CAJ | 학술논문

目的：分析肝硬化合并糖尿病患者的临床特征、转归及预后，并探讨其相关危险因素。方法回顾性分析2011年1月至2011年12月间住院的133例肝硬化合并糖尿病患者，并随机抽取同期住院的137例肝硬化无糖尿病患者，从临床特点、生化检查、并发症、肝功能分级、转归等进行对比分析研究。结果肝硬化合并糖尿病患者和肝硬化无糖尿病患者的平均年龄分别为（55.9±11.0）岁和（50.2±12.0）岁，平均住院天数为（15.6±11.3）天和（12.8±8.4）天，入院时空腹血糖为（9.8±5.5） mmol/L和（5.1±2.1） mmol/L，天门冬氨酸氨基转移酶为（83.2±98.6） u/L和（65.3±88.8） u/L，白蛋白为（29.1±4.7） g/L和（30.5±5.5）g/L，甘油三脂为（1.1±0.9） mmol/L和（0.7±0.4） mmol/L，血钠为（134.3±5.1） mmol/L和（135.8±5.7） mmol/L，差异均具有显著统计学意义（P均＜0.05）；合并糖尿病患者酒精性病因（11.3%）、Child-Pugh C级（26.3%）、腹水（36.8%）、自发性腹膜炎（33.8%）、肝性脑病（18.0%）和高血压（21.1%）所占比例显著高于无糖尿病患者（3.7%、11.3%、29.9%、22.6%、9.0%和2.9%，P均＜0.05）；合并糖尿尿病患者住院期间病死率为18.8%，显著高于无糖尿病患者（9.5%，P＜0.05）；经Logistic分析显示，高龄、住院时间、高血压、高血糖、高甘油三酯（OR 值分别1.054、1.052、16.182、1.503和1.503，P均＜0.01）是肝硬化患者发生糖尿病的危险因素。结论与肝硬化无糖尿病患者相比，合并糖尿病的肝硬化患者肝功能状况和预后差，糖尿病可能是肝硬化患者预后不佳的危险因素。
목적：분석간경화합병당뇨병환자적림상특정、전귀급예후，병탐토기상관위험인소。방법회고성분석2011년1월지2011년12월간주원적133례간경화합병당뇨병환자，병수궤추취동기주원적137례간경화무당뇨병환자，종림상특점、생화검사、병발증、간공능분급、전귀등진행대비분석연구。결과간경화합병당뇨병환자화간경화무당뇨병환자적평균년령분별위（55.9±11.0）세화（50.2±12.0）세，평균주원천수위（15.6±11.3）천화（12.8±8.4）천，입원시공복혈당위（9.8±5.5） mmol/L화（5.1±2.1） mmol/L，천문동안산안기전이매위（83.2±98.6） u/L화（65.3±88.8） u/L，백단백위（29.1±4.7） g/L화（30.5±5.5）g/L，감유삼지위（1.1±0.9） mmol/L화（0.7±0.4） mmol/L，혈납위（134.3±5.1） mmol/L화（135.8±5.7） mmol/L，차이균구유현저통계학의의（P균＜0.05）；합병당뇨병환자주정성병인（11.3%）、Child-Pugh C급（26.3%）、복수（36.8%）、자발성복막염（33.8%）、간성뇌병（18.0%）화고혈압（21.1%）소점비례현저고우무당뇨병환자（3.7%、11.3%、29.9%、22.6%、9.0%화2.9%，P균＜0.05）；합병당뇨뇨병환자주원기간병사솔위18.8%，현저고우무당뇨병환자（9.5%，P＜0.05）；경Logistic분석현시，고령、주원시간、고혈압、고혈당、고감유삼지（OR 치분별1.054、1.052、16.182、1.503화1.503，P균＜0.01）시간경화환자발생당뇨병적위험인소。결론여간경화무당뇨병환자상비，합병당뇨병적간경화환자간공능상황화예후차，당뇨병가능시간경화환자예후불가적위험인소。
Objective To analyze the clinical features,outcomes,prognosis and related risk factors of cir-rhotic patients complicated with diabetes. Methods Retrospective analysis was conducted in 133 cases of cir-rhotic patients complicated with diabetes and 137 random cases of cirrhotic patients without diabetes from January 2011 to December 2011;the clinical characteristics,biochemical examination,complications,classification of liver function and disease outcome were recorded and compared. Results Average age of cirrhotic patients complicated with diabetes and non-diabetic cirrhotic patients were(55.9±11.0) years and(50.2 ±12.0) years respectively,aver-age hospital stays were(15.6±11.3) days and (12.8±8.4) days,fasting blood glucose were (9.8±5.5) mmol/L and (5.1±2.1) mmol/L,aspartate aminotransferase (AST) were (83.2±98.6) u/L and (65.3±88.8) u/L,albumin (ALB) were (29.1±4.7) g/L and (30.5±5.5) g/L,triglycerides were (1.1±0.9) mmol/L and (0.7±0.4) mmol/L,and serum sodium were (134.3±5.1) mmol/L and(135.8 ± 5.7) mmol/L,respectively (P<0.05 for all). In patients with dia-betes,the numbers of alcoholic causes,Child-Pugh C grade,ascites,spontaneous bacterial peritonitis,hepatic en-cephalopathy and hypertension were significantly higher than those without diabetes (11.3 vs 3.7%,26.3 vs 11.3%, 36.8 vs 29.9%,33.8 vs 22.6%,18.0 vs 9.0% and 21.1 vs 2.9%,respectively,P<0.05 for all);Meanwhile,the mor-tality during hospitalization of patients with diabetes was significantly higher than that of patients without diabetes (18.8 vs 9.5%,P<0.05). The Logistic analysis revealed that advanced age,duration of hospitalization,hyperten-sion,hyperglycemia and triglyceride were the risk factor for diabetes in cirrhotic patients (odds ratio were 1.054, 1.052,16.182,1.503 and 1.503 respectively,P<0.01 for all). Conclusion Compared with cirrhotic patients without diabetes,liver function and prognosis of cirrhotic patients with diabetes was poorer. Diabetes may contribute to the poor prognosis of patients with cirrhosis.