| Chapter 1 Detection of Insulin resistance index and its clinical Significance in Chronic liver disease related to Hepatitis B virusObjective:To investigate the role of the Insulin resistance index (HOMA-IR) in predicting hepatogenous diabetes subsequent to chronic liver disease(CLD) related to hepatitis B patients.Method:Fasting plasma glucose(FPG) and fasting serum insulin (FINS) were measured in 216 patients,including 120 patients with chronic hepatitis B(CHB),66 patients with liver cirrhosis(LC),and 30 patients with chronic severe hepatitis B(CSHB).In addition 30 health subjects were served as a control(HC).Then the HOMA-IR was calculated.None of the subjects in the study had a history of diabetes.Results:Among the HC and CHB,LC and CSHB patients,there was no significant difference in FPG(P>0.05);but both FINS and HOMA-IR levels gradually elevated.FINS and HOMA-IR in CHB patients(10.58±5.93,2.36±1.39) were significantly higher than those in HC(7.39±2.14,1.53±0.50)(P<0.05),while lower than those in LC(12.69±5.93,2.87±1.45) and CSHB(18.30±14.17,4.35±3.77) patients(P<0.05).The incidence of Insulin resistance in the CLD patients were CHB(27.5%),LC(37.9%),CSHB(53.3%). Conclusions:The insulin resistance index may be used as an important predictor of hepatogenous diabetes in these patients with CLD related to hepatitis B virus. Chapter 2 A study of correlation between Insulin resistance and the clinical pathology characters in chronic hepatitis B patientsObjective:To investigate the relationship between insulin resistance index(HOMA-IR) and the clinical pathology features in chronic hepatitis B(CHB) patients.Method:The Biochemical and hepatitis B virus loading level and HOMA-IR were measured in 120 CHB patients;correlation analysis was performed with pathological features of liver tissue.Results:Insulin resistance(IR) was much more obvious in patients with severer degree of liver inflammation and fibrosis.HOMA-IR and fasting serum insulin were higher in G3 grade and S3 stage of CHB patients than those in G2 grade and S2 stage of CHB patients.The HOMA-IR was positive correlation with Age,ALT,AST,TG and BMI; while negative correlation with PTA.By non-conditional Multi-logistic regression analysis,age and severe inflammation and fibrosis were important risk factor in the IR of CHB patients.Conclusions:The development of IR in CHB patients was closely correlation with Age and the degree of liver inflammation and fibrosis. Chapter 3 The level of Insulin receptor in Liver tissue of Chronic hepatitis B patientsObjective:To investigate the pathogenesis of hepatogenous insulin resistance in chronic hepatitis B(CHB) patients.Methods:HOMA-IR and plasma biochemical indices were measured in G1 and G3 grade of CHB patients,what's more,Detect the insulin receptor of hepatic cells in G1 and G3 grade of CHB patients by Immunohistochemical staining.Results:The fasting serum insulin and HOMA-IR in G3 grade of CHB patients(14.47±6.84,3.31±1.72) were found to be significantly higher than those in G1 grade of CHB patients(7.03±1.55,1.51±0.35) (P<0.01).Nine of twelve liver specimens were Insulin receptor strong positive in G1 grade of CHB;ten of twelve liver specimens were insulin receptor weakly positive in G3 grade.They were significant difference in two groups(P<0.01).Conclusion:The pathology of IR in G3 grade of CHB patients is possible the decreasing of insulin receptor in hepatic cells during sever Necro-inflammation.
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