Observational Research Of Clinical Characteristics, Prognosis And Indicators Of Glucose Metabolism In Patients With Decompensated Liver Cirrhosis And Diabetes

Objective To understand the incidence of diabetes in decompensated liver cirrhosis, clinical characteristics and outcomes of decompensated liver cirrhosis with diabetes. To analyze the similarities and differences of clinical characteristics and prognosis between liver cirrhosis with hepatogenous diabetes(HD) and type2diabetes(T2DM), and explore the significance of indicators of glucose metabolism in the diagnosis of of HD.Methods1. It was a retrospective study. Retrospective analysis of clinical data of412cases hospitalized decompensated liver cirrhosis from January2006to December2009at the department of gastroenterology, the first affiliated hospital of anhui medical university. According to diagnostic criteria of diabetes, divide them into liver cirrhosis combining with diabetic group and non-diabetic group, then contrast analysis the clinical characteristic, complication, liver functional classification and turnover.2. It was a prospective study. Collected clinical data of246cases decompensated liver cirrhosis, attending the Department of Gastroenterology in our hospital from November2010to April2012. According to diagnostic criteria of diabetes, divide them into liver cirrhosis combining with diabetic group(LC-DM) and non-diabetic group(LC). Diabetic group line OGTT and insulin C-peptide release test, then divided them into hepatogenous diabetes group(HD) and type2diabetes group(T2DM) according to the inclusion criteria of hepatogenous diabetes. All patients were followed until death or study termination. Contrast analysis the clinical, prognosis and indicators of glucose metabolism of every group. Results1. Retrospective clinical analysis of decompensated liver cirrhosis combining with diabetes There were total412cases of decompensated liver cirrhosis, including313cases of non-diabetes(76.0%) and99cases of diabetes(24.0%). There were46cases of which diabetes occurred after or combined with cirrhosis(hepatogenous diabetes,46.5%), and53cases of which diabetes occurred before cirrhosis(type2diabetes,53.5%). The incidence rate of diabetes in females of liver cirrhosis was significantly higher than that in males (45/99vs89/313,P<0.05). The mean age of liver cirrhosis combining with diabetic group was higher than that of non-diabetic group (63.03±11.69years vs53.97±14.47years,P<0.05). Liver cirrhosis combining with diabetic group was easier to happen upper gastrointestinal bleeding, hepatic encephalopathy, and electrolyte disturbances, and mortality in hospital was higher than non-diabetic group (P<0.05). There was no significant difference of clinical characteristic, Child-Pugh class, and incidence of liver cirrhosis complication in hepatogenous diabetes group and non-hepatogenous diabetes group (P>0.05).2. Prospective research of clinical, prognosis and indicators of glucose metabolism of decompensated liver cirrhosis and diabetes (1) The incidence of liver cirrhosis with diabetes was29.3%(72/246), including HD45.8%(33/72), and T2DM54.2%(39/72). Follow-up mortality rate was17.9%(44/246), and the mortality was26.4%(19/72) in patients with diabetes.(2)LC-DM group compared with LC group, hospitalization days were longer(P<0.05), the incidence of upper gastrointestinal bleeding, hepatic encephalopathy and electrolyte disturbances were higher(P<0.05). And the Child-Pugh score and the mortality rate were significantly higher in diabetes group than without diabetes group(P<0.05).(3)OGTT and insulin C-peptide releasing test showed that HD group had hyperinsulinemia, C-peptide secretion curve was normal, and T2DM group had insulin hyposecretion, C-peptide secretion curve was flat. There were no statistically significant differences in complications, hospitalization days, liver function classification and mortality in HD and T2DM group(P>0.05).(4) Univariate analysis showed that: age≥60years old, albumin<28g/L, diabetes and Child-Pugh C level were influence factors of death of liver cirrhosis patients. Multiple factors logistic regression analysis showed that only Child-Pugh C level was an independent predictor of death(OR=3.056,P=0.013).Conclusions1. The patients of decompensated liver cirrhosis and diabetes have a poor liver function, longer hospitalization days, high rate of cirrhosis complications and a high mortality rate.2. There is no significant difference in distinguishing HD and T2DM about the clinical outcome and prognosis.3. The patients of HD have hyperinsulinemia and normal C peptide secretion curve. Insulin and C peptide release test have some prompt significance in the diagnosis of HD.