Clinical analysis of insulin resistance in liver cirrhosis patients

doi:10.3969/j.issn.1674-8115.2023.02.007

Abstract

Abstract:

Objective ·To investigate the insulin resistance in liver cirrhosis patients. Methods ·Patients with liver cirrhosis from Xinhua Hospital,Shanghai Jiao Tong University School of Medicine in 2013?2017 were retrospectively assessed. Biochemical indexes, including fasting blood glucose (FBG), glycosylated hemoglobin A1c (HbA1c), fasting insulin and homeostatic model assessment-insulin resistance (HOMA-IR), were collected. The complications of liver cirrhosis were recorded, including esophagogastric varices bleeding (EVB), ascites and hepatic encephalopathy (HE). According to HOMA-IR value, the liver cirrhosis patients were divided into non-insulin resistance group (IR≤1.64) and insulin resistance group (IR>1.64). Various indicators were compared between the two groups. Results ·A total of 376 patients with liver cirrhosis were included in this study. The proportions of Child-Pugh A, Child-Pugh B and Child-Pugh C were 162 (43.09%), 148 (39.36%), and 66 (17.55%), respectively. The main cause of liver cirrhosis was hepatitis B virus infection 163 (43.35%). Fasting insulin levels were measured in 208 of 376 liver cirrhosis patients. Among them, 117 patients (56.25%) had no insulin resistance and 91 patients (43.75%) had insulin resistance. The body mass index (BMI) of liver cirrhosis patients in the insulin resistance group was significantly higher than that in the non-insulin resistance group (P=0.000), and the prevalence of type 2 diabetes in the former was also higher (P=0.001). The scores of Child-Pugh in patients with liver cirrhosis in the insulin resistance group were lower than those in the non-insulin resistance group, and the difference in Child-Pugh score was statistically significant (6.93±1.99 vs 7.63±2.20, P=0.020). The proportion of Child-Pugh C grade in the insulin resistance group was significantly lower than that in the patients without insulin resistance (P=0.028). The prevalence of ascites in cirrhotic patients with insulin resistance was significantly lower than that in cirrhotic patients without insulin resistance (36.26% vs 66.67%, P=0.000). There was no significant difference in the prevalence of EVB and HE between the two groups (P>0.05). Conclusion ·Nearly half of patients with liver cirrhosis are associated with insulin resistance. Compared with no-insulin resistance patients, cirrhotic patients with insulin resistance have a higher BMI, lower percentage of Child-Pugh C, and fewer ascites prevalence.

Key words: liver cirrhosis, insulin resistance, homeostatic model assessment-insulin resistance (HOMA-IR), Child-Pugh classification

CLC Number:

R657.3

SHI Cuicui, ZHANG Jie, HUANG Heming, SANG Yuer, LI Guangming. Clinical analysis of insulin resistance in liver cirrhosis patients[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(2): 188-193.

Figures/Tables 3

TrendMD

References 20

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Item	IR ≤ 1.64 (n=117)	IR > 1.64 (n=91)	P value
Age/year	63.23±12.38	61.48±11.11	0.290
BMI/(kg·m^-2)	22.05±3.50	25.64±3.65	0.000
Male/n (%)	74 (63.25)	45 (49.45)	0.049
Smoke/n (%)	42 (35.90)	31 (34.07)	0.880
Alcohol/n (%)	29 (24.79)	22 (24.18)	>0.990
T2DM/n (%)	30 (25.64)	44 (48.35)	0.001
Hypertension/n (%)	28 (23.93)	29 (31.87)	0.210
Child-Pugh grade
Child-Pugh A/n(%)	47 (40.17)	49 (53.85)	0.070
Child-Pugh B /n(%)	43 (36.75)	32 (35.16)	0.880
Child-Pugh C/n(%)	27 (23.08)	10 (10.99)	0.028
Child-Pugh score	7.63±2.20	6.93±1.99	0.020
FBG/(mmol·L^-1)	5.44±1.71	7.58±3.24	0.000
HbA1c/%	5.43±1.02	6.54±2.31	0.000
Fasting insulin/(mIU·L^-1)	4.06±1.87	12.32±8.39	0.000
HOMA-IR	0.94±0.39	4.25±4.51	0.000
Complication
EVB/n(%)	51 (43.59)	40 (43.96)	>0.990
Ascites/n(%)	78 (66.67)	33 (36.26)	0.000
HE/n(%)	7 (5.98)	5 (5.49)	>0.990

Item	IR ≤ 1.64 (n=117)	IR > 1.64 (n=91)	P value
Age/year	63.23±12.38	61.48±11.11	0.290
BMI/(kg·m^-2)	22.05±3.50	25.64±3.65	0.000
Male/n (%)	74 (63.25)	45 (49.45)	0.049
Smoke/n (%)	42 (35.90)	31 (34.07)	0.880
Alcohol/n (%)	29 (24.79)	22 (24.18)	>0.990
T2DM/n (%)	30 (25.64)	44 (48.35)	0.001
Hypertension/n (%)	28 (23.93)	29 (31.87)	0.210
Child-Pugh grade
Child-Pugh A/n(%)	47 (40.17)	49 (53.85)	0.070
Child-Pugh B /n(%)	43 (36.75)	32 (35.16)	0.880
Child-Pugh C/n(%)	27 (23.08)	10 (10.99)	0.028
Child-Pugh score	7.63±2.20	6.93±1.99	0.020
FBG/(mmol·L^-1)	5.44±1.71	7.58±3.24	0.000
HbA1c/%	5.43±1.02	6.54±2.31	0.000
Fasting insulin/(mIU·L^-1)	4.06±1.87	12.32±8.39	0.000
HOMA-IR	0.94±0.39	4.25±4.51	0.000
Complication
EVB/n(%)	51 (43.59)	40 (43.96)	>0.990
Ascites/n(%)	78 (66.67)	33 (36.26)	0.000
HE/n(%)	7 (5.98)	5 (5.49)	>0.990

Item	Child-Pugh A (n=162)	Child-Pugh B (n=148)	Child-Pugh C (n=66)	P value
FBG/(mmol·L^-1)	6.59±2.82	6.79±2.88	4.98±1.26	0.002
HbA1c/%	5.98±1.41	5.69±1.17	5.45±2.27	0.350
Fasting insulin/(mIU·L^-1)	9.04±8.36	6.49±5.26	5.62±5.75	0.010
HOMA-IR	3.02±4.47	2.01±2.11	1.54±1.68	0.038

Item	Child-Pugh A (n=162)	Child-Pugh B (n=148)	Child-Pugh C (n=66)	P value
FBG/(mmol·L^-1)	6.59±2.82	6.79±2.88	4.98±1.26	0.002
HbA1c/%	5.98±1.41	5.69±1.17	5.45±2.27	0.350
Fasting insulin/(mIU·L^-1)	9.04±8.36	6.49±5.26	5.62±5.75	0.010
HOMA-IR	3.02±4.47	2.01±2.11	1.54±1.68	0.038

Item	Cryptogenic cirrhosis (n=71)	Cirrhosis of the other etiologies (n=305)	P value
FBG/(mmol·L^-1)	6.47±2.69	6.22±2.57	0.464
HbA1c/%	5.95±2.28	5.73±1.29	0.287
Fasting insulin/(mIU·L^-1)	6.69±5.66	7.95±7.34	0.277
HOMA-IR	2.25±3.09	2.43±3.51	0.746