The prevalence of diabetes mellitus in chronic liver disease / 대한내과학회지

The insulin resistance and the altered glucose metabolism in chronic liver disease increase the alteration of glucose intolerance and the prevalence of diabetes mellitus. The prevalence of DM is higher in advanced cirrhosis than in early cirrhosis and higher in C-viral hepatitis or alcoholic liver disease than in B-viral hepatitis. The purpose of this study is to assess the prevalence of DM in chronic liver disease in Korea. METHODS: We reviewed the medical records of 417 patients with chronic liver disease who visit the Yonsei University Sevrance Hospital from January 1994 to March 1998. We examined fasting blood sugar, biochemical study and abdominal ultrasonography. DM was defined on the basis of fasting hyperglycemia (fasting blood sugar exceeding 140 mg/dl) at least two consecutive samples or active treatment with insulin or oral hypoglycemic agents. RESULTS:1) The DM prevalence was 16.8%(70 cases) in total patients and 25.0% (56 cases) in cirrhotic patients. 2) According to sex, there was no statistically significant difference in DM prevalence(16.8% in men and 18.1% in women P=0.78). 3) The DM prevalence was increased with increasing of age(0% in below 30 years, 4.9% in 31-40, 19.6% in 41-50, 22.9% in 51-60, 21.3% in 61-70 and 44.4% in over 71 years, p<0.01). 3) According to severity of liver disease, the DM prevalence was higher in uncompensated cirrhosis than in compensated cirrhosis(2.3% in chronic viral carrier, 8.8% in chronic hepatitis, 17.9% in cirrhosis Child class A, 33.9% in class B, 29.5% in class C). 4) According to cause of liver disease, the DM prevalence was higher in C-viral hepatitis and alcoholics than in B-viral hepatitis(12.1% in B-viral hepatitis, 35.1% in C-viral hepatitis, 40.0% in alcoholics). CONCLUSION: The prevalence of diabetes in the patients with chronic liver disease is much higher than in general population. And the DM prevalence is increased in advanced cirrhosis and C-viral or alcoholic hepatitis. The early diagnosis and treatment of DM in chronic liver disease patients are important.

Seroconversion in Nonresponders to Hepatitis B vaccination after double dose vaccination only once

BACKGROUND: Korea is, known to be an endemic area of viral hepatitis B, and 5-6% of population are carriers. Immunization can reduce the spread of hepatitis B infection. Hower, not all people respond to hepatitis B immunsation. 5-15% of primary vaccinees fail to be immunized. After revaccination, only 37.5 44% of the primary failures elicit antibody response. Recent studies have reported that it is effective to inject a double dose vaccination in immunocompromsed patients. In some country, they recommend that neonate whode mother is HBV carrier shoud receive double dose vaccination. This study documented the results of double dose vaccintion only once to nonrsponders toward the HBV immunzation. METHODS: Healthy nonresponders to Hepatitis B immunization were recuited from Sep. 1995 to Aug. 1996. Subjects with their AST/ALT level over 40, or over 65 years old were excluded. They were received 2ml of plasma-derived vaccine(Hepavax-B) intramuscularly in the deltoid muscle. Anti-HBs antibody testing were performed at 1 to 3 months after vaccintion. RESULTS: 17 healthy nanreponders to Hepatitis B immunization(male 10, female 7) were included. Their mean ages were 47(32 to64), AST/ALT level 20/19(16 to 28/11 to 35), smoking 4.3pys(1 to 7). Seroconversion occured in 13 of them(76.5%). CONCLUSIONS: Nonresponders to Hepatitis B vaccintion respond well to double dose vaccination once.