CAJ | 학술논문

目的：探讨肝源性糖尿病（HD）患者的临床特点及生存状况，并对影响HD患者预后的危险因素进行分析。方法收集2011年1月至2012年12月该院消化内科收治的168例肝硬化患者的临床资料，根据患者是否合并糖尿病将患者分为单纯肝硬化组74例，合并HD组48例以及合并2型糖尿病（T2MD）组46例，所有病例以死亡为随访终点。对比分析各组患者临床特点及预后情况。肝硬化患者预后危险因素采用单因素及Logistic多因素分析。结果T2MD组患者糖尿病史高于HD组及肝硬化组（P＜0．05），HD组及T2MD组酒精性肝硬化比例高于肝硬化组（P＜0．05），HD组及T2MD组患者肝性脑病、上消化道出血、电解质紊乱等并发症发生率、病死率、Child‐Pugh评分及住院时间显著高于肝硬化组，差异有统计学意义（P＜0．05），而HD组与T2MD组差异无统计学意义（P＞0．05）。HD组患者总胆红素（TBil）水平高于T2MD组及肝硬化组（P＜0．05），肝硬化组空腹血糖水平（FPG）、胰岛抵抗指数（HOMA‐IR）、总胆固醇（TG）、C肽水平低于HD组及T2MD组（P＜0．05），而HD组FPG、C肽均高于T2MD组（P＜0．05），T2MD组TG水平高于HD组（P＜0．05）。经Logistic多因素分析显示，年龄、饮酒、腹水、合并HD、合并T2DM、Child‐Pugh评分是肝硬化患者死亡的独立危险因素。结论HD患者与肝硬化患者相比并发症发生率及病死率更高，HD可增加肝硬化患者死亡风险。
목적：탐토간원성당뇨병（HD）환자적림상특점급생존상황，병대영향HD환자예후적위험인소진행분석。방법수집2011년1월지2012년12월해원소화내과수치적168례간경화환자적림상자료，근거환자시부합병당뇨병장환자분위단순간경화조74례，합병HD조48례이급합병2형당뇨병（T2MD）조46례，소유병례이사망위수방종점。대비분석각조환자림상특점급예후정황。간경화환자예후위험인소채용단인소급Logistic다인소분석。결과T2MD조환자당뇨병사고우HD조급간경화조（P＜0．05），HD조급T2MD조주정성간경화비례고우간경화조（P＜0．05），HD조급T2MD조환자간성뇌병、상소화도출혈、전해질문란등병발증발생솔、병사솔、Child‐Pugh평분급주원시간현저고우간경화조，차이유통계학의의（P＜0．05），이HD조여T2MD조차이무통계학의의（P＞0．05）。HD조환자총담홍소（TBil）수평고우T2MD조급간경화조（P＜0．05），간경화조공복혈당수평（FPG）、이도저항지수（HOMA‐IR）、총담고순（TG）、C태수평저우HD조급T2MD조（P＜0．05），이HD조FPG、C태균고우T2MD조（P＜0．05），T2MD조TG수평고우HD조（P＜0．05）。경Logistic다인소분석현시，년령、음주、복수、합병HD、합병T2DM、Child‐Pugh평분시간경화환자사망적독립위험인소。결론HD환자여간경화환자상비병발증발생솔급병사솔경고，HD가증가간경화환자사망풍험。
Objective To investigate the clinical characteristics and living conditions of hepatic diabetes (HD) patients and to analyze the risk factors of the prognosis of HD patient .Methods One hundred and sixty‐eight cases of cirrhosis cases were divided into liver cirrhosis group(n=74) ,the combined group cases(n=48)and combined HD type 2 diabetes (T2MD) group(n=46)se‐lected from January 2011 to December 2012 .Death was end point .The clinical features and prognosis of patients were compared . The risk factors for liver cirrhosis were analyzed by the simple factor analysis and Logistic regression analysis .Results The pa‐tients with history of diabetes in T2MD group were more than those in the HD group and the cirrhosis group (P<0 .05) .The pro‐portion of alcoholic cirrhosis cirrhosis of HD group and T2MD group were higher than those in liver cirrhosis group (P<0 .05) . The hepatic encephalopathy ,upper gastrointestinal bleeding ,electrolyte disorders and other complications ,mortality ,Child‐Pugh score and length of hospital stay of HD group and T2MD groups were significantly higher than those in liver cirrhosis group(P<0 .05) ,but there was no significant difference between HD and T2MD group(P>0 .05) .The total bilirubin (TBil) of HD group was higher than those of the T2MD group and liver cirrhosis group(P<0 .05) .The levels of fasting glucose levels(FPG) ,insulin resistance index (HOMA‐IR) ,total cholesterol (TG) ,C‐peptide of liver cirrhosis group were lower than HD group and T2MD group (P<0 .05) .The levels of FPG ,C peptide of HD group were higher than that of T2MD group (P<0 .05) .The levels of TG of T2MD group were higher than that of HD group (P<0 .05) .Logistic multivariate analysis showed that age ,alcohol consump‐tion ,diabetes ,Child‐Pugh score were independent risk factors for death in patients with liver cirrhosis .Conclusion The morbidity and mortality of HD patients may be higher than patients with liver cirrhosis ,and HD could increase the risk of death in patients with liver cirrhosis .