Occlusion of portosystemic shunts improves hyperinsulinemia due to insulin resistance in cirrhotic patients with portal hypertension
Occlusion of portosystemic shunts improves hyperinsulinemia due to insulin resistance in cirrhotic patients with portal hypertension
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DOI：
10.1007/s00535-013-0893-z
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发表时间：
2014-09-01
影响因子：
6.3
通讯作者：
Sakaida, Isao
中科院分区：
文献类型：
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作者：
Ishikawa, Tsuyoshi;Shiratsuki, Shogo;Sakaida, Isao
背景肝硬化（LC）常并发胰岛素抵抗（IR）导致的高胰岛素血症，这被认为与分流形成和肝功能受损密切相关。本研究评估球囊闭塞逆行经静脉闭塞术 (BRTO) 是否会影响 LC 患者的葡萄糖和胰岛素代谢。 方法 25 名肝硬化患者（平均年龄 = 69.6 岁；女性/男性 = 12/13；丙型肝炎病毒/酒精/非酒精性脂肪性肝炎 = 14/6/5；Child-Pugh 分级 A/B = 10/15）患有胃溃疡因门静脉高压（PH）导致的门体分流（PSS）引起的静脉曲张和/或肝性脑病在我院接受了 B-RTO。在术前和术后1个月进行测试。结果分流阻断导致肝外侧支血流量减少和门静脉流量增加，以及肝功能指标的显着改善。此外，B-RTO 显着降低了 IR 的稳态模型评估 (HOMA)，而 β 细胞功能的 HOMA 没有统计下降。 75克口服葡萄糖耐量试验（75-OGTT）显示，PSS的阻断降低了空腹免疫反应性胰岛素（IRI）水平和IRI曲线下面积。然而，没有观察到餐前或餐后血浆葡萄糖水平的显着变化。此外，根据美国糖尿病协会的标准，B-RTO 使 58.3% 术前糖耐量受损或糖尿病的患者的 75-OGTT 曲线得到改善。结论 分流封堵通过增加门静脉流量、改善肝功能以及随后增加肝硬化 PH 患者的肝脏胰岛素清除率，改善 IR 相关的高胰岛素血症。
Background Liver cirrhosis (LC) is often complicated by hyperinsulinemia due to insulin resistance (IR), which is considered to be closely related to shunt formation and impaired liver function. This study evaluates whether balloon- occluded retrograde transvenous obliteration (BRTO) can affect glucose and insulin metabolism in patients with LC.Methods Twenty-five cirrhotic patients (mean age = 69.6 years; female/male = 12/13; hepatitis C virus/alcohol/nonalcoholic steatohepatitis = 14/6/5; Child-Pugh's class A/B = 10/15) with gastric varices and/or hepatic encephalopathy caused by portosystemic shunts (PSS) due to portal hypertension (PH) underwent B-RTO at our hospital. Testing was performed before and at 1 month after the procedure.Results Shunt occlusion resulted in a decrease in extrahepatic collateral blood flow and an increase in portal venous flow, as well as a dramatic improvement in hepatic function markers. In addition, B-RTO significantly decreased homeostasis model assessment (HOMA) of IR without a statistical decline of HOMA of beta-cell function. The 75-g oral glucose tolerance test (75-OGTT) revealed that occlusion of PSS reduced both fasting immunoreactive insulin (IRI) levels and the area under the curve for IRI. However, no significant change in preprandial or postprandial plasma glucose levels was observed. Furthermore, according to the criteria of the American Diabetes Association, B-RTO led to an improved 75-OGTT profile in 58.3 % of patients who had impaired glucose tolerance or diabetes mellitus before the procedure.Conclusions Shunt occlusion improves IR-related hyperinsulinemia through increased portal venous flow, ameliorated liver function, and consequent augmented hepatic insulin clearance in cirrhotic patients with PH.