Relationship Between HOMA-IR?HOMA-? And Liver Injury In Patients With Hepatitis B Cirrhosis Complicated With HD

Objective : To explore the relationship between islet ?-cell function and insulin resistance index and liver liver injury in patients with hepatitis B cirrhosis complicated with hepatogenous diabetes(HD).Methods : 52 patients with hepatitis B related liver cirrhosis(LC)admitted to our hospital from December 2016 to March 2018 were included in this study.According to inclusion and exclusion criteria,39 patients were eventually enrolled.All patients were checked for HD by OGTT assay.They were divided into LC with HD group(LC+HD,n=20)and LC with NGT group(LC+NGT,n=19).In the same period,20 healthy people in the physical examination department of the hospital were included as normal control(NC).The fasting plasma glucose(FPG),fasting insulin(FINS),fasting c-peptide(FCP),Homeostasis Model for Assessment of Insulin Resistance(HOMA-IR)and insulin beta cell function(HOMA-?)in two groups were compared with NC group.The relationship between HOMA-IR,HOMA-? and the degree of liver injury in HD patients was analyzed.To explore the effect of antiviral therapy on glucose metabolism and insulin resistance,16 patients with HD were given entecavir antiviral treatment.The changes of FPG,FINS,FCP,HOMA-IR and HOMA-? were compared before and after treatment.Result:1.A total of 52 patients with hepatitis B liver cirrhosis were included.Thirty-nine patients were eventually enrolled according to the inclusion and exclusion criteria.There were 20 patients who were diagnosed diabetes according to the OGTT test and 16 of them(80.00%)had normal FPG.2.The level of HOMA-IR and FINS in patients with HD were significantly higher than those in NC group(P<0.05);There were no significant differences of FPG and HOMA-? among the patients with LC+HD,LC+NGT and NC group(P>0.05).3.There was difference of Child-Pugh classification between the patients of liver cirrhosis with HD and NGT group.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).4.HOMA-IR showed positive correlation with the levels of FPG,OGTT 2h glucose,FCP,FINS,?-glutamyl transpeptidase(GGT),cholinesterase(CHE).HOMA-? level showed positive correlation with the levels of total bilirubin(TBIL),aspartate aminotransferase(AST),alkaline phosphatase(ALP),Total bile acid(TBA),scores for model for end-stage of liver diseases(MELD),fibrosis-4 index(FIB-4),aspartate-to-platelet ratio index(APRI),FINS and FCP,whereas it had negative correlation with the levels of FPG,?-glutamyl transpeptidase(GGT),high density lipoprotein cholesterol(HDL-C).5.After 6.5±3.5 months of treatment with entecavir,the FPG in the patients with HD significantly decreased,however,their FINS and FCP significantly increased(P<0.05).No significant changes of HOMA-IR and HOMA-? were found before and after treatment.Conclusions:1.The diagnosis of HD depends on OGTT assay.2.Insulin resistance(IR)existed in patients with hepatitis B cirrhosis,HOMA-IR in patients with HD was significantly higher than that of NC group.3.HOMA-? in patients with hepatitis B cirrhosis complicated with HD had the tendency to increase with the increasing of severity of liver injury and liver fibrosis.4.Short-term NAs combined with hypoglycemic therapy can effectively inhibit the replication of HBV DNA and improve liver function in patients with HD,but no improvement in insulin resistance and pancreatic ?-cell function.