摘要目的 探讨老年肝硬化合并糖尿病患者胰岛素抵抗,以及其与肝功能的关系,为临床治疗提供参考. 方法 选择老年肝硬化患者、老年肝硬化合并糖尿病患者、60岁及以下非老年肝硬化合并糖尿病患者及对照组各30例,测定空腹血浆胰岛素、葡萄糖,计算胰岛素抵抗指数,比较其在各组间的差异,分析其与患者肝功能Child-Pugh分级间的关系. 结果 老年肝硬化组患者血浆胰岛素水平与胰岛素抵抗指数分别为(9.58±3.62) mU/L、2.47±0.88,均明显高于对照组(6.03±1.99)mU/L、2.12±0.99(均P=0.000),老年肝硬化合并糖尿病组患者血糖、血浆胰岛素水平及胰岛素抵抗指数分别为(5.83±1.40)mmol/L、(15.63±6.37)mU/L、6.33±2.59,均明显高于老年肝硬化组(5.03±0.83) mmol/L、(9.58±3.62)mU/L、2.47±0.88及对照组(5.31±0.58) mmol/L、(6.03±1.99)mU/L、2.12±0.99(均P＜0.05).老年肝硬化合并糖尿病组血糖、血浆胰岛素水平及胰岛素抵抗指数与60岁及以下非老年肝硬化合并糖尿病组患者比较差异无统计学意义(均P＞0.05).老年肝硬化合并糖尿病组患者中Child-Pugh分级为C级患者的比例[20例(66.7％)]高于老年肝硬化组患者[11例(36.7％)](x2=5.406,P=0.019);同时也高于60岁及以下非老年肝硬化合并糖尿病组中Child-Pugh C级患者比例(40.0％,12例),差异有统计学意义(x2=4.286,P=0.037).肝硬化及肝硬化合并糖尿病患者的胰岛素抵抗指数在Child Pugh分级为C级者为7.39±2.25,高于B级胰岛素抵抗指数4.90±1.76,而Child-Pugh分级B级者胰岛素抵抗指数4.90±1.76,高于A级2.69±1.02(均P＜0.05). 结论 老年肝硬化患者体内存在高胰岛素血症与胰岛素抵抗,合并糖尿病时更加明显,且合并糖尿病的老年肝硬化患者肝功能状态更差,预后不佳.

abstractsObjective To investigate the relationship between insulin resistance and hepatic function in elderly liver cirrhosis (LC)patients with diabetes (LC-DM)and to provide evidence for clinical treatment.Methods Thirty cases of elderly LC,30 cases of elderly LC-DM,30 younger patients (＜60 years)with LC-DM and 30 healthy subjects were enrolled.Levels of fasting plasma glucose(FPG)and fasting plasma insulin(FINS)were examined to evaluate the homeostasis model for assessment of insulin resistance (HOMA-IR),which was used for comparison between the groups.Moreover,the relationship between HOMA-IR and the Child Pugh classification was also analyzed.Results Patients in the elderly LC group were associated with significantly higher levels of FINS (9.58±3.62 vs.6.03±1.99 mU/L,P＜0.05)and HOMA-IR(2.47±0.88 vs.2.12±0.99,P＜0.05),compared with the control group.Meanwhile,levels of FPG,FINS and HOMA-IR in the elderly LC-DM group were (5.83 ± 1.40) mmol/L,(15.63 ± 6.37) mU/L and 6.33 ± 2.59,respectively,significantly higher than those[(5.03±0.83)mmol/L,(9.58±3.62)mU/L,2.47±0.88]in the elderly LC group and those[(5.31±0.58)mmol/L,(6.03±1.99)mU/L,2.12±0.99]in the control group (all P＜0.05).However,levels of FPG,FINS and HOMA IR were similar between the elderly LC-DM group and the younger LC-DM group(P＞0.05).In the elderly LC-DM group,more patients(66.7 ％) had Child-Pugh C liver function compared with the elderly LC group(36.7 ％)and the younger LC-DM group(40.0％)(both P＜0.05).Of those in the LC and LC-DM groups,levels of HOMA IR were 7.39±2.25 in patients with Child-Pugh C,which were significantly higher than those in patients with Child Pugh B function(4.90± 1.76) and with Child Pugh A liver function(2.69± 1.02)(both P＜0.05).Conclusions Hyperinsulinemia and insulin resistance are more pronounced in elderly LC DM than in elderly LC,with poor liver function and prognosis.