空腹血糖水平对乙型肝炎病毒相关慢加急性肝衰竭患者疾病转归的影响

doi:10.3969/j.issn.1006-5725.2023.18.015

Abstract

Abstract:

Objective To explore the effect of fasting blood glucose（FPG） on the prognosis of disease in patients with HBV-related acute-on-chronic liver failure. Methods The clinical data of 109 HBV-related ACLF patients admitted to the Department of Infectious Diseases of a tertiary a hospital in Yunnan Province were retrospectively analyzed， and grouped according to different FPG levels and prothrombin international standardized ratio（PT-INR） of prothrombin. ANOVA test， Chi-square test， Spearman correlation analysis and binary logistic regression were used to analyze the effect of FPG level on the prognosis of disease of HBV-related ACLF patients. Results The incidence and mortality of HBV-related ACLF complications （HE， hyponatremia， SBP） in low FPG group were higher than those in normal FPG and high FPG group （P < 0.05）. The incidence of low FPG and mortality of patients in middle-late stage group were higher than those in pre-early stage group （P < 0.05）. Child-Pugh score， MELD score and INR were positively correlated （P < 0.001）. Binary Logistic regression analysis showed that low FPG and normal FPG were independent risk factors for disease progression in HBV-related ACLF patients （OR = 0.174， 95%CI： 0.066 ~ 0.461，P < 0.05）. Conclusion Low FPG increases the risk of worsening disease progression in patients with HBV-related ACLF， while high FPG may play a role in protecting liver function.

Key words: hepatitis B virus, acute-on-chronic liver failure, fasting plasma glucose, risk factors, protection

CLC Number:

R575.3

Haibin WANG,Hui LI,Xiaolei CHEN,Na LIU,Quanmei LI,Yu ZOU,Chunmei LI,Jingquan GAN,Changhui WU,Huaxian CHEN,Xiang LIU,Ming. GONG. Effect of fasting plasma glucose level on the prognosis of disease in patients with HBV⁃related acute⁃on⁃chronic liver failure[J]. The Journal of Practical Medicine, 2023, 39(18): 2373-2378.

Figures/Tables 6

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

References 25

1	中华医学会感染病学分会肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南（2018年版）［J］. 中华传染病杂志， 2019， 37（1）：1-9.
2	SHANG D B， XIANG X G. Advances in the pathogenesis and treatment of acute-on-chronic liver failure［J］. J Clin Hepatol， 2021， 37（4）：765-769.
3	CHOUDHARY N S， SARAF N， SAIGAL S， et al. Letter to the Editor： Incidence and Mortality of Acute on Chronic Liver Failure Using Two Definitions in Patients With Compensated Cirrhosis［J］. Hepatology， 2019， 70（6）：2235-2236.
4	中华医学会感染病学分会，中华医学会肝病学分会. 慢性乙型肝炎防治指南（2019年版）［J］. 中华临床感染病杂志， 2019， 12（6）：401-428.
5	中华医学会风湿病学分会. 自身免疫性肝病诊断和治疗指南［J］. 中华风湿病学杂志， 2011， 15（8）：556-558.
6	中华医学会肝病学分会. 肝硬化诊治指南［J］. 中华肝脏病杂志， 2019， 27（11）：846-865.
7	中华医学会糖尿病学分会. 中国2型糖尿病防治指南（2020年版）［J］. 中华糖尿病杂志， 2021， 13（4）：315-409.
8	LIU L， YUE C X. Application value of Child-Pugh classification combined with serum PA， CHE and PTA levels in the evaluation of patients with liver cirrhosis［J］. Med J Chin Peopleʼs Heal， 2019， 31（13）：114-115.
9	MALINCHOC M， KAMATH P S， GORDON F D， et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts［J］. Hepatology， 2000， 31（4）：864-871.
10	杨燕卿. 重症化慢性乙型肝炎患者进展为慢加急性肝衰竭的危险因素分析及六种评分模型预测价值比较［D］. 遵义：遵义医科大学， 2020.
11	CHEN Y T， KE R S， CAI Q C， et al. Advances in the application of model for end-stage liver disease and MELD-Na scores in liver transplantation［J］. Chin Arch Gen Surg Electron Ed， 2019， 13（6）：488-491.
12	曾雨雨，甘达凯，谢能文，等. 国际标准化比值不同分层的慢加急性肝衰竭患者行人工肝治疗的预后及不良反应观察［J］. 临床肝胆病杂志， 2022， 38（10）：2308-2312.
13	胡晗，胡欣欣，林世德. 糖尿病与HBV感染相关慢加急性肝衰竭患者短期不良预后有关［J］. 临床肝胆病杂志， 2022， 38（2）：432.
14	何娜，江淑贤，郑子梅，等. 慢加急性肝衰竭患者低血糖发生现状及危险因素分析［J］. 中华护理杂志， 2022， 57（7）：846-852.
15	WU F P， LI Y P， YANG Y， et al. Blood glucose and total cholesterol in the prognosis of patients with liver failure［J］. J Pract Hepatol， 2018， 21（3）：413-416.
16	胡欣欣. HBV相关慢加急性肝衰竭患者血糖变化及其危险因素分析［D］. 遵义：遵义医学院， 2018.
17	查锡良. 生物化学与分子生物学［M］. 第9版. 北京：人民卫生出版社， 2018.
18	KANG W J， WU J， WU J S， et al. Effect and mechanism of silent information regulator 6 on gluconeogenesis in acute-on-chronic liver failure［J］. Chin J Hepatobiliary Surg， 2020， 26（3）：165-169.
19	田成，张亚军，李俊，等. 慢加急性肝衰竭并Wernicke脑病1例报道［J］.胃肠病学和肝病学杂志， 2022， 31（3）：331-332.
20	DRUMMOND J B， SOARES B S， VIEIRA E L M， et al. Interleukin-6 response to insulin-induced hypoglycemia is associated with hypothalamic-pituitary-adrenal axis activation［J］. J Neuroimmunol， 2020， 350：577446.
21	WOOLF G M， REDEKER A G. Treatment of fulminant hepatic failure with insulin and glucagon［J］. Dig Dis Sci， 1991， 36（1）：92-96.
22	YUE H W， WANG Y Y. Change rule of blood coagulation， fibrinolysis and anti-coagulation indexes during the progress of chronic hepatitis B［J］. Lab Med Clin， 2020， 17（6）：755-757.
23	NANCHAL R， SUBRAMANIAN R， KARVELLAS C J， et al. Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU： Cardiovascular， Endocrine， Hematologic， Pulmonary and Renal Considerations： Executive Summary［J］. Crit Care Med， 2020， 48（3）：415-419.
24	邓丽红，潘兴飞，李刚. 重症肝炎患者的血糖水平高低与预后的关系［J］. 胃肠病学和肝病学杂志， 2013， 22（8）：794-796.
25	HIBI M， HARI S， YAMAGUCHI T， et al. Effect of Short-Term Increase in Meal Frequency on Glucose Metabolism in Individuals with Normal Glucose Tolerance or Impaired Fasting Glucose： A Randomized Crossover Clinical Trial［J］. Nutrients， 2019， 11（9）：2126.

研究因素	低FPG组（n = 29）	正常FPG组（n = 59）	高FPG组（n = 21）	χ²值	P值
性别				6.184	0.045
男	21（72.4）	40（67.8）	20（95.2）
女	8（27.6）	19（32.2）	1（4.8）
年龄				1.422	0.491
< 40岁	6（20.7）	8（13.6）	5（23.8）
≥ 40岁	23（79.3）	51（86.4）	16（76.2）
PT-INR				13.750	0.001
< 1.9	11（37.9）	46（78.0）	14（66.7）
≥ 1.9	18（62.1）	13（22.0）	7（33.3）
病死率	5（17.2）	1（1.7）	1（4.8）	7.939	0.019
HE	17（58.6）	11（18.6）	7（33.3）	14.272	0.001
低钠血症	20（69.0）	22（37.3）	10（47.6）	7.821	0.020
SBP	23（79.3）	20（33.9）	12（57.1）	16.505	< 0.001
腹水	20（69.0）	25（42.4）	14（66.7）	7.184	0.028

研究因素	前-早期组（PT-INR < 1.9）（n = 71）	中-晚期组（PT-INR ≥ 1.9）（n = 38）	χ²值	P值
性别			0.012	0.913
男	53（74.6）	28（73.7）
女	18（25.4）	10（26.3）
年龄			0.532	0.466
< 40岁	11（15.5）	8（21.1）
≥ 40岁	60（84.5）	30（78.9）
病死率	1（1.4）	6（15.8）	6.293	0.012
FPG水平			13.750	0.001
低FPG	11（15.5）	18（47.4）
正常FPG	46（64.8）	13（34.2）
高FPG	14（19.7）	7（18.4）

研究因素	R值	P值
年龄	-0.136	0.159
住院时间	0.168	0.081
TBil	0.390	< 0.001
ALT	0.104	0.281
ALB	-0.274	0.004
PAB	-0.373	< 0.001
CHE	-0.241	0.011
Scr	-0.008	0.932
Child-Pugh评分	0.587	< 0.001
MELD评分	0.550	< 0.001

研究因素	低FPG组（n = 29）	正常FPG组（n = 59）	高FPG组（n = 21）	F值	P值
TBil（μmol/L）	190.39 ± 131.86	112.29 ± 97.91	105.52 ± 75.62	6.251	0.003
ALT（U/L）	264.45 ± 874.51	178.49 ± 412.81	298.67 ± 488.60	0.421	0.657
ALB（g/L）	26.01 ± 4.87	28.95 ± 5.03	27.63 ± 3.97	3.672	0.029
PAB（mg/L）	62.66 ± 18.66	85.37 ± 36.15	59.24 ± 30.12	8.143	0.001
CHE（U/L）	2 215.41 ± 908.84	3 157.20 ± 1 458.51	2 720.29 ± 1 645.90	4.626	0.012
Scr（μmol/L）	93.41 ± 67.04	63.40 ± 19.86	63.19 ± 14.90	6.658	0.002
PT（s）	23.80 ± 4.99	19.69 ± 2.53	21.50 ± 1.53	15.788	< 0.001
PT-INR	2.08 ± 0.44	1.72 ± 0.22	1.88 ± 0.13	15.756	< 0.001
Child-Pugh评分（分）	12.34 ± 1.84	10.00 ± 2.04	10.96 ± 2.16	17.118	< 0.001
MELD评分（分）	12.97 ± 2.68	9.92 ± 2.07	10.66 ± 1.28	20.027	< 0.001
住院时间（d）	19.69 ± 10.03	14.53 ± 5.26	14.33 ± 3.92	6.500	0.002

研究因素	赋值
性别
女	0
男	1
年龄
< 40岁	0
≥ 40岁	1
PT-INR
< 1.9	0
≥1.9	1
FPG水平
低FPG	0
正常FPG	1
高FPG	2

Effect of fasting plasma glucose level on the prognosis of disease in patients with HBV⁃related acute⁃on⁃chronic liver failure

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 25

Related Articles 15

Recommended Articles

Metrics

Comments

研究因素	B值	S.E.值	χ²值	P值	OR值	95%CI
性别	-0.138	0.513	0.073	0.787	0.871	0.318 ~ 2.382
年龄	-0.266	0.556	0.229	0.632	0.766	0.258 ~ 2.279
低FPG			12.437	0.002
正常FPG	-1.749	0.498	12.348	< 0.001	0.174	0.066 ~ 0.461
高FPG	-1.167	0.613	3.628	0.057	0.311	0.094 ~ 1.034

[1]	Qingqing WANG,Jie DING,Haiwen LI,Zhijian DONG,Yiying WANG,Siqi LIU,Guoji CHANG,Lijuan HUA,Huayi CHEN,Shenghao LI,Yongrui. YANG. Analysis of factors influencing short⁃term adverse clinical outcome in cirrhotic patients with grade 2/3 ascites [J]. The Journal of Practical Medicine, 2024, 40(8): 1114-1120.
[2]	Xiaotong LIU,Xianhua SU,Zhijun XIN,Fengqiong GAO,Jiayi FENG,Tongxia. XIA. Risk factors of postoperative complications in patients with spinal tuberculosis and the predictive value of prognostic nutritional index [J]. The Journal of Practical Medicine, 2024, 40(7): 972-978.
[3]	Changzhi GUO,Tao SUN,Shuman HAN,Lingxiang WANG,Mengjing. NIU. Risk factors of peripheral infections of knee joint tumor prosthesis and predictive value of serum D⁃dimer and TLR2 [J]. The Journal of Practical Medicine, 2024, 40(6): 814-819.
[4]	Xilin WANG,Chanjuan YANG,Daomeng. CHENG. Construction of a nomogram prediction model for aggressive behavior in patients with bipolar disorder [J]. The Journal of Practical Medicine, 2024, 40(5): 677-681.
[5]	Bo ZOU,Longchuan ZHU,Dakai GAN,Xinyao ZHANG,Xuebing YAO. Effects of LPE combined with DPMAS on liver function and inflammatory cytokines in patients with acute⁃chronic liver failure [J]. The Journal of Practical Medicine, 2024, 40(3): 348-352.
[6]	Huiqun WANG,Chao YE,Chao XU,Si CHEN,Kaiguang ZHANG,Mei. XIAO. A 5⁃year follow⁃up study of rebleeding after endoscopic treatment of esophageal gastric varices rebleeding associated with liver cirrhosis [J]. The Journal of Practical Medicine, 2024, 40(22): 3155-3159.
[7]	Shijun LUO,Lizi ZHANG,Dunjin. CHEN. Diagnosis， prevention and treatment of placenta accreta spectrum with non⁃traumatic factors [J]. The Journal of Practical Medicine, 2024, 40(21): 2971-2975.
[8]	Lili TANG,Xueming LI,Liming LEI,Xiaodong ZENG,Yun LING,Qiongyu LIN,Sumin. ZHU. Risk factors for prolonged ICU stay after surgery in patients with infective endocarditis [J]. The Journal of Practical Medicine, 2024, 40(20): 2854-2859.
[9]	Yang ZHOU,Jiaxin HUANG,Jianchao. LI. Closed femoro⁃femoral partial bypass management strategies for thoracoabdominal aortic replacement [J]. The Journal of Practical Medicine, 2024, 40(19): 2760-2765.
[10]	Xianghong CHEN,Xiumin CHEN,Yingyan ZHOU,Li LI,Zhenxiong. XU. Advancements in the investigation of cardiovascular risk associated with idiopathic inflammatory myopathy [J]. The Journal of Practical Medicine, 2024, 40(19): 2801-2805.
[11]	Jun ZHENG,Qiye WU,Xia ZENG,Zhixian LEI,Dufei. ZHANG. Clinical characteristics and risk factors of the occurrence of hypoxic hepatitis in children with shock [J]. The Journal of Practical Medicine, 2024, 40(15): 2126-2132.
[12]	Lanrong WANG,Xiaocui WANG,Yang CAO,Rui LI,Weihong WANG,Yingxi XU,Weixiang SHI,Yufei YANG,Ke MENG,Wei. ZHANG. A cross⁃sectional study on the risk of early screening for lung cancer in Zhengzhou City [J]. The Journal of Practical Medicine, 2024, 40(15): 2154-2160.
[13]	Guirong CHEN,Minggang WANG,Huaming LIN,Xinxin CHEN,Juan LUO,Fengqin YE,Xiufeng. WANG. Potential value of liver macrophages and their plasticity in the treatment of ACLF [J]. The Journal of Practical Medicine, 2024, 40(14): 2035-2040.
[14]	Yan WANG,Tiejun PAN,Zhenyu LIU,Jinbo SUN,Yu ZHOU,Chaosheng LI,Lei. GAO. Protective role of intestinal microbial network in hyperoxaluria⁃induced kidney impairment in rats [J]. The Journal of Practical Medicine, 2024, 40(13): 1771-1777.
[15]	Qian DOU,Yuzhen ZHANG,Yong. ZHOU. EBV infection and influencing factors of nasopharyngeal carcinoma screening population in Guangzhou [J]. The Journal of Practical Medicine, 2024, 40(10): 1440-1444.