肝硬化门脉高压症患者胰腺内分泌细胞的变化及其对糖代谢的影响

目的 通过检测肝硬化门脉高压症脾切除患者胰腺A、B细胞及几种糖代谢指标的变化特点,探讨胰腺在肝硬化门脉高压症糖代谢异常发生中的作用.方法 分析2005年3月～2006年3月期间住我院且行脾切除的肝硬化门脉高压症与外伤性脾破裂病人,挑选术中切除脾脏时于脾门处连带有少许胰腺组织的病例作为研究对象,最终收集到15例病例.其中肝硬化门脉高压症11例作为病例组,外伤性脾破裂4例作为对照组.11例肝硬化门静脉高压症患者根据术中门静脉压力检测结果及肝功能Child分级依次分为门静脉压低、中、高和肝功能Child A、B、C3组.对15例病人术前采集空腹血样,保存后统一检测空腹血糖（FPG）、C肽（FCP）与胰高血糖素（Glc）;并通过胰腺形态学变化,分析胰腺组织变化与门脉压力、糖代谢之间的关系.结果 与对照组相比,胰岛A、B细胞数量于门脉压低组（32.5±3.5,82.5±10.6）与中组（29.0±6.0,81.6±5.7）较对照组（29.8±5.0,84.8±5.3）相比无显著差异（P＞0.05）,而门脉压高组（21.8±3.5,74.5±5.2）则明显低于对照组（29.8±5.0,84.8±5.3）,P＜0.05].空腹血糖（FPG）：肝功能A级（4.85±0.86）、B级（4.10±0.30）与对照组（4.60±0.74）相比无显著差异（P＞0.05）,肝功能C级（6.98±1.30）则明显高于肝功能A、B级与对照组（P＜0.05）;门脉压低组（4.67±0.98）、中组（4.25±0.43）与对照组（4.60±0.74）相比无显著差异（P＞0.05）,高组（7.10±1.12）则明显高于低、中组与对照组（P＜0.05）;空腹C肽（FCP）：肝功能A级（1.14±0.13）、B级（1.43±0.10）均明显高于对照组（0.92±0.08）,P＜0.05],C级（0.71±0.06）明显低于A、B级与对照组（P＜0.05）.门脉压低组（1.17±0.20）、中组（1.35±0.12）均明显高于对照组（0.92±0.08）,P＜0.05],高组（0.77±0.10）明显低于A、B级与对照组（P＜0.05）;胰高血糖素（Glc）：肝功能A级（154.08±12.38）、B级（235.82±15.92）、C级（325.58±14.56）,门脉压低组（148.36±15.45）、中组（228.53±19.97）、高组（330.46±20.65）均明显高于对照组（92.13±14.92）,P＜0.05],且随着肝功能损害的加重及门脉压力的升高逐渐升高.病理检查证实胰腺内分泌部出现了相应的病理改变结论 肝硬化门静脉高压症时,胰腺内分泌部可能参与了胰腺糖代谢异常的发生,Glc、FCP在不同肝功能分级间有显著差异,有可能作为判断肝硬化门脉高压症患者肝功能的一项指标.

The effects of pancreas endocrine cells and glycometabolism in patients with liver cirrhosis and portal hypertension

Objective We desire to observe the variation of pancreas endocrine cells in patients with liver cirrhosis and portal hypertension.We detected several glycometabolism indexes in these patients serum in order to investigate the role of pancreas changes in glycometabolism abnormality happened in patients with liver cirrhosis and portal hypertension.Methods We selected patients with portal hypertension and rupture of spleen that a little pancreatic tissue was taken from in lienectomy as the investigation objects in our hospital from Mar,2005 to Mar,2006.Eventually 15 samples were collected.11 samples with liver cirrhosis and portal hypertension were to be the hepatic cirrhosis group and 4 samples with liver traumatic rupture were to be the control group.The patients in hepatic cirrhosis group were divided to Child A class,Child B class and Child C Class according to the standardization of hepatic functional classification and were divided to high class,middle class and low class according to the PVP level.We gathered preoperative empty stomach blood sample of all samples and detected fasting blood glucose （FPG）,fasting C peptide（FCP）,fasting glucagons（Glc）.Pancreatic islet A cells,B cells were counted in light microscope and ultramicrostructures were observed in electron microscope.Finally we compared the difference between two groups and analyzed the relationship among pancreas histology changes,portal vein pressure and glycometabolism.Results The A cell population in low PVP group （32.5 ± 3.5） and middle PVP group （29.0±6.0） had no significant deviation compared with control group （29.8± 5.0）（P〉0.05）.High PVP group（21.8±3.5） is lower than control group obviously（P〈0.05）.The B cell population in low PVP group （82.5±10.6） and middle PVP group （81.6 ± 5.7） had no significant deviation compared with control group （84.8 ± 5.3） （P〉0.05）.High PVP group （74.5±5.2）,which was lower than control group obviously（P〈0.05） Fasting blood glucose：All compared with control group（4.60±0.74）,the level in Child C class（6.98±1.30）is higher significantly （P〈0.05）and the level in Child A class （4.85±0.86）,B class （4.10±0.30） is not differential （P〈0.05）.The level in high PVP group （7.10±1.12） is higher significantly （P〈0.05） and the level in low PVP （4.67±0.98） and middle PVP（4.25±0.43） is not differential （P〉0.05） ; fasting C peptide：the level in Child A （1.14±0.13） and Child B class （1.43± 0.10） are higher significantly than that in control group （0.92±0.08） （P〈0.05）.The level in Child C class （0.71±0.06） is lower significantly than that in control group（P〈0.05）.To compared each class in hepatic cirrhosis group,Child C class is lower significantly than Child A class and Child B class （P〈0.01）.The level in low PVP group （1.17±0.20） and middle PVP group （1.35±0.12） are higher significantly than that in control group （0.92±0.08） （P〈0.05）.The level in high PVP group （0.77±0.10） is lower significantly than that in control group （P〈0.05） ; fasting glucagon：to compared with the control group that the level of cirrhosis group is significantly higher（low PVP 148.36 ± 15.45,middle PVP 228.53±19.97,high PVP 330.46±20.65,control group 92.13±14.92,P〈0.05）.With the progression of impairment of liver function,the level increased gradually in patients with hepatic cirrhosis.There was a significant difference among each class （Child A class 154.08±12.38,Child B class 235.82±15.92,Class C class 325.58±14.56,P〈0.01）.Conclusion The tissue of pancreas occurs pathology changes accordingly when liver cirrhosis and portal hypertension,These changes appear in endocrine gland.It may participate in the occurrence of glycometabolism abnormality.But the certain mechanism is to be investigated deeply.Fasting C peptide and glucagon are sensitive biochemical parameters in evaluating hepatic functions of cirrhotic patients.Perhaps we can assess liver function of cirrhosis patients through them.But it is to be investigated further.