Glucose metabolism and insulin secretion in patients with chronic hepatitis B cirrhosis of different Child-Pugh grades and their association with inflammatory response

Objective To investigate glucose metabolism and insulin secretion in patients with chronic hepatitis B( CHB) of different Child-Pugh grades and liver cirrhosis and their association with inflammatory response. Methods A total of 147 patients with CHB and liver cirrhosis who were admitted to Guangzhou Red Cross Hospital from January 2013 to January 2018 were enrolled,and 65 healthy individuals who underwent physical examination in our hospital during the same period of time were enrolled as control group. The clinical data within 12 hours after admission were collected,including age,sex,body mass index,systolic pressure,diastolic pressure,HBV DNA load,total cholesterol,triglyceride,low-density lipoprotein,high-density lipoprotein,alanine aminotransferase,aspartate aminotransferase,tumor necrosis factor α( TNFα),neutrophil-lymphocyte ratio( NLR),fasting blood glucose,plasma insulin,C-peptide level,homeostasis model assessment of insulin resistance( HOMA-IR),and insulin secretion function. Blood glucose,insulin,and C-peptide were recorded at 2 hours after oral glucose tolerance test( OGTT). The chi-square test was used for comparison of categorical data between two groups; the t-test was used for comparison of continuous data between two groups; the Kruskal-Wallis H test was used for comparison of ranked data between multiple groups and further comparison between two groups. A Pearson correlation analysis was used to investigate correlation.Results Compared with the control group,the patients with CHB and liver cirrhosis had significantly higher TNFα,interleukin-6( IL-6),NLR,insulin,and HOMA-IR( all P < 0. 05) and significantly lower insulin secretion function( P < 0. 05). The 147 patients with CHB and liver cirrhosis were divided into Child-Pugh A,B,and C groups according to Child-Pugh grade,and there were significant differences in TNFα,IL-6,NLR,insulin,HOMA-IR,and insulin secretion function between these three groups( all P < 0. 05). Compared with the control group,the patients with CHB and liver cirrhosis had significantly higher blood glucose,insulin,C-peptide,NLR,TNFα,and IL-6 at 2 hours after OGTT( all P < 0. 05); there were significant differences in blood glucose,insulin,NLR,TNFα,and IL-6 at 2 hours after OGTT between the three groups with different Child-Pugh grades( all P < 0. 05). Child-Pugh score was positively correlated with NLR and blood glucose and insulin at 2 hours after OGTT( r = 0. 678,0. 451,and 0. 644,all P < 0. 001),and NLR was positively correlated with blood glucose and insulin at 2 hours after OGTT( r = 0. 408 and 0. 795,both P < 0. 001). Conclusion There is a certain degree of abnormal glucose metabolism and insulin resistance in CHB patients with liver cirrhosis,and the severities of abnormal glucose metabolism and insulin resistance increase with the increase in liver injury,while inflammation may mediate the association between them.