Type 2 diabetes and hepatocellular carcinoma: A cohort study in high prevalence area of hepatitis virus infection
Type 2 diabetes and hepatocellular carcinoma: A cohort study in high prevalence area of hepatitis virus infection
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DOI：
10.1002/hep.21208
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发表时间：
2006-06-01
期刊：
影响因子：
13.5
通讯作者：
Chen, Tony Hsiu-Hsi
中科院分区：
文献类型：
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作者：
Lai, Mei-Shu;Hsieh, Meng-Shu;Chen, Tony Hsiu-Hsi
本研究旨在阐明肝炎感染高发国家2型糖尿病、其他已知危险因素与原发性肝细胞癌（HCC）的关系。我们追踪了1999年至2002年期间参加基隆市社区为基础的综合筛查计划的54，979名受试者的前瞻性队列。根据空腹血糖水平，在入组时共确定了5，732例2型糖尿病患者，通过两阶段肝癌筛查或与国家癌症登记处联系，共确定了138例确诊的HCC病例。采用考克斯比例风险回归模型评估2型糖尿病对HCC发病率的独立影响以及2型糖尿病与肝炎感染或血脂谱之间的相互作用。在控制了年龄、性别、B型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、吸烟和饮酒等因素后，2型糖尿病与HCC发病率（不包括33例在入组时确定的流行病例）之间的相关性被HCV状态和胆固醇水平所改变。仅HCV阴性和高胆固醇血症（校正的HR = 2.81 [1.20-6-55]）的相关性具有统计学显著性（校正的风险比[HR] = 2.08 [1-03-4.18]）。即使排除入组时新诊断的糖尿病病例，这些统计学显着的发现仍然存在。总之，在一个肝炎病毒感染率高的地区，2型糖尿病增加了HCV阴性或总胆固醇水平高的人患HCC的风险。
This study aimed to elucidate the relationship of type 2 diabetes, other known risk factors, and primary hepatocellular carcinoma (HCC) in countries with a high prevalence of hepatitis infection. We followed a prospective cohort of 54,979 subjects who participated in the Keelung Community-Based Integrated Screening program between 1999 and 2002. A total of 5,732 subjects with type 2 diabetes cases were identified at enrollment on the basis of fasting blood glucose level, and a total of 138 confirmed HCC cases were identified either through two-stage liver cancer screening or linkage with the National Cancer Registry. The independent effect of type 2 diabetes on the incidence of HCC and the interaction between type 2 diabetes and hepatitis infection or lipids profile were assessed using the Cox proportional hazards regression model. After controlling for age, sex, hepatitis B virus (HBV), hepatitis C virus (HCV), smoking, and alcohol consumption, the association between type 2 diabetes and incidence of HCC (excluding 33 prevalent cases identified at enrollment) was modified by HCV status and cholesterol level. The associations were only statistically significant (adjusted hazard ratio [HR] = 2.08 [1-03-4.18]) for being HCV negative and for having hypercholesterolemia (adjusted HR = 2.81 [1.20-6-55]). These statistically significant findings remained even excluding cases of diabetes newly diagnosed at enrollment. In conclusion, in an area with a high prevalence of hepatitis virus infection, type 2 diabetes increases the risk of developing HCC in those who are HCV negative or have a high level of total cholesterol.