目的：乙型肝炎病毒（HBV）相关的慢加急性肝衰竭（ACLF）患者的血糖稳态紊乱与预后之间的关系尚不清楚。本研究旨在调查HBV相关ACLF患者血糖稳态紊乱的临床特征及其与90天死亡率的关系。
方法：前瞻性纳入了96例HBV相关ACLF患者，没有预先存在的糖尿病。根据入院时和随访期间的空腹血糖和口服葡萄糖耐量试验结果诊断葡萄糖异常。稳态模型评估用于建立胰岛素抵抗（HOMA2-IR），胰岛素敏感性（HOMA2-IS）和HOMA2-β细胞功能（HOMA2-β）。采用多因素Cox比例风险分析确定入院后90天内死亡的独立危险因素。
结果：在96例ACLF患者中，51（53.1%）患有糖尿病，29例（30.2%）糖耐量受损（IGT），17例(17.7%)出现低血糖.糖尿病患者的HOMA2-β水平明显低于糖耐量正常的患者。在22名糖尿病或IGT患者中，没有抗高血糖治疗，8（36.4％）在32.8±28.8天的随访后表现出葡萄糖代谢紊乱的消退，和较高的血小板水平与消退有关。ACLF患者25例（25.0%）在90天内死于肝功能衰竭。糖尿病[比值比（OR）3.601，95％置信区间（CI）1.342-9.661]和年龄（OR1.045，95％CI1.010-1.082）是与死亡率相关的独立危险因素。
结论：胰岛β细胞功能受损与糖尿病的发展有关。糖尿病与慢性HBV相关ACLF患者的高死亡率相关。
OBJECTIVE: Associations between the disturbances in glucose homeostasis and prognosis in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) remain unclear. This study was conducted to investigate the clinical characteristics of disturbances in glucose homeostasis and their associations with 90-day mortality in patients with HBV-related ACLF.
METHODS: Ninety-six patients with HBV-related ACLF without pre-existing diabetes were prospectively included. Glucose abnormalities were diagnosed based on fasting plasma glucose and oral glucose tolerance test results on admission and during follow-up. Homeostasis model assessment was used to establish insulin resistance (HOMA2-IR), insulin sensitivity (HOMA2-IS) and HOMA2-β-cell function (HOMA2-β). Multivariate Cox proportional hazards analysis was used to identify independent risk factors for death within 90 days after admission.
RESULTS: Among 96 patients with ACLF, 51 (53.1%) had diabetes, 29 (30.2%) had impaired glucose tolerance (IGT), and 17 (17.7%) had hypoglycemia. Patients with diabetes had significantly lower levels of HOMA2-β than did patients with normal glucose tolerance. Of 22 patients with diabetes or IGT and without anti-hyperglycemic treatment, 8 (36.4%) exhibited regression of their glucose metabolism disorders after a follow-up of 32.8 ± 28.8 days, and higher platelet levels were associated with regression. Twenty-five patients (25.0%) with ACLF died of liver failure within 90 days. Diabetes [odds ratio (OR) 3.601, 95% confidence interval (CI) 1.342-9.661] and age (OR 1.045, 95% CI 1.010-1.082) were the independent risk factors associated with mortality.
CONCLUSIONS: Impaired pancreatic β-cell function is related to diabetes development, and diabetes is associated with high mortality in patients with chronic HBV-related ACLF.
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