Dynamic Changes Of Hepatogenous Diabetes And Related Glycometabolism Index In Patients With Acute Exacerbation Of Chronic HBV Infection

Objective: To explore the dynamic changes of hepatogenous diabetes(HD)and related glycometabolism indexes in patients with severe chronic hepatitis B virus(HBV)infection during the recovering process of live function.Methods: Patients with severe chronic HBV infection and HD or impaired glucose tolerance(IGT)who were hospitalized in the Department of Infectious Diseases of our hospital from December 2016 to December 2020 were selected as the research subjects.All patients underwent oral glucose tolerance test(OGTT)when they were admitted to the hospital,and the diagnosis of HD or IGT was based on its measured values.According to the inclusion and exclusion criteria,86 patients were finally enrolled.The patients were divided into liver cirrhosis(LC)group(n=55)and chronic hepatitis B(CHB)group(n=31)according to whether LC was present.All patients were treated with nucleoside(acid)analogue antiviral and hepatoprotective drugs,and observed short-term(within 12 weeks is defined as shortterm)and long-term(more than 52 weeks is defined as long-term)the dynamic changes of glycometabolism disorders and related factors after treatment.Results:1.A total of 86 patients with severe chronic HBV infection with glycometabolism disorders were included in this study,including 31 in the CHB group and 55 in the LC group.In the CHB group,8 cases(25.8%)had HD,and 23 cases(74.2%)had IGT.In the LC group,30cases(54.5%)had HD,and 25 cases(45.5%)had IGT.2.After short-term(2.9±2.7 weeks)treatment,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),prothrombin activity(PTA)and other indicators of liver function and coagulation function were significantly improved in CHB group.The incidence of HD and IGT decreased from 25.8% and 74.2% before treatment to3.2% and 9.7% after treatment,respectively.After treatment,OGTT for 2 hours plasma glucose(OGTT2h-PG),OGTT for 2 hours c-peptide(OGTT2h-CP),OGTT for 2 hours insulin(OGTT2h-Ins)significantly decreased(P<0.05).There was no significant difference in fasting plasma glucose(FPG),homeostasis model assessment islet beta cell function(HOMA-β),homeostasis model assessment insulin resistance and other related glycometabolism indexes before and after treatment.3.After short-term(6.0±5.1 weeks)treatment in the LC group,ALT,AST,TBIL,albumin(albumin,ALB),fibrosis 4 score(FIB-4),and aspartate aminotransferase-to-platelet ratio index(APRI)were significantly different,the proportion of HD after treatment also significantly different,from 54.5% before treatment to 23.7%.After treatment,OGTT 2hPG,OGTT2h-CP significantly decreased than that before treatment(P<0.05).FPG,OGTT2h-Ins,HOMA-β,HOMA-IR were not significantly different from these before treatment(P>0.05).4.After short-term treatment in the LC group,HOMA-β and ALB in the regression group were significantly increased,and the FIB-4 score was significantly decreased(P<0.05).The proportion of Child-Pugh C patients in the non-regression group was significantly higher than that in the regression group(P<0.05).High level of serum ALB is an independent predictor of the recovery of glucose metabolism disorders after short-term treatment.5.After long-term(65.1±9.9 weeks)treatment of 16 patients in the LC group,the proportion of patients with HD and IGT decreased from 43.8% and 50.0% after short-term treatment to18.75% and 18.75% after long-term treatment.OGTT 2h-PG and OGTT 2h-Ins decreased significantly after treatment(P<0.05),but FPG,fasting insulin(FINS),HOMA-β,HOMAIR were not significant different before and after treatment(P>0.05).6.The HOMA-β in LC patients whose glycometabolism returned to normal after long-term treatment was significantly higher than that of LC patients who did not return to normal(P<0.05).Conclusion: 1.Whether patients are complicated with liver cirrhosis or not,the prevalenvce of glycometabolism disorders in patients with severe chronic HBV infection after short-term treatment decreased as their liver function improved.2.Serum ALB level in patients with LC is an independent predictor for regression of glucose metabolism disorders after short-term treatment.3.The disorder of glycometabolism can be further refressed after long-term treatment in patients with LC.High level of HOMA-β after treatment may be a related factor for the regression of glucose metabolism disorders.