目的 探究乙型病毒性肝炎不同状态合并2型糖尿病患者的临床特点。方法 对62例乙型肝炎病毒携带合并2型糖尿病(组1)、129例乙型病毒性肝炎合并2型糖尿病(组2)和83例乙型病毒性肝炎肝硬化合并2型糖尿病(组3)患者的临床资料进行回顾性分析。结果 各组间在性别和年龄上差异有统计学意义(χ²=11.133、P=0.004,F=7.640、P=0.001)。3组研究对象糖化血红蛋白(HbA1c)、总胆固醇(Tch)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血清白蛋白(ALB)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)和总胆汁酸(TBA)水平差异有统计学意义(F=4.028、P=0.019,F=4.140、P=0.017,F=3.172、P=0.044,F=6.701、P=0.002,F=53.156、P<0.001,F=4.920、P=0.008,F=4.173、P=0.017,F=7.181、P=0.001,F=9.170、P<0.001)。进一步两两比较,肝炎肝硬化组HbA1c、Tch 、LDL-C、ALB水平降低,但TBIL、IBIL、TBA增高,分别与另2组比较差异有统计学意义(P<0.05);组2空腹血糖(FBG)、HDL-C水平最高,前者高于组1,后者高于组3。各组糖尿病并发症居前三的都是周围神经病变、糖尿病肾病和糖尿病视网膜病变。结论 乙型病毒性肝炎合并2型糖尿病时其不同状态间具有不同的疾病特点,主要体现在携带状态Tch、TG、LDL-C高水平,肝炎状态FBG高水平,肝炎肝硬化状态HbAlc、ALB低水平但胆红素、胆汁酸水平高,在糖尿病并发症方面均以周围神经病变、糖尿病肾病和糖尿病视网膜病变为主。

Objective To study the clinical feature of different viral hepatitis B status with type 2 diabetes. Methods A retrospective analysis was carried out on 62 hepatitis B virus carriers with type 2 diabetes (group 1),129 viral hepatitis B patients with type 2 diabetes (group 2) and 83 viral hepatitis B cirrhosis patients with type 2 diabetes (group 3). Results The differences in gender and age among the three groups were significantly different (χ²=11.133, P=0.004 and F=7.640,P=0.001). The levels of HbA1c, total cholesterol (Tch), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), serum albumin (ALB), total bilirubin(TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL)and total bile acid (TBA)in three groups were significantly different (F=4.028, P=0.019.F=4.140, P=0.017.F=3.172, P=0.044.F=6.701, P=0.002.F=53.156, P<0.001.F=4.920, P=0.008.F=4.173, P=0.017.F=7.181, P=0.001.F=9.170, P<0.001). In further pairwise comparison, the levels of HbA1c, Tch, LDL-C and ALB of group 3 decreased significantly compared with other two groups, but the levels of TBIL, IBIL and TBA increased, with significant differences.The levels of fasting blood glucose(FBG) and HDL-C in group 2 were the highest,and the FBG was significantly higher than that in group 1, while the HDL-C was significantly higher than that in group 3.In the three groups, the top three diabetic complications were peripheral neuropathy, diabetic nephropathy and diabetic retinopathy. Conclusion Different statuses of viral hepatitis B with type 2 diabetes had different disease characteristics, mainly reflected in the high levels of Tch, TG and LDL-C in the hepatitis B virus carriers, high FBG level in the viral hepatitis B patients, low levels of HbAlc and ALB but high levels of bilirubin and bile acid in the cirrhosis patients.Peripheral neuropathy, diabetic nephropathy and diabetic retinopathy were the main complications of diabetes.