在肝癌患者中持续性低血糖症
Kemal Fariz Kalista1, Hanum Citra Nur Rahma2, Dicky Levenus Tahapary3
1Division of Hepatobiliary, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Endocrinology, diabetes & metabolism case reports
|July 2, 2024
概括
肝癌患者的低血糖症往往表明预后不佳,经常发生在晚期. 支持性治疗,如乳糖注射和类固醇可以帮助管理血糖水平,当瘤细胞减轻是不可行的.
科学领域:
- 在瘤学瘤学.
- 内分泌学 在内分泌学.
- 肝病学 肝病学是一种肝病学.
背景情况:
- 低血糖是原发性和二次性肝癌中关键的副瘤综合征表现,表明预后不佳.
- 它通常呈现于晚期,由于广泛的瘤负担而使治疗复杂化.
- 潜在的机制涉及到由瘤和过度胰岛素生长因子 (IGF) 产生的肝膜替代.
研究的目的:
- 为了表征具有低血糖症的原发性和二次性肝癌患者.
- 分析这些患者的临床形状,管理和结果.
- 鉴定晚期肝癌中低血糖症的有效支持性治疗方法.
主要方法:
- 一系列病例包括41名患有低血糖症的肝癌患者,他们被送往印度尼西亚的第三级转诊医院.
- 数据收集包括患者人口统计,临床表现,瘤特征,血糖水平,Child-Pugh评分和治疗方式.
- 对治疗反应和死亡率的分析.
主要成果:
- 肝细胞癌是最常见的诊断 (51.2%),其次是转移性肝病 (14.6%).
- 患者主要是男性 (65.9%),平均年龄为47.7岁,经常出现黄 (58.5%) 和肝病 (70.7%).
- 平均初始血糖为42.15毫克/分升,Child-Pugh评分高 (9.93). 瘤的特征包括大尺寸 (平均12.6厘米),多重性,在大多数情况下双边叶卷入. 支持性治疗在41.5%的患者中实现了血糖控制,而56.1%的患者是耐火的. 死亡率高达70.7%,发生在低血糖开始后不久.
结论:
- 晚期肝癌中低血糖的管理具有挑战性,往往阻止治疗瘤的治疗,如细胞减少.
- 支持性治疗,包括频繁的饮食,静脉注射的乳糖和类固醇,对于血糖控制至关重要.
- 类固醇通过刺激葡萄糖生成和调节GH-IGF轴来证明有效性,在治疗持续性低血糖症方面起着至关重要的作用.
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