В последние годы идет активное обсуждение связи сахарного диабета (СД) и хронических заболеваний печени (ХЗП). С одной стороны, у пациентов с СД отмечается повышенный риск развития ХЗП, с другой – у пациентов с ХЗП очень часто выявляются нарушения метаболизма глюкозы, что в конечном счете приводит к нарушению толерантности к глюкозе и развитию СД. В настоящем обзоре освещены возможные причинно-следственные связи между некоторыми ХЗП и СД. Представлены механизмы, провоцирующие метаболические и аутоиммунные нарушения при развитии различных нозологий из группы ХЗП, приводящие к стеатозу, инсулинорезистентности, нарушению толерантности к глюкозе и развитию СД. Описаны определенные особенности оценки компенсации углеводного обмена у пациентов с нарушением печеночной функции, анемией и нарушениями белкового обмена.
In recent years there has been an active discussion about the relationship between diabetes mellitus (DM) and chronic liver diseases (CLD). On the one hand, patients with diabetes have an increased risk of developing CLD. On the other hand, patients with CLD very often identify abnormal glucose metabolism which ultimately leads to impaired glucose tolerance and the development of diabetes. This review outlines potential causal relationships between some CLD and DM. Common mechanisms that provoke metabolic and autoimmune disorders in the development of various nosologies of the CKD group, leading to steatosis, insulin resistance, impaired glucose tolerance and the development of diabetes are described. Certain features of the assessment of carbohydrate metabolism compensation in patients with hepatic dysfunction, anemia and protein metabolism disorders are described.
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2. Stasi C, Silvestri C, Voller F, Cipriani F. Epidemiology of Liver Cirrhosis. J Clin Exp Hepatol. 2015;5(3):272. doi: 10.1016/j.jceh.2015.06.002
3. García-Compeán D, González-González JA, Lavalle-González FJ, et al. Hepatogenous diabetes: Is it a neglected condition in chronic liver disease? World J Gastroenterol. 2016;22(10):2869-74. doi: 10.3748/wjg.v22.i10.289
4. Conn HO, Schreiber W, Elkington SG. Cirrhosis and diabetes. II. Association of impaired glucose tolerance with portal-systemic shunting in Laennec’s cirrhosis. Am J Dig Dis. 1971;16(3):227-39.
5. Tolman KG, Fonseca V, Dalpiaz A, Tan MH. Spectrum of Liver Disease in Type 2 Diabetes and Management of Patients With Diabetes and Liver Disease. Diabetes Care. 2007;30(3):734-43. doi: 10.2337/dc06-1539
6. Khan R, Foster R, Chowdhury A. Managing Diabetes in Patients with Chronic Liver Disease. Postgrad Med. 2012;124(4):130-7. doi: 10.3810/pgm.2012.07.2574
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12. García-Compeán D, Jáquez-Quintana JO, Lavalle-González FJ, et al. The prevalence and clinical characteristics of glucose metabolism disorders in patients with liver cirrhosis. A prospective study. Ann Hepatol. 2012;11(2):240-8. doi: 10.1016/S1665-2681(19)31030-0
13. Martínez-Esparza M. Inflammatory status in human hepatic cirrhosis. World J Gastroenterol. 2015;21(41):11522. doi: 10.3748/wjg.v21.i41.11522
14. Coffin CS, Fraser HF, Panaccione R, Ghosh S. Liver diseases associated with anti-tumor necrosis factor-alpha (TNF-α) use for inflammatory bowel disease. Inflamm Bowel Dis. 2011;17(1):479-84. doi: 10.1002/ibd.21336
15. Yang YM, Seki E. TNFα in Liver Fibrosis. Curr Pathobiol Rep. 2015;3(4):253-61. doi: 10.1007/s40139-015-0093-z
16. Borst SE. The Role of TNF-α in Insulin Resistance. Endocrine. 2004;23(2-3):177-82. doi: 10.1385/ENDO:23:2-3:177
17. Sawada M, Kiyono T, Nakashima S, et al. Molecular mechanisms of TNF-α-induced ceramide formation in human glioma cells:P53-mediated oxidant stress-dependent and independent pathways. Cell Death Differ. 2004;11(9):997-1008. doi: 10.1038/sj.cdd.4401438
18. Meex RCR, Watt MJ. Hepatokines: linking nonalcoholic fatty liver disease and insulin resistance. Nat Rev Endocrinol. 2017;13(9):509-20. doi: 10.1038/nrendo.2017.56
19. Hammerstad SS, Grock SF, Lee HJ, Hasham A. Diabetes and hepatitis C: a two-way association. Front Endocrinol. 2015;6(September). doi: 10.3389/fendo.2015.00134
20. Kingston ME, Ali MA, Atiyeh M, Donnelly RJ. Diabetes mellitus in chronic active hepatitis and cirrhosis. Gastroenterology. 1984;87(3):688-94.
21. Huang JF, Dai CY, Hwang SJ, et al. Hepatitis C viremia increases the association with type 2 diabetes mellitus in a hepatitis B and C endemic area: an epidemiological link with virological implication. Am J Gastroenterol. 2007;102(6):1237-43. doi: 10.1111/j.1572-0241.2007.01181.x
22. Hong YS, Chang Y, Ryu S, et al. Hepatitis B and C virus infection and diabetes mellitus: A cohort study. Sci Rep. 2017;7(1):4606. doi: 10.1038/s41598-017-04206-6
23. Analytic and Reporting Guidelines: The Third National Health and Nutrition Examination Survey, NHANES III (1988–94). doi: 10.3886/ICPSR02231.v1
24. Knobler H, Schihmanter R, Zifroni A, Fenakel G, Schattner A. Increased Risk of Type 2 Diabetes in Noncirrhotic Patients With Chronic Hepatitis C Virus Infection. Mayo Clin Proc. 2000;75(4):355-9. doi: 10.4065/75.4.355
25. Pattullo V, Heathcote J. Hepatitis C and diabetes: one treatment for two diseases? Liver Int. 2009;30(3):356-64. doi: 10.1111/j.1478-3231.2009.02185.x
26. Bose SK. Hepatitis C virus infection and insulin resistance. World J Diabetes. 2014;5(1):52. doi: 10.4239/wjd.v5.i1.52
27. Akyürek N, Atabek ME, Eklioglu BS. Possible Associations of Acut Hepatitis B With New-onset Type 1 Diabetes: A Case Report. Gazi Med J. 2015;26(2). doi: 10.12996/gmj.2015.21
28. Chen LK, Chou YC, Tsai ST, Hwang SJ, Lee SD. Hepatitis C virus infection-related Type 1 diabetes mellitus. Diabet Med. 2005;22(3):340-3. doi: 10.1111/j.1464-5491.2005.01412.x
29. Targher G, Marchesini G, Byrne CD. Risk of type 2 diabetes in patients with non-alcoholic fatty liver disease: Causal association or epiphenomenon? Diabetes Metab. 2006;42(3):142-56. doi: 10.1016/j.diabet.2016.04.002
30. Shah RV, Allison MA, Lima JAC, et al. Liver fat, statin use, and incident diabetes: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis. 2015;242(1):211-7. doi: 10.1016/j.atherosclerosis.2015.07.018
31. Kumashiro N, Erion DM, Zhang D, et al. Cellular mechanism of insulin resistance in nonalcoholic fatty liver disease. Proc Natl Acad Sci. 2011;108(39):16381-5. doi: 10.1073/pnas.1113359108
32. Allen KJ, Gurrin LC, Constantine CC, et al. Iron-Overload – Related Disease in HFE Hereditary Hemochromatosis. N Engl J Med. 2008;358(3):221-30. doi: 10.1056/NEJMoa073286
33. Еремина Е.Ю. Гемохроматоз в практике клинициста. Медицинский альманах. 2015;36(1):74-8 [Eremina EYu. Hemochromatosis in the practice of the clinician. Meditsinskiy Al’manakh = Medical Almanac. 2015;36(1):74-8 (In Russ.)].
34. Mitchell TC, Mcclain DA. Diabetes and Hemochromatosis. Curr Diabet Rep. 2014;14:488. doi: 10.1007/s11892-014-0488-y
35. Moczulski DK, Grzeszczak W, Gawlik B. Role of hemochromatosis C282Y and H63D mutations in HFE gene in development of type 2 diabetes and diabetic nephropathy. Diabetes Care. 2001;24(7):1187-91.
36. Ellervik C, Mandrup-Poulsen T, Nordestgaard BG, et al. Prevalence of hereditary haemochromatosis in late-onset type 1 diabetes mellitus: a retrospective study. Lancet. 2001;358:1405-9. doi: 10.1016/S0140-6736(01)06526-6
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38. Baliunas O, Taylor J, Irving H, et al. Alcohol as a Risk Factor for Type 2 Diabetes. Diabetes Care. 2009;32(11):2123-32. doi: 10.2337/dc09-0227
39. Koko V, Todorović V, Nikolić JA, et al. Rat pancreatic B-cells after chronic alcohol feeding. A morphometric and fine structural study. Histol Histopathol. 1995;10(2):325-7.
40. Wei M, Gibbons LW, Mitchell TL, Kampert JB BS. Alcohol intake and incidence of type 2 diabetes in men. Diabetes Care. 2000;23(1):18-22.
41. Nilsson A, Tideholm B, Kalén J KP. Incidence of severe hypoglycemia and its causes in insulin-treated. Acta Med Scand. 1988;224(3):257-62.
42. Ribeiro R, Marinho RT, Suri JS, Sanches JM. Classification and Staging of Chronic Liver Disease Based on Ultrasound, Laboratorial, and Clinical Data. In: Ultrasound Imaging. Boston, MA: Springer US; 2012. P. 255-82. doi: 10.1007/978-1-4614-1180-2_11
43. Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2015;149(2):389-97.e10. doi: 10.1053/j.gastro.2015.04.043
44. Kim MG, Choi WC. [Differential diagnosis of diabetes mellitus caused by liver cirrhosis and other type 2 diabetes mellitus]. Korean J Hepatol. 2006;12(4):524-9.
45. Acevedo JG, Cramp ME. Hepatorenal syndrome: Update on diagnosis and therapy. World J Hepatol. 2017;9(6):293-9. doi: 10.4254/wjh.v9.i6.293
46. Gangopadhyay KK. Consensus Statement on Dose Modifications of Antidiabetic Agents in Patients with Hepatic Impairment. Ind J Endocrinol Metab. 2017;21(2):341-54. doi: 10.4103/ijem.IJEM
47. Моргунов ЛЮ. Сахарный диабет у пациентов с циррозом печени:новые возможности лечения. Исследования и практика в медицине. 2017;4(3):75-85 [Morgunov LYu. Diabetes mellitus in patients with liver cirrhosis: new treatment options. Issledovaniya i Praktika v Meditsine = Research and Practice in Medicine. 2017;4(3):75-85 (In Russ.)]. doi: 10.17709/2409-2231-2017-4-3-7
________________________________________________
1. IDF Diabetes atlas. 7th ed. 2015. Available from: http://www.diabetesatlas.org. Accessed July 29, 2018.
2. Stasi C, Silvestri C, Voller F, Cipriani F. Epidemiology of Liver Cirrhosis. J Clin Exp Hepatol. 2015;5(3):272. doi: 10.1016/j.jceh.2015.06.002
3. García-Compeán D, González-González JA, Lavalle-González FJ, et al. Hepatogenous diabetes: Is it a neglected condition in chronic liver disease? World J Gastroenterol. 2016;22(10):2869-74. doi: 10.3748/wjg.v22.i10.289
4. Conn HO, Schreiber W, Elkington SG. Cirrhosis and diabetes. II. Association of impaired glucose tolerance with portal-systemic shunting in Laennec’s cirrhosis. Am J Dig Dis. 1971;16(3):227-39.
5. Tolman KG, Fonseca V, Dalpiaz A, Tan MH. Spectrum of Liver Disease in Type 2 Diabetes and Management of Patients With Diabetes and Liver Disease. Diabetes Care. 2007;30(3):734-43. doi: 10.2337/dc06-1539
6. Khan R, Foster R, Chowdhury A. Managing Diabetes in Patients with Chronic Liver Disease. Postgrad Med. 2012;124(4):130-7. doi: 10.3810/pgm.2012.07.2574
7. [Tkachuk VA, Vorotnikov AV. Molecular mechanisms for the development of insulin resistance. Sakharnyi Diabet. 2014;17(2):29-40 (In Russ.)]. doi: 10.14341/DM2014229-40
8. Saini V. Molecular mechanisms of insulin resistance in type 2 diabetes mellitus. World J Diabetes. 2010;1(3):68. doi: 10.4239/wjd.v1.i3.68
9. [Mishina EE, Majorov AYu, Bogomolov PO, et al. Non-alcoholic fatty liver disease: a cause or consequence of insulin resistance? Sakharnyi Diabet. 2017;20(5):335-43 (In Russ.)]. doi: 10.14341/DM9372
10. Parola M, Pinzani M. Liver fibrosis: Pathophysiology, pathogenetic targets and clinical issues. Mol Aspects Med. 2018 Sep. doi: 10.1016/j.mam.2018.09.002
11. Kiziltas S. Toll-like receptors in pathophysiology of liver diseases. World J Hepatol. 2016;8(32):1354-69. doi: 10.4254/wjh.v8.i32.1354
12. García-Compeán D, Jáquez-Quintana JO, Lavalle-González FJ, et al. The prevalence and clinical characteristics of glucose metabolism disorders in patients with liver cirrhosis. A prospective study. Ann Hepatol. 2012;11(2):240-8. doi: 10.1016/S1665-2681(19)31030-0
13. Martínez-Esparza M. Inflammatory status in human hepatic cirrhosis. World J Gastroenterol. 2015;21(41):11522. doi: 10.3748/wjg.v21.i41.11522
14. Coffin CS, Fraser HF, Panaccione R, Ghosh S. Liver diseases associated with anti-tumor necrosis factor-alpha (TNF-α) use for inflammatory bowel disease. Inflamm Bowel Dis. 2011;17(1):479-84. doi: 10.1002/ibd.21336
15. Yang YM, Seki E. TNFα in Liver Fibrosis. Curr Pathobiol Rep. 2015;3(4):253-61. doi: 10.1007/s40139-015-0093-z
16. Borst SE. The Role of TNF-α in Insulin Resistance. Endocrine. 2004;23(2-3):177-82. doi: 10.1385/ENDO:23:2-3:177
17. Sawada M, Kiyono T, Nakashima S, et al. Molecular mechanisms of TNF-α-induced ceramide formation in human glioma cells:P53-mediated oxidant stress-dependent and independent pathways. Cell Death Differ. 2004;11(9):997-1008. doi: 10.1038/sj.cdd.4401438
18. Meex RCR, Watt MJ. Hepatokines: linking nonalcoholic fatty liver disease and insulin resistance. Nat Rev Endocrinol. 2017;13(9):509-20. doi: 10.1038/nrendo.2017.56
19. Hammerstad SS, Grock SF, Lee HJ, Hasham A. Diabetes and hepatitis C: a two-way association. Front Endocrinol. 2015;6(September). doi: 10.3389/fendo.2015.00134
20. Kingston ME, Ali MA, Atiyeh M, Donnelly RJ. Diabetes mellitus in chronic active hepatitis and cirrhosis. Gastroenterology. 1984;87(3):688-94.
21. Huang JF, Dai CY, Hwang SJ, et al. Hepatitis C viremia increases the association with type 2 diabetes mellitus in a hepatitis B and C endemic area: an epidemiological link with virological implication. Am J Gastroenterol. 2007;102(6):1237-43. doi: 10.1111/j.1572-0241.2007.01181.x
22. Hong YS, Chang Y, Ryu S, et al. Hepatitis B and C virus infection and diabetes mellitus: A cohort study. Sci Rep. 2017;7(1):4606. doi: 10.1038/s41598-017-04206-6
23. Analytic and Reporting Guidelines: The Third National Health and Nutrition Examination Survey, NHANES III (1988–94). doi: 10.3886/ICPSR02231.v1
24. Knobler H, Schihmanter R, Zifroni A, Fenakel G, Schattner A. Increased Risk of Type 2 Diabetes in Noncirrhotic Patients With Chronic Hepatitis C Virus Infection. Mayo Clin Proc. 2000;75(4):355-9. doi: 10.4065/75.4.355
25. Pattullo V, Heathcote J. Hepatitis C and diabetes: one treatment for two diseases? Liver Int. 2009;30(3):356-64. doi: 10.1111/j.1478-3231.2009.02185.x
26. Bose SK. Hepatitis C virus infection and insulin resistance. World J Diabetes. 2014;5(1):52. doi: 10.4239/wjd.v5.i1.52
27. Akyürek N, Atabek ME, Eklioglu BS. Possible Associations of Acut Hepatitis B With New-onset Type 1 Diabetes: A Case Report. Gazi Med J. 2015;26(2). doi: 10.12996/gmj.2015.21
28. Chen LK, Chou YC, Tsai ST, Hwang SJ, Lee SD. Hepatitis C virus infection-related Type 1 diabetes mellitus. Diabet Med. 2005;22(3):340-3. doi: 10.1111/j.1464-5491.2005.01412.x
29. Targher G, Marchesini G, Byrne CD. Risk of type 2 diabetes in patients with non-alcoholic fatty liver disease: Causal association or epiphenomenon? Diabetes Metab. 2006;42(3):142-56. doi: 10.1016/j.diabet.2016.04.002
30. Shah RV, Allison MA, Lima JAC, et al. Liver fat, statin use, and incident diabetes: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis. 2015;242(1):211-7. doi: 10.1016/j.atherosclerosis.2015.07.018
31. Kumashiro N, Erion DM, Zhang D, et al. Cellular mechanism of insulin resistance in nonalcoholic fatty liver disease. Proc Natl Acad Sci. 2011;108(39):16381-5. doi: 10.1073/pnas.1113359108
32. Allen KJ, Gurrin LC, Constantine CC, et al. Iron-Overload – Related Disease in HFE Hereditary Hemochromatosis. N Engl J Med. 2008;358(3):221-30. doi: 10.1056/NEJMoa073286
33. [Eremina EYu. Hemochromatosis in the practice of the clinician. Meditsinskiy Al’manakh = Medical Almanac. 2015;36(1):74-8 (In Russ.)].
34. Mitchell TC, Mcclain DA. Diabetes and Hemochromatosis. Curr Diabet Rep. 2014;14:488. doi: 10.1007/s11892-014-0488-y
35. Moczulski DK, Grzeszczak W, Gawlik B. Role of hemochromatosis C282Y and H63D mutations in HFE gene in development of type 2 diabetes and diabetic nephropathy. Diabetes Care. 2001;24(7):1187-91.
36. Ellervik C, Mandrup-Poulsen T, Nordestgaard BG, et al. Prevalence of hereditary haemochromatosis in late-onset type 1 diabetes mellitus: a retrospective study. Lancet. 2001;358:1405-9. doi: 10.1016/S0140-6736(01)06526-6
37. [Ivashkin VT, Mayevskaya MV, Pavlov CS, et al. Clinical recommendations of the Russian Society for the Study of the Liver on the management of adult patients with alcoholic liver disease. Rossiiskii Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2017;27(6):20-40 (In Russ.)]. doi: 10.22416/1382-4376-2017-27-6-20-40
38. Baliunas O, Taylor J, Irving H, et al. Alcohol as a Risk Factor for Type 2 Diabetes. Diabetes Care. 2009;32(11):2123-32. doi: 10.2337/dc09-0227
39. Koko V, Todorović V, Nikolić JA, et al. Rat pancreatic B-cells after chronic alcohol feeding. A morphometric and fine structural study. Histol Histopathol. 1995;10(2):325-7.
40. Wei M, Gibbons LW, Mitchell TL, Kampert JB BS. Alcohol intake and incidence of type 2 diabetes in men. Diabetes Care. 2000;23(1):18-22.
41. Nilsson A, Tideholm B, Kalén J KP. Incidence of severe hypoglycemia and its causes in insulin-treated. Acta Med Scand. 1988;224(3):257-62.
42. Ribeiro R, Marinho RT, Suri JS, Sanches JM. Classification and Staging of Chronic Liver Disease Based on Ultrasound, Laboratorial, and Clinical Data. In: Ultrasound Imaging. Boston, MA: Springer US; 2012. P. 255-82. doi: 10.1007/978-1-4614-1180-2_11
43. Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2015;149(2):389-97.e10. doi: 10.1053/j.gastro.2015.04.043
44. Kim MG, Choi WC. [Differential diagnosis of diabetes mellitus caused by liver cirrhosis and other type 2 diabetes mellitus]. Korean J Hepatol. 2006;12(4):524-9.
45. Acevedo JG, Cramp ME. Hepatorenal syndrome: Update on diagnosis and therapy. World J Hepatol. 2017;9(6):293-9. doi: 10.4254/wjh.v9.i6.293
46. Gangopadhyay KK. Consensus Statement on Dose Modifications of Antidiabetic Agents in Patients with Hepatic Impairment. Ind J Endocrinol Metab. 2017;21(2):341-54. doi: 10.4103/ijem.IJEM
47. [Morgunov LYu. Diabetes mellitus in patients with liver cirrhosis: new treatment options. Issledovaniya i Praktika v Meditsine = Research and Practice in Medicine. 2017;4(3):75-85 (In Russ.)]. doi: 10.17709/2409-2231-2017-4-3-7
Авторы
З.А. Калмыкова, И.В. Кононенко, А.Ю. Майоров
ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия