Hepatogenous Diabetes And Its Association With Prognosis In Patients With Acute Exacerbation Of Chronic HBV Infection

Objective:To explore the clinical characteristics of hepatogenous diabetes(HD)and its association within 90 days prognosis in patients with acute exacerbation(AE)of chronic hepatitis B virus(HBV)infection.Method:265 patients with AE of chronic HBV infection who were hospitalized in the Department of Infectious Diseases of our hospital from October 2017 to December 2020were selected as subjects for this prospective study.According to the inclusion and exclusion criteria,214 patients with AE of chronic HBV infection were finally enrolled.All patients underwent oral glucose tolerance tests(OGTT)when they were admitted to the hospital,and the diagnosis of HD was based on its measured values.patients with acute exacerbation of chronic hepatitis B virus infection were divided into chronic hepatitis B(CHB),liver cirrhosis(LC)and acute-on-chronic liver failure(ACLF)groups,among them,CHB patients have no LC basis,and LC patients have not progressed to ACLF.The clinical characteristics of patients with HD were compared to these of without HD in each groups.Finally,According to whether ACLF patients died within 90 days after admission,they were divided into death group and non-death group.Univariate and multivariate Cox regression were used to analyze the correlation between ACLF patients with HD and prognosis within 90 days.Results:Of the 214 patients with AE of chronic HBV infection,48(22.4%)of patients were identified as CHB,70(32.7%)of patients suffer from LC,and 96(44.9%)of patients had ACLF.In the group of patients with CHB,these with HD had significant higher level ofα-fetoprotein(AFP)than that in patients without HD(P<0.05);in the patients with LC,these with HD had significant lower levels of platelets(PLT)and homeostasis model assessment 2-beta-cell function(HOMA2-β)than that in patients without HD(P<0.05).In the patients with ACLF,these with HD had significant lower levels of uric acid(UA)and HOMA2-βthan those in patients without HD(P<0.05).The incidence of HD in ACLF patients(53.1%)was significantly higher than those in patients with CHB(20.8%)or with LC(47.1%)(P<0.05).the homeostasis model assessment2-insulin resistance(HOMA2-IR),HOMA2-βand international normalized ratio(INR),total bilirubin(TBIL),model for end-stage liver disease(MELD)of patients with ACLF are significantly higher than those of CHB patients and LC patients,and the homeostasis model assessment 2-insulin sensitivity(HOMA2-IS),prothrombin activity(PTA),albumin(ALB),sodium(Na~+),UA,total cholesterol(TC),high-density lipoprotein(HDL),PLT was significantly lower than that in CHB patients and LC patients(P<0.05).24 patients(25.0%)of ACLF died within 90 days.Patients who died within 90 days had significantly higher levels of Age,HD incidence rates,INR,TBIL,and MELD scores and significant lower levels of fasting insulin(FINS)than the control.Age,HD,INR,TBIL and MELD scores were found as the risk factors related to death,The(HR=3.601,95%CI:1.342～9.661)and age(HR=1.045,95%CI:1.010～1.082)were independent risk factors,which contribute to death rate within 90 days of ACLF patients through multivariate Cox regression analysis.Conclusion:1.As acute and chronic liver injury worsens,patients with AE of chronic HBV infection have obvious insulin resistance and insulin insensitivity,and the incidence of HD has increased significantly;2.The occurrence of HD in patients with acute exacerbation of chronic HBV infection in LC and ACLF related to the decrease of pancreaticβ-cell function;3.Age and HD was one of independent risk factors related to death within 90 days in patients with ACLF.