The Study Of Insulin Resistance: In Liver Cirrhosis With Diabetes Mellitus And Relationship With Hepatic Function

Objective:The aim of the present study was to examine the relationship between the patients with liver cirrhosis and the patients with diabetes mellitus in liver cirrhosis and theirs insulin resistance. Additionally, research the relationship between the insulin resistance and hepatic function.Methods:Sixty patients with liver cirrhosis without diabetes mellitus, sixty patients with diabetes mellitus in liver cirrhosis and sixty normal subjects were elected to investigate the changes of fasting plasma glucose (FPG), fasting plasma insulin(FINS) and hepatic function.Applying radioimmunoassay to examine FINS and glucose oxidase device to examine FPG. Homeostasis Model for Assessment of Insulin Resistance (HOMA-IR):HOMA-IR=FPG×FINS/22.5. Using Jendrassik-Grof examine total bilirubin, dye bromcresol green examine albumin, handiwork method examine prothrombin time and investigate the hepatic encephalopathy,ascites of the elected patients to calculate the Child-Pugh. According Child-Pugh classification to evaluate the damage of hepatic function and the elected patients were classified Child-Pugh A,B,C. Meanwhile adopting chromatometry to detect cholesterol, fluorometric method to detect triglyceride, precipitation method to detect alpha-lipoprotein and low density lipoprotein for the purpose of observing the difference between the patients and normal subjects. Statistics method was to elect SPSS 11.5 software package to saving and handling data. Measurement data was demonstrated by x±s. Comparison of two groups used t-test and three groups used q-test. Enumeration data used X2 test. Results:1. There was no difference of FPG between the patients with liver cirrhosis and normal subjects(P>0.05), but the FINS and HOMA-IR of the patients with liver cirrhosis was higher than the normal subjects(P<0.05). All the FPG, FINS and HOMA-IR of the patients with diabetes mellitus in liver cirrhosis were higher than the patients with liver cirrhosis without diabetes mellitus and normal subjects(P<0.05).2. There was difference of Child-Pugh classification between the patients of liver cirrhosis with diabetes mellitus and without diabetes mellitus. The former of Child-Pugh C was more than the latter and the Child-Pugh A, B were less than the latter(P<0.05).3. All the 120 patients were divided into Child-Pugh A, B, C according to Child-Pugh classification. The FINS of the patients with Child-Pugh C was higher than Child-Pugh A (P<0.05), though was higher than Child-Pugh B, there was no statistical significance(P>0.05).And there was no significant difference between Child-PughA and Child-PughB(P>0.05).The HOMA-IR of the patients with Child-Pugh C was higher than Child-Pugh B and Child-Pugh A (P<0.05), moreover Child-Pugh B was also higher than Child-Pugh A(P<0.05).4. The cholesterol of the patients with liver cirrhosis and with diabetes mellitus in liver cirrhosis were both higher than normal subjects(P<0.05). And the patients with diabetes mellitus in liver cirrhosis were higher than those without diabetes mellitus(P<0.05). The triglyceride of the patients with liver cirrhosis and with diabetes mellitus in liver cirrhosis were both higher than normal subjects(P<0.05). Although there was difference between the patients with diabetes mellitus in liver cirrhosis and the patients without diabetes mellitus, no statistical significance(P>0.05). Neither alpha-lipoprotein nor low density lipoprotein had difference in the three groups (P>0.05).Conclusion:1. The patients of liver cirrhosis had hyperinsulinemia and insulin resistance. And the patients with diabetes mellitus in liver cirrhosis had more severe hyperinsulinemia and insulin resistance than those without diabetes mellitus. 2. The damage of hepatic function was associated with insulin resistance. The damage of hepatic function was more severe and the insulin resistance was more obvious.