关键词: 慢性重型肝炎, 胰岛素样生长因子-1, 呼吸商

Abstract: Objective To investigate the changes in serum insulin-like growth factor 1(IGF-1) in patients with chronic severe hepatitis B and hypoglycemia and its relationship to the fasting blood glucose and serum insulin, liver functions and respiratory quotient(RQ). Methods Twenty patients with severe chronic hepatitis B and hypoglycemia and 20 patients with chronic hepatitis B only as the control were recruited. The levels of serum insulin-like growth factor(IGF-1) and the fasting insulin were detected with RIA in the two groups, and the differences were compared; indirect calorimetry was employed to detect RQ. Results The levels of serum IGF-1(11.9±2.6)μg/L in patients with severe chronic hepatitis B and hypoglycemia were significantly lower than those in patients with chronic hepatitis B and (159.8±35.7)μg/L(P<0.01); The levels of serum IGF-1 in patients with intermediate and advanced stages of severe chronic hepatitis B were(8.99±4.61)μg/L; case fatality was 60%, The levels of serum IGF-1 in patients with morning stage severe chronic hepatitis B were(15.43±3.70)μg/L and case fatality was 20%. The levels of serum insulin with severe chronic hepatitis B(19.2±10.9)mIU/L were significantly higher than those in patients with chronic hepatitis B only(10.6±7.3)mIU/L(P<0.01). The differences in the levels of serum IGF-1 and case fatality between intermediate and advanced stages and morning stage were significant(P<0.01). When the level of serum IGF-1 in patients with severe chronic hepatitis B was lower than 19.03 μg/L. It suggested poor prognosis. The level of IGF-1 in patients with severe chronic hepatitis B and hypoglycemia had positive correlation with the ALB, PTA and RQ(B=0.O45, B=0.O32, B=0.O65 respectively, P<0.05), and negative correlation with the fasting serum insulin(B=-0.053, P<0.05). However it had no correlation with TBIL and the fasting blood glucose(B=0.32, B=0.78 respectively, P>0.05). Conclusion The level of serum IGF-1 is significantly decreased in patients with severe chronic hepatitis B, and is closely correlated with the severity of the disease, which suggests that IGF-1 might be an indicator of prognosis in patients with severe chronic hepatitis B and has close relationship with the development of hypoglycemia.

Key words: severe chronic hepatitis B, insulin-like growth factor 1, respiratory quotient