Clinical characteristics, prognosis and indicators of glucose metabolism of liver cirrhosis complicated with diabetes / 中华消化杂志

ABSTRACT

Objective To investigate clinical characteristics and outcome of patients with liver cirrhosis complicated with diabetes,and to explore the differences of clinical characteristics and prognosis between hepatogenous diabetes (HD) and type 2 diabetes mellitus (T2DM).Methods From November 2010 to April 2012,246 patients with liver cirrhosis were collected and divided into liver cirrhosis complicated with diabetes (LC-DM) group (n=72) and liver cirrhosis without diabetes (LC) group (n=174).LC-DM group was then sub-divided into HD group (n=33) and T2DM group (n =39).All the patients were followed up until death or the study endpoint.The clinical characteristics,prognosis and indicators of glucose metabolism were compared and analyzed.Oral glucose tolerance test and insulin C-peptide release test were conducted in part of patients in LC-DM group.Student t test was performed for mean comparison between two groups.Chi-square test was used for count data and rate comparison between two groups.The death related factors of liver cirrhosis were analyzed by Logistic regression analysis.Results The percentage of alcoholic liver cirrhosis of LC-DM group was 18.1 ％ (13/72),which was higher than that of LC group (6.9％,12/ 174) and the difference was statistically significant (x2=6.946,P=0.008).In HD group,the percentage of patients with diabetes family history was 9.1％ (3/33),which was lower than that of T2DM group (30.8％,12/39),the percentage of alcoholic liver cirrhosis was 30.3％ (10/33),which was higher than that of T2DM group (7.7％,3/39),the total bilirubin level ((43.4±57.7) μmol/L) was higher than that of T2DM group ((22.6 ± 13.3) μmol/L),the total cholesterol level ((3.3 ±1.2) mmol/L) was lower than that of T2DM group ((4.0±1.6) mmol/L),and the differences were statistically significant (x2=5.093 and 6.177,t=2.178 and 2.014,P=0.024,0.013,0.033 and 0.048).The duration of hospitalization,Chiid-Pugh score,the incidence of upper gastrointestinal bleeding,the incidence of hepatic encephalopathy,electrolyte disturbances and mortality of LC-DM group were all higher than those of LC group and the differences were statistically significant(t=2.389 and 2.270,x2 =6.496,5.572,5.194,19.646,all P＜0.05),and there was no significant difference between HD group and T2DM group(all P＞0.05).The blood glucose levels of HD group at different time point (0,30,60,120,180 min) were all lower than those of T2DM group and the differences were statistically significant (t=3.175,2.345,3.444,3.090,3.542,all P＜0.05).The fasting insulin level of HD group was close to that of T2DM group,the insulin levels of HD group at other time point (30,60,120,180 min) were all higher than those of T2DM group and the differences were statistically significant (t =3.084,2.881,3.648,2.840,all P＜ 0.05).There was obvious hyperinsulinemia in HD group.At 0,30,60,120,180 min,C-peptide level of HD group was at normal levels,and which of T2DM group was lower than normal.Child-Pugh grade C was an independent predictor factor of death in patients with liver cirrhosis (OR =3.056,95 ％ CI1.268 ～ 7.346,P=0.013).Conclusions Compared with liver cirrhosis patients without diabetes,the liver function of patients complicated with diabetes was worse,and the incidence of complication and mortality was higher.However there was no significant difference between HD group and T2DM group.