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目的：探讨肝硬化患者糖代谢及胰岛β细胞分泌功能的变化。方法：对２１名正常人和７１例肝硬化患者进行葡萄糖耐量试验、胰岛素和Ｃ肽释放试验，肝硬化组按葡萄糖耐量试验结果分为４小组。分别比较空腹及２小时的血糖、胰岛素和Ｃ肽水平。结果：肝硬化糖代谢异常总发生率占６９％（４９／７１）。糖耐量减低组空腹及２小时的胰岛素、Ｃ肽水平等４项指标高（与其余各组相比，Ｐ＜０．０１），但随着糖代谢紊乱程度的逐渐加重而减少，在重型糖尿病组此４项指标呈显著低水平（与其余各组相比，Ｐ＜０．０１或Ｐ＜０．０５）。结论：肝硬化有较高的糖代谢异常发生率。肝硬化病人存在严重的胰岛素抵抗和高胰岛素血症。胰岛素抵抗和高胰岛素血症可能是β细胞分泌功能紊乱和肝源性糖尿病发生、发展的重要原因。
Objective: To investigate the changes of glucose metabolism and pancreatic β-cell secretion in patients with cirrhosis. Methods: Twenty - one normal subjects and 71 cirrhotic patients underwent glucose tolerance test, insulin and C peptide release test. The liver cirrhosis group was divided into 4 groups according to the results of glucose tolerance test. Fasting and 2-hour blood glucose, insulin and C-peptide levels were compared. Results: The total incidence of hepatic cirrhosis with abnormal glucose metabolism accounted for 69% (49/71). The fasting and 2-hour insulin and C-peptide levels in the impaired glucose tolerance group were higher than those in other groups (P <0.01), but decreased with the aggravating degree of glucose metabolism. In severe diabetes mellitus The four indicators were significantly lower (P <0.01 or P <0.05, compared with the rest of the groups). Conclusion: Cirrhosis has a higher incidence of abnormal glucose metabolism. Patients with cirrhosis have severe insulin resistance and hyperinsulinemia. Insulin resistance and hyperinsulinemia may be an important reason for the occurrence and development of β-cell dysfunction and liver-derived diabetes.