肝源性糖尿病53例临床剖析.docVIP

肝源性糖尿病53例临床剖析 　　[摘要] 目的：探讨肝源性糖尿病的临床特点、治疗及与慢性肝病临床类型的关系。方法：回顾性分析我院2003年1月～2006年12月诊治的53例肝源性糖尿病患者的临床资料。结果：肝源性糖尿病在急、慢性肝病中的发生率为31.36%(53/169)，在肝硬化中的发生率高于慢性肝炎与慢性重型肝炎，差异有显著性(P＜0.05)。血糖中、重度升高的比率，肝硬化高于慢性肝炎、慢性重型肝炎，差异有显著性(P＜0.05)。通过饮食控制、护肝、抗病毒和（或）胰岛素治疗，除3例死于肝病严重并发症外，其余患者血糖水平均得到有效控制。结论：糖尿病轻重与肝损害程度呈正相关，治疗后随肝损害减轻而糖尿病症状逐步好转。 　　[关键词] 肝炎；肝硬化；肝源性糖尿病 　　[中图分类号] R587.1[文献标识码]C [文章编号]1673-7210（2008）09（c）-031-02 　　 　　Clinical analysis of 53 cases of hepatogenous diabetes 　　ZUO En-zhu 　　（Affiliated Clinic of Limited Company of Municipal Building of Jilin City, Jilin Province，Jilin132011,China) 　　[Abstract] Objective: To investigate the clinical characteristics and treatment of hepatogenic diabetes and the relationship between hepatogenic diabetes and the type of chronic liver diseases. Methods: To analyze clinical data of 53 hepatogenic diabetes cases from January 2003 to December 2006 regressively. Results: The incidence of hepatogenous diabetes was 31.36%(53/169) in acute or chronic liver diseases. There was significant differences between hepatocirrhosis with chronic hepatitis and severe chronic hepatitis in the incidence of hepatogenic diabetes(P＜0.05) and percentage of prominently elevated blood sugar(P＜0.05). Except 3 patients died of severe hepato-complications，all patients blood sugars were controlled effectively by diet control，liver-protecting，antivirus and/or insulin therapy. Conclusion: It is suggested that the scale of the symptomatic severity of diabetes mellitus is positively related to degree of liver function damage. It would be getting over gradually following the recovery of liver function after effective therapy. 　　[Key words] Hepatitis; Hepatocirrhosis; Hepatogenous diabetes 　　 　　1906年Naunyn等学者首次提出将继发于肝实质损害的糖尿病称之为肝源性糖尿病（hepatogenous diabetes，HD）。肝脏是维持血糖代谢平衡的重要器官。无论是急、慢性肝炎，还是肝硬化都有可能由于肝脏的实质性病变，导致糖代谢紊乱而诱发糖尿病（diabetes mellitus，DM）的发生。而慢性肝病（如肝硬化）患者有50%～80%出现糖耐量异常，其中20%～30%最终发展成DM [1]。肝炎或肝硬化与DM并存时可相互影响，形成恶性循环，严重影响预后。现将我院2003年1月～2006年12月有完整资料的53例HD病例分析报道如下： 　　1资料