The role of diabetes in hepatocellular carcinoma: A case-control study among United States veterans
The role of diabetes in hepatocellular carcinoma: A case-control study among United States veterans
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DOI：
10.1111/j.1572-0241.2001.04054.x
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发表时间：
2001-08-01
影响因子：
9.8
通讯作者：
Everhart, JE
中科院分区：
文献类型：
--
作者：
El-Serag, HB;Richardson, PA;Everhart, JE
目的：糖尿病（DM）已被报道增加肝细胞癌（HCC）的风险。我们进行了一项病例对照研究，以检查糖尿病的作用，同时控制几个已知的危险因素hcz.METHODS：所有住院患者原发性肝癌（PLC）在1997-1999年期间被确定在计算机数据库的退伍军人事务部，患者治疗文件。在同一时间段内，从患者治疗文件中随机分配未患癌症的对照。对住院和门诊病例进行了检索，以了解多种疾病，包括糖尿病、丙型肝炎病毒（HCV）、B肝炎病毒（HBV）、酒精性肝硬化、自身免疫性肝炎、血色素沉着症和非特异性肝硬化。调整后的优势比（OR）计算在多变量logistic回归model.Results：我们确定了823例PLC和3459对照组。病例组年龄较大（62岁[+/- 10] vs 60岁[+/- 11]，p < 0.0001）。有更多的男性（99%比97%。0.0004），和非白人（66%对71%，0.0009）与对照组相比，更高的频率。然而，HCV和HBV感染的患者比对照组年轻。在PLC病例中更常见的危险因素包括HCV（34% vs 5%，p < 0.0001），HBV（11% vs 2%）。酒精性肝硬化（47%对6%，p < 0.0001）。血色素沉着症（2%vs0.3%，p < 0.0001），自身免疫性肝炎（5%vs0.5%，p < 0.0001）。p < 0.0001）和糖尿病（33%对30%。p = 0.059）。多因素Logistic回归分析显示，合并HCV、HBV的糖尿病患者合并PLC的校正OR值显著增加（1.57，1.08-2.28，p = 0.02）。或者酒精性肝硬化在没有慢性肝病标志物的情况下，糖尿病和PLC的校正OR没有显著增加（1.08，0.86-1.18）。p = 0.4）。在调整HCV和HBV感染病例的年轻年龄后，HCV调整的OR（17.27，95%CI = 11.98-24.89）和HBV调整的OR（9.22，95%CI = 4.52-18.80）增加。合并HCV和酒精性肝硬化进一步增加风险，调整后OR为79.21（60.29-103.41）。结论：糖尿病仅在合并其他危险因素如丙型肝炎、B型肝炎或酒精性肝硬化的情况下增加PLC的危险性。丙型肝炎感染和酒精性肝硬化占退伍军人PLC的大部分。
OBJECTIVE: Diabetes mellitus (DM) has been reported to increase the risk of hepatocellular carcinoma (HCC). We carried out a case-control study to examine the role of DM while controlling for several known risk factors of HCC.METHODS: All hospitalized patients with primary liver cancer (PLC) during 1997-1999 were identified in the computerized database of the Department of Veterans Affairs, the Patient Treatment File. Controls without cancer were randomly assigned from the Patient Treatment File during the same time period. The inpatient and outpatient files were searched for several conditions including DM, hepatitis C virus (HCV), hepatitis B virus (HBV), alcoholic cirrhosis, autoimmune hepatitis, hemochromatosis, and nonspecific cirrhosis. Adjusted odds ratios (OR) were calculated in a multivariable logistic regression model.RESULTS: We identified 823 patients with PLC and 3459 controls. The case group was older (62 yr [+/- 10] vs 60 [+/- 11], p < 0.0001). had more men (99% vs 97%. 0.0004), and a greater frequency of nonwhites (66% vs 71%, 0.0009) compared with controls. However, HCV- and HBV-infected patients were younger among cases than controls. Risk factors that were significantly more frequent among PLC cases included HCV (34% vs 5%, p < 0.0001), HBV (11% vs 2%. p < 0.0001), alcoholic cirrhosis (47% vs 6%, p < 0.0001). hemochromatosis (2% vs 0.3%, p < 0.0001), autoimmune hepatitis (5% vs 0.5%. p < 0.0001), and diabetes (33% vs 30%. p = 0.059). In the multivariable logistic regression, diabetes was associated with a significant increase in the adjusted OR of PLC (1.57, 1.08-2.28, p = 0.02) in the presence of HCV, HBV. or alcoholic cirrhosis. Without markers of chronic liver disease, the adjusted OR for diabetes and PLC was not significantly increased (1.08, 0.86-1.18. p = 0.4). There was an increase in the HCV adjusted OR (17.27, 95% CI = 11.98-24.89) and HBV (9.22, 95% Cl = 4.52-18.80) after adjusting for the younger age of HCV- and HBV-infected cases. The combined presence of HCV and alcoholic cirrhosis further increases the risk with an adjusted OR of 79.21 (60.29-103.41). The population attributable fraction for HCV among hospitalized veterans was 44.8%, whereas that of alcoholic cirrhosis was 51%.CONCLUSION: DM increased the risk of PLC only in the presence of other risk factors such as hepatitis C or B or alcoholic cirrhosis. Hepatitis C infection and alcoholic cirrhosis account for most of PLC among veterans.