PDF(Pubmed)
Abstract：
The diabetogenic potential of liver cirrhosis (LC) has been known for a long time, and the name \"hepatogenous diabetes\" (HD) was coined in 1906 to define the condition. Diabetes mellitus (DM) that develops as a consequence of LC is referred to as HD. In patients with LC, the prevalence rates of HD have been reported to vary from 21% to 57%. The pathophysiological basis of HD seems to involve insulin resistance (IR) and pancreatic β-cell dysfunction. The neurohormonal changes, endotoxemia, and chronic inflammation of LC initially create IR; however, the toxic effects eventually lead to β-cell dysfunction, which marks the transition from impaired glucose tolerance to HD. In addition, a number of factors, including sarcopenia, sarcopenic obesity, gut dysbiosis, and hyperammonemia, have recently been linked to impaired glucose metabolism in LC. DM is associated with complications and poor outcomes in patients with LC, although the individual impact of each type 2 DM and HD is unknown due to a lack of categorization of diabetes in most published research. In fact, there is much skepticism within scientific organizations over the recognition of HD as a separate disease and a consequence of LC. Currently, T2DM and HD are being treated in a similar manner although no standardized guidelines are available. The different pathophysiological basis of HD may have an impact on treatment options. This review article discusses the existence of HD as a distinct entity with high prevalence rates, a strong pathophysiological basis, clinical and therapeutic implications, as well as widespread skepticism and knowledge gaps.
摘要：
肝硬化（LC）的糖尿病可能早已为人所知，和名称“肝源性糖尿病”（HD）是在1906年创造的定义条件。作为LC的结果而发展的糖尿病(DM)被称为HD。在LC患者中，据报道,HD的患病率从21%到57%不等.HD的病理生理基础似乎涉及胰岛素抵抗（IR）和胰腺β细胞功能障碍。神经激素的变化,内毒素血症,和LC的慢性炎症最初产生IR;然而，毒性作用最终导致β细胞功能障碍,这标志着从糖耐量受损到HD的转变。此外,许多因素,包括少肌症,肌肉减少性肥胖，肠道菌群失调，和高氨血症，最近与LC中葡萄糖代谢受损有关。DM与LC患者的并发症和不良预后相关，尽管在大多数已发表的研究中，由于缺乏糖尿病分类，因此每种2型DM和HD的个体影响尚不清楚。事实上,科学组织内部对将HD视为一种单独的疾病和LC的后果持怀疑态度。目前,T2DM和HD正在以类似的方式治疗，尽管没有标准化的指南可用。HD的不同病理生理学基础可能对治疗方案产生影响。这篇综述文章讨论了HD作为一个具有高患病率的独特实体的存在，有很强的病理生理基础,临床和治疗意义，以及广泛的怀疑主义和知识差距。
