assessed the prevalence, severity, causes and prognostic impact of impaired glucose metabolism following transcatheter arterial chemo-embolization.
Plasma glucose, pancreatic and thyroid hormones, cortisol, growth hormone, ACTH and TSH concentrations were determined before and after transcatheter arterial chemo-embolization in 98 patients (70 with a normal fasting glucose, 7 with mild fasting hyperglycaemia and 21 diabetics) undergoing 226 transcatheter arterial chemo-embolization procedures. Child status, body temperature, serum ALT and amylase levels, tumour size, gelfoam embolization and disease aetiology were recorded. Liver function was assessed before and after transcatheter arterial chemo-embolization by measuring monoethylglycinexylidide formation after i.v. lidocaine.
A significant rise in glucose levels (p < 0.0001) was observed in 30/98 patients. Hyperglycaemia was more frequent in diabetics (67%) and patients with mild fasting hyperglycaemia (71%). Glucose concentrations doubled in 12 patients; 4 required long-term insulin. Fever, a previously altered carbohydrate metabolism and raised ALT levels were prognostic factors for hyperglycaemia (p < 0.01). Plasma C-peptide, glucose/insulin and glucose/C-peptide ratios, were increased after transcatheter arterial chemo-embolization (p < 0.05). Transcatheter arterial chemo-embolization was followed by a reduction in the monoethylglycinexylidide formation capacity (p < 0.05), particularly in hyperglycaemia patients (p < 0.02).
Transcatheter arterial chemo-embolization is frequently followed by a derangement in glucose metabolism which is potentially severe, associated with preceding glucose imbalance, fever and a transient deterioration in liver function.
在一名患有肝细胞癌的肝硬化患者接受经动脉化疗栓塞术并发高渗性糖尿病昏迷后，我们评估了经动脉化疗栓塞术后糖代谢受损的发生率、严重程度、原因及预后影响。
对98例患者（70例空腹血糖正常、7例轻度空腹血糖升高和21例糖尿病患者）进行了226次经动脉化疗栓塞术，分别在术前和术后测定血浆葡萄糖、胰腺和甲状腺激素、皮质醇、生长激素、促肾上腺皮质激素和促甲状腺激素浓度。记录Child分级、体温、血清谷丙转氨酶（ALT）和淀粉酶水平、肿瘤大小、明胶海绵栓塞情况及疾病病因。通过静脉注射利多卡因后测定单乙基甘氨酰二甲苯胺的形成来评估经动脉化疗栓塞术前和术后的肝功能。
98例患者中有30例（p < 0.0001）血糖水平显著升高。高血糖在糖尿病患者（67%）和轻度空腹血糖升高患者（71%）中更为常见。12例患者血糖浓度翻倍；4例需要长期胰岛素治疗。发热、既往碳水化合物代谢改变和ALT水平升高是高血糖的预后因素（p < 0.01）。经动脉化疗栓塞术后血浆C肽、葡萄糖/胰岛素和葡萄糖/C肽比值升高（p < 0.05）。经动脉化疗栓塞术后单乙基甘氨酰二甲苯胺形成能力降低（p < 0.05），尤其是在高血糖患者中（p < 0.02）。
经动脉化疗栓塞术后常伴有糖代谢紊乱，可能较为严重，与既往血糖失衡、发热及肝功能短暂恶化有关。
