간경변증 환자에서 유발된 당뇨병과 다른 제2형 당뇨병 환자의 감별진단
Differential Diagnosis of Diabetes Mellitus caused by Liver Cirrhosis and Other Type 2 Diabetes Mellitus
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목적: 간은 혈당조절호르몬인 인슐린의 대사에 중요한 장기이며, 자체의 포도당 합성 및 글리코겐의 저장 또는 분해기능으로 체내 포도당 농도를 일정하게 유지하는 당 대사에 중요한 장기이다. 간경변증 환자에서 당뇨병은 흔히 발생되지만, 임상 형태 및 예후는 다른 제2형 당뇨병과 차이가 있는 것으로 알려져 있다. 간경변성 당뇨병과 다른 제2형 당뇨병의 감별을 위하여 임상에서 쉽게 시행할 수 있는 혈액검사로 알아보기 위해 연구를 시행하였다. 대상과 방법: 당뇨병이 동반된 간경변증 환자 18명과 간경변증이 없는 유사 연령, 성별의 제2형 당뇨병 환자 18명의 FPG, PP2h, HbA1c, 공복혈장인슐린, 공복혈장C-펩타이드를 측정하였고, PP2h/ FPG의 비, 공복혈장인슐린/C-펩타이드 비, 인슐린저항성의 지표로서 HOMA IR index[fasting insulin (mIU/L)×fasting glucose (mmol/L)/22.5]를 계산하여 비교하였다. 결과: PP2h/FPG의 비(2.27 vs. 1.69), 공복혈장인슐린(23.2 : 11.6 IU/ mL), HOMA IR index는(8.38 vs. 3.52) 간경변성 당뇨병 환자군이 다른 제2형 당뇨병 환자군보다 의미 있게 높았다(P<0.05). PP2h, 공복혈장C-펩타이드, 공복혈장인슐린/C-펩타이드 비는 간경변성 당뇨병 환자군에서 높은 경향은 있었으나 통계에서 유의하지는 않았다. FPG, HbA1c는 양군 간의 차이가 없었다. 결론: 간경변성 당뇨병 환자군과 다른 제2형 당뇨병 환자와의 감별에 PP2h/FPG의 비, 공복혈장인슐린 및 인슐린저항성(HOMA-IR)검사가 도움이 될 것으로 생각한다.
Abstract
The liver plays important roles in the homeostasis of glucose metabolism since it acts as a major target organ for insulin and a site for gluconeogenesis and glycogen storage. Diabetes mellitus (DM) commonly develops in patients with liver cirrhosis as the result of hepatocyte dysfunction and/or inadequate mass. To assess differences between DM due to liver cirrhosis (hepatogenous DM) and the other type 2 DM, we compared the patterns of hyperglycemia and hyperinsulinemia in hepatogenous DM with those observed in type 2 DM. Methods: 18 diabetic patients with liver cirrhosis (caused by alcohol, n=8; HBV, n=5; HCV, n=2; others, n=3) were matched with 18 type 2 diabetic patients without liver cirrhosis for age and gender. None of the patients or controls had been treated with insulin or β-blockers. The level of glycosylated hemoglobin (HbA1C), fasting plasma glucose (FPG), postprandial plasma glucose (PP2h), fasting plasma C-peptide and insulin were measured. Results: The ratio of PP2h/FPG (2.27 vs. 1.69), fasting insulin (23.2: 11.6 µIU/mL) and HOMA-IR index (8.38 vs. 3.52) were significantly higher in hepatogenous DM than the other type 2 DM (P<0.05). PP2h, fasting C-peptide and ratio of fasting insulin/C-peptide tend to be higher in hepatogenous DM than those of controls, but which were not statistically significant. Conclusions: The ratio of PP2h/FPG and fasting plasma insulin differentiated hepatogenous DM from the other type 2 DM. Insulin resistance in liver cirrhosis was higher than the other type 2 DM, and impaired hepatic insulin degradation might be an important mechanism of hyperinsulinemia in liver cirrhosis.
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