[摘要] 目的 探讨恩替卡韦治疗代偿期乙型肝炎后肝硬化（HBC）伴肝源性糖尿病（HD）的临床效果。 方法 将代偿期HBC伴HD患者按是否自愿应用恩替卡韦分为观察组（25例）和对照组（20例），两组均给予糖尿病饮食和常规性保肝降酶支持治疗，空腹血糖（FPG）轻度者只给予糖尿病饮食，中度者口服阿卡波糖，重度者注射胰岛素，同时观察组服国产恩替卡韦0.5 mg/d，48周后比较两组的肝功能指标、肝纤维化指标、HBV DNA、FPG、空腹胰岛素（FINS），餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）等指标。 结果 治疗前两组上述指标差异无统计学意义（P＞0.05）；治疗后两组FPG差异无统计学意义（P＞0.05），肝功能指标、肝纤维化指标、HBV DNA、2hPG、FINS，HbA1c差异有统计学意义（P＜0.05）。观察组24、48周时HBV DNA及血糖达标率与对照组比较，差异有统计学意义（P＜0.05）。 结论 代偿期HBC伴HD患者应用恩替卡韦能有效抑制病毒复制，改善肝功能及肝纤维化程度，可使HD得到有效控制，有助于缩短血糖达标时间。

[关键词] 恩替卡韦；肝源性糖尿病；胰岛素；血糖

[中图分类号] R575.2[文献标识码] B[文章编号] 1674-4721（2014）04（c）-0093-04

Efficacy analysis of entecavir in treatment of decompensated hepatitis Bcirrhosis with hepatic diabetes

YUAN Bao-hui

Department of Infectious Diseases,Feng County People′s Hospital of Jiangsu Province,Feng County 221700,China

[Abstract] Objective To investigate the efficacy of entecavir in the treatment of decompensated hepatitis B cirrhosis (HBC) with hepatic diabetes (HD).Methods 45 cases of patients with HBC with HD were divided into the observation group (n=25) and control group (n=20) according to the principle of voluntary.All were given conventional diabetes diet and liver treatment.The light type of fasting plasma glucose (FPG) were only given with diabetic diet,medium type were given with oral administration of acarbose,severe type were given with insulin injection.The observation group were given with domestic entecavir 0.5 mg/d.The liver function,liver fibrosis,HBV DNA,FPG,fasting insulin (FINS),2 hour postprandial blood glucose (2hPG),glycosylated hemoglobin (HbA1c) of two groups were detected after 48 weeks treatment.Results There was no significant difference about the indicators in two groups before treatment (P>0.05).After treatment,FPG had no significant difference in two groups;the liver function,hepatic fibrosis index,HBV DNA,2hPG,FINS,HbA1c had significant difference between the two groups (P<0.05).The HBV DNA and glucose success rate after 24 and 48 weeks treatment between the two groups had significant difference (P<0.05).Conclusion Entecavir treating patients with HBC with HD can inhibit viral replication,improve the function of live and the hepatic fibrosis,avoid prematurely into decompensated period,effectively control the HD,shorten the time of blood glucose.

[Key words] Entecavir;Hepatic diabetes;Insulin;Blood glucose

肝源性糖尿病（hepatic diabetes，HD）是指继发于慢性肝损伤导致的糖尿病。近年来HD的发病率呈上升趋势，是肝硬化患者十分常见、又容易被忽视的一种并发症，60％～80％的慢性肝病患者有糖耐量减退，其中20％～30％发展为HD[1]，其发病机制尚未完全清楚，一般认为胰岛素抵抗与肝细胞损伤是HD的主要病因。活动性乙型肝炎后肝硬化（hepatitis B cirrhosis，HBC）伴HD时，病毒复制依然活跃，常导致病情加速进展，常规护肝和降血糖效果较差，如单纯降血糖常难以达到满意的血糖达标率。病毒治疗是HBC治疗的根本[2]。恩……