摘要
目的 探讨肝源性糖尿病的发病机制、诊断及治疗.方法 回顾分析1例肝源性糖尿病的病历资料,并复习相关文献.结果 病人为中年男性,血糖升高8年,血糖控制不佳2月余.既往有乙型肝炎肝硬化病史20余年.否认糖尿病家族史,有乙型肝炎家族史.临床表现和实验室检查提示存在肝功能损害,血清C肽释放试验提示分泌高峰延迟及高峰值偏低.病人未应用引起糖代谢紊乱的药物,排除其他原因引起的继发性高糖血症.综合上述考虑病人诊断为肝源性糖尿病.病人行糖尿病饮食,应用抗乙肝病毒、利格列汀联合胰岛素强化治疗方案,血糖控制平稳.结论 目前肝源性糖尿病的诊断尚无统一标准,需综合病人的病史、临床表现和实验室证据来诊断.肝源性糖尿病主要由胰岛 β细胞功能障碍及胰岛素抵抗引起,其治疗应采取以治疗肝脏原发疾病为基础,兼顾饮食、运动、降糖药物使用等多方面的个体化综合治疗.
Abstract
Objective To investigate the pathogenesis,diagnosis,and treatment of hepatogenous diabetes.Methods A retrospective analysis was performed for the medical records of a case of hepatogenous diabetes,and a literature review was per-formed.Results The middle-aged male patient had elevated blood glucose for 8 years and poor blood glucose control for more than 2 months,with a history of hepatitis B cirrhosis for more than 20 years.He denied the family history of diabetes and had a family history of hepatitis B.Clinical manifestation and laboratory tests showedliver function damage,and the serum C-peptide re-lease test showed delayed peak secretion and a relatively low peak value.The patient did not use drugs causing glucose metabolism disorders,and secondary hyperglycemia caused by other causes was excluded.Therefore,the patient was diagnosed with hepatoge-nous diabetes and was given diabetic diet and the treatment regimen of anti-hepatitis B virus drugs,linagliptin,and insulin intensive treatment,which helped to achieve stable blood glucose control.Conclusion At present,there is no unified standard for the diagnosis of hepatogenous diabetes,and diagnosis should be made through a comprehensive analysis of medical history,clinical manifestations,and laboratory evidence.Hepatogenous diabetes is mainly caused by pancreatic βcell dysfunction and insulin resis-tance,and an individualized comprehensive treatment regimen based on the treatment of primary liver diseases should be adopted,with considerations to diet,exercise,and hypoglycemic drugs.
基金项目
青岛市创新领军人才项目(16-8-3-24-zhc)
国家科技期刊平台
NSTL
万方数据