Journal of Shanghai Jiao Tong University (Medical Science) >

2023 , Vol. 43 >Issue 2: 188 - 193

DOI: https://doi.org/10.3969/j.issn.1674-8115.2023.02.007

Clinical research

Clinical analysis of insulin resistance in liver cirrhosis patients

  • Cuicui SHI ,
  • Jie ZHANG ,
  • Heming HUANG ,
  • Yuer SANG ,
  • Guangming LI
Expand
  • Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
LI Guangming, E-mail: ligm68@126.com.
SANG Yuer, E-mail: sangyuer@xinhuamed.com.cn

Received date: 2022-09-09

  Accepted date: 2023-02-09

  Online published: 2023-02-28

Supported by

National Natural Science Foundation of China(82170617)

Fold

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

Cite this article

Cuicui SHI , Jie ZHANG , Heming HUANG , Yuer SANG , Guangming LI . Clinical analysis of insulin resistance in liver cirrhosis patients[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023 , 43(2) : 188 -193 . DOI: 10.3969/j.issn.1674-8115.2023.02.007

References

1 CHAO L T, WU C F, SUNG F Y, et al. Insulin, glucose and hepatocellular carcinoma risk in male hepatitis B carriers: results from 17-year follow-up of a population-based cohort[J]. Carcinogenesis, 2011, 32(6): 876-881.
2 SINGAL A K, AYOOLA A E. Prevalence and factors affecting occurrence of type 2 diabetes mellitus in Saudi patients with chronic liver disease[J]. Saudi J Gastroenterol, 2008, 14(3): 118-121.
3 HUNG C H, WANG J H, HU T H, et al. Insulin resistance is associated with hepatocellular carcinoma in chronic hepatitis C infection[J]. World J Gastroenterol, 2010, 16(18): 2265-2271.
4 PANG Y, KARTSONAKI C, TURNBULL I, et al. Diabetes, plasma glucose, and incidence of fatty liver, cirrhosis, and liver cancer: a prospective study of 0.5 million people[J]. Hepatology, 2018, 68(4): 1308-1318.
5 LIU T L, TROGDON J, WEINBERGER M, et al. Diabetes is associated with clinical decompensation events in patients with cirrhosis[J]. Dig Dis Sci, 2016, 61(11): 3335-3345.
6 ANTY R, ANTY R, IANNELLI A, et al. A new composite model including metabolic syndrome, alanine aminotransferase and cytokeratin-18 for the diagnosis of non-alcoholic steatohepatitis in morbidly obese patients[J]. Aliment Pharmacol Ther, 2010, 32(11/12): 1315-1322.
7 BHAGAT V, MINDIKOGLU A L, NUDO C G, et al. Outcomes of liver transplantation in patients with cirrhosis due to nonalcoholic steatohepatitis versus patients with cirrhosis due to alcoholic liver disease[J]. Liver Transpl, 2009, 15(12): 1814-1820.
8 PETERSEN M C, SHULMAN G I. Mechanisms of insulin action and insulin resistance[J]. Physiol Rev, 2018, 98(4): 2133-2223.
9 ESLAM M, SANYAL A J, GEORGE J, et al. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease[J]. Gastroenterology, 2020, 158(7): 1999-2014.e1.
10 KITADE H, CHEN G, NI Y, et al. Nonalcoholic fatty liver disease and insulin resistance: new insights and potential new treatments[J]. Nutrients, 2017, 9(4): E387.
11 孙志梅, 齐亚娟. 胰岛素信号通路与胰岛素抵抗[J]. 世界最新医学信息文摘, 2019, 19(52): 62-63.
11 SUN Z M, QI Y J.Insulin signaling pathway and insulin resistance[J].World's Latest Medical Information Digest, 2019, 19(52): 62-63.
12 HARDEEP S D, NAVIDA B, DEVINDER S M.Prevalence of insulin resistance in cirrhosis of liver[J]. Int J Adv Med, 2018, 5(2): 375.
13 GORAL V, ATALAY R, KUCUKONER M. Insulin resistance in liver cirrhosis[J]. Hepatogastroenterology, 2010, 57(98): 309-315.
14 YAGMUR E, WEISKIRCHEN R, GRESSNER A M, et al. Insulin resistance in liver cirrhosis is not associated with circulating retinol-binding protein 4[J]. Diabetes Care, 2007, 30(5): 1168-1172.
15 GHARAVI A, HAJAGHA M A, ZIAEE A, et al. Investigation of insulin resistance in patients with liver cirrhosis and its relationship with severity of disease[J].J Qazvin Univ Med Sci, 2008, 12(1): 27-34.
16 中华医学会糖尿病学分会胰岛素抵抗学组(筹). 胰岛素抵抗评估方法和应用的专家指导意见[J]. 中华糖尿病杂志, 2018, 10(6): 377-385.
16 Insulin Resistance Group of Diabetics Branch of Chinese Medical Association. Expert guidance on methods and application of insulin resistance assessment[J].Chinese Journal of Diabetes,2018,10(6):377-385.
17 PETTA S, CAMMà C, DI MARCO V, et al. Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection[J]. Liver Int, 2011, 31(4): 507-515.
18 GUO C H, SUN T T, WENG X D, et al. The investigation of glucose metabolism and insulin secretion in subjects of chronic hepatitis B with cirrhosis[J]. Int J Clin Exp Pathol, 2015, 8(10): 13381-13386.
19 刘丽, 江颖仪, 刘景. 不同Child-Pugh分级慢性乙型肝炎肝硬化患者糖代谢、胰岛素分泌情况及其与炎症反应的相关性分析[J]. 临床肝胆病杂志, 2020, 36(2): 324-328.
19 LIU L, JIANG Y Y, LIU J.Glucose metabolism and insulin secretion in patients with chronic hepatitis B cirrhosis of different Child-Pugh grades and their association with inflammatory response[J].Journal of Clinical Hepatobiliary Disease, 2020, 36(2): 324-328.
20 ALSEBAEY A, ELHELBAWY M. Insulin resistance is not a risk factor for oesophageal varices development in hepatitis C[J]. Trop Doct, 2019, 49(4): 281-285.
Options
Outlines

/

〈 〉