关键词: 肝硬化, 乙型肝炎, 糖尿病, 睡前加餐, 能量代谢, 胰岛素抵抗

Abstract: Background　Many patients with liver cirrhosis and diabetes mellitus（DM）suffer from protein-energy malnutrition as well as disorder of glycometabolism.With poor glycogen reserve and insulin resistance，these patients are prone to hypoglycemia in the morning.Previous studies have reported that late-evening snack（LES） is able to shorten the time of hunger and reduce the energy supply of oxidative decomposition of fat and protein to prevent hypoglycemia in the next morning in patients with cirrhosis.However，whether LES plays a role in cirrhosis patients with DM is still worth exploring.Objective　To investigate the effect of 200 kcal of LES on energy metabolism and glucose metabolism in patients with liver cirrhosis and DM.Methods　Twenty-five patients with hepatitis B cirrhosis and DM who met the research criteria were selected from January 1，2015 to December 30，2017 in the Department of Severe Liver Diseases in Beijing You'an Hospital，Capital Medical University. They were divided into high-carbohydrate LES management group with low-glycemic index（intervention group，n=13） and cirrhosis and DM diet group（non-intervention group，n=12） according to the random number table method.All patients continued to have antiviral，liver protection and hypoglycemic treatment.The non-intervention group maintained three meals a day；the intervention group changed the traditional three meals to four meals，and each meal reduced 67 kcal（16.7 g carbohydrate），and added a meal one hour before bedtime.The baseline demographic data（sex and age），baseline anthropometric data（body mass and BMI）before and after three-month intervention，dietary intake（carbohydrate，fat，protein and energy），energy metabolism index〔resting energy expenditure（REE），predicted resting energy expenditure（PREE），percentage of PREE（PREE%），respiratory quotient（RQ），carbohydrate oxidation rate（CHO%），fat oxidation rate（FAT%） and protein oxidation rate（PRO%）〕，glucose metabolism index〔glycosylated hemoglobin（HbA1c），fasting blood glucose （FBG） and fasting insulin （FINS）〕，insulin resistance index（HOMA-IR），islet B cell function index （FBCI） and liver function index （ALT，AST，TBIL，TP，ALB，PALB，CHE and PTA） were compared between two groups.Results　There was no significant difference in body mass，BMI，carbohydrate intake，fat intake，protein intake and energy intake between the two groups at baseline and three months after intervention（P>0.05）．There was no significant difference in REE，PREE and PREE% between the two groups after three-month intervention（P> 0.05）．RQ and CHO% in the intervention group were higher than those in the non-intervention group after three-month intervention，while FAT and PRO% were lower（P<0.05）．RQ and CHO% after three-month intervention in intervention group were higher than those at baseline in the same group，while FAT and PRO% were lower（P<0.05）．HbA1c，FBG，FINS and HOMA-IR in intervention group were lower than those in non-intervention group at 3 months after intervention（P<0.05）．There was no significant difference in FBCI between the two groups at 3 months after intervention （P> 0.05）．HbA1c，FBG，FINS and HOMA-IR in the intervention group at 3 months after intervention were lower than those in the same group at baseline（P<0.05）．TP，ALB and PALB in the intervention group at 3 months after intervention were higher than those in the same group at baseline（P<0.05）．Conclusion　Before going to bed，200 kcal of food with low-glycemic index and high-carbohydrate can improve nutritional metabolism and blood sugar control in patients with hepatitis B cirrhosis and DM，reduce insulin resistance and prevent hypoglycemia caused by disorders of glucose metabolism.

Key words: Liver cirrhosis, Hepatitis B, Diabetes mellitus, Late-evening snack, Energy metabolism, Insulin resistance