Analysis Of Blood Glucose Changes And Risk Factors In Patients With HBV Related Acute On Chronic Liver Failure

Objective:To analyze the changes of blood glucose in patients with hepatitis B virus(HBV)related acute on chronic liver failure(ACLF)and explore its risk factors for hepatogenous diabetes(HD)and death.Methods:According to the inclusion and exclusion criteria of this study,63 patients with "HBV related ACLF" as the main diagnosis were collected from January to December of2017 in the Department of infection in our hospital,analyze the characteristics of their glucose metabolism.They were divided into HD group and control group according to the existence of HD.Monofactor analysis was used to analyze the demographic data,blood biochemistry and routine indicators,complications and prognosis,to find the risk factors for progression to HD.Independent risk factors were identified by multifactor two classification unconditional logistic regression analysis.At the same time,they were divided into death group and survival group according to whether they died within 12 weeks,finding the risk factors for death,exploreing its correlation with blood glucose.Results:41 patients with HBV related ACLF who met inclusion and exclusion criteria were screened,among them,36 cases were male and 5 cases were female.The incidence of low blood glucose was 34.15%.The incidence of insulin resistance(IR)was 29.27%.The prevalence of HD in patients with oral glucose tolerance test(OGTT)was 52.38%.Monofactor analysis revealed that alkaline phosphatase(ALP),international standardization ratio(INR),prothrombin time(PT),fibrinogen(FIB),and prothrombin time ratio(PTR)may be risk factors for the development of hepatogenous diabetes(HD)in patients with HBV related ACLF.Logistic regression analysis suggested that FIB is an independent risk factor for progression of HBV related ACLF in patients with hepatogenous diabetes.Monofactor analysis found that fasting insulin(FINS)and fasting C-peptide(FCP),total bilimin(TBIL),INR,FIB,urea(Ur),creatinine,Cr),model forend-stage liver disease(MELD)scores,and spontaneous bacterial peritonitis(SBP)may be risk factors for the death of patients with HBV related ACLF.Conclusions:FIB is an independent risk factor for the HBV related ACLF patients who progression to hepatogenous diabetes;the risk factors for the death of patients with HBV related ACLF patients may include FINS,fasting C peptide,TBIL,INR,FIB,Ur,Cr,MELD scores,spontaneous bacterial peritonitis.