慢性乙型病毒性肝炎合并慢性胆囊炎与糖尿病的关联性探讨

摘要

目的探讨慢性乙型病毒性肝炎合并慢性胆囊炎与糖尿病的关联性，并为慢性乙型病毒性肝炎合并慢性胆囊炎的治疗提供借鉴。方法选取住院的轻、中度慢性乙型病毒性肝炎396例为研究对象。查空腹血糖、餐后2 h血糖，糖耐量试验筛查糖尿病；做肝胆B超或CT筛查慢性胆囊炎，统计并比较有糖尿病者和无糖尿病者慢性胆囊炎的发生率。以同时合并慢性胆囊炎和糖尿病（或糖耐量异常）者72例为治疗Ⅰ组，单纯合并慢性胆囊炎者119例为治疗Ⅱ组。两组治疗方法相同，比较治疗效果。治疗Ⅰ组无效者，加胰岛素治疗，观察疗效。结果慢性胆囊炎发生率，有糖尿病者100.0％（72/72），无糖尿病者36.7％（119/324），两者比较差异有统计学意义（P＜0.01）。分组治疗，治疗Ⅰ组肝功能复常率及总有效率显著低于治疗Ⅱ组（P＜0.01）；胆道声像改善总有效率亦显著低于治疗Ⅱ组（ P＜0.01）。治疗Ⅰ组肝功能治疗无效者，加胰岛素治疗后，总有效率为68.3％。结论慢性乙型病毒性肝炎合并慢性胆囊炎与糖尿病密切相关，且糖尿病的存在直接影响到肝功能及胆道病变的治疗效果，但可通过胰岛素治疗获得良好预后。慢性乙型病毒性肝炎合并慢性胆囊炎时，排查糖尿病尤为重要。%Objective To study the relevance between diabetes and chronic hepatitis B with chronic chole -cystitis and provide reference for the treatment of chronic hepatitis B with chronic cholecystitis .Methods Three hun-dred and ninety-six patients with mild or moderate chronic hepatitis B were studied .The fasting blood glucose ,2 h post-prandial blood glucose ,sugar tolerance in these patients were detected to screen out patients with diabetes ;type-B ultra-sonic examination and CT examination were performed to screen out patients with chronic cholecystitis ,and the inci-dence of chronic cholecystitis between patients with and without diabetes were compared .Seventy-two chronic hepatitis B patients with chronic cholecystitis and diabetes were set as groupⅠfor treatments,and 119 chronic hepatitis B patients with chronic cholecystitis without diabetes were set as group Ⅱfor treatments.The treatments for both groups were the same,and the results of the treatments were analyzed and recorded .For patients in the groupⅠ,who did not respond to the treatments,additional insulin treatment was given ,and the results of the treatments were analyzed and compared .Re-sults The incidences of cholecystitis in patients with or without diabetes were 100.0%(72/72) and 36.7%(119/324) respectively and the difference was significant ( P<0.01 ) .The recovery rate and the total effective rate of liver function in groupⅠwere lower than those in groupⅡafter the treatments ( P<0.01);the total effective rate of improve-ment of sonographic characteristics of biliary tract in groupⅠwas lower than that in groupⅡafter the treatments ( P<0.01) .The total effective rate of insulin treatment in recovering liver function after failure of treatments in group Ⅰwas 68.3%.Conclusion Chronic hepatitis B with chronic cholecystitis is strongly relevant with diabetes and the existence of diabetes directly affects the treatments for liver function and biliary tract ,but insulin treatment can lead to good prog-nosis.For chronic hepatitis B patients with chronic cholecystitis ,the screening of diabetes is extremely important .