Newly diagnosed diabetes mellitus as a risk factor for serious liver disease
Newly diagnosed diabetes mellitus as a risk factor for serious liver disease
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DOI：
10.1503/cmaj.092144
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发表时间：
2010-08-10
影响因子：
14.6
通讯作者：
Booth, Gillian L.
中科院分区：
文献类型：
--
作者：
Porepa, Liane;Ray, Joel G.;Booth, Gillian L.
背景资料：糖尿病的负面影响是众所周知的，但对这种疾病对肝脏的影响知之甚少，肝脏是一个易患与胰岛素抵抗相关的非酒精性脂肪肝的器官。我们评估了新诊断的糖尿病成人是否在严重liver diseases.Methods的风险增加：我们使用的行政卫生数据库为安大略省（1994-2006年）进行人口为基础的匹配回顾性队列研究。暴露组包括438069名新诊断糖尿病的成年人。未暴露的对照组，即那些没有已知的糖尿病患者，由2 059 708人组成，按出生年份、性别和当地卫生区域与暴露人员按5：1匹配。我们排除了先前存在肝脏或酒精相关疾病的个体。主要的研究结果是严重的肝脏疾病，即肝硬化，肝功能衰竭及其后遗症，或接受肝transplant.Results：严重的肝脏疾病的发病率为8.19每10 000人年的新诊断的糖尿病和4.17每10 000人年的那些没有糖尿病。未校正的风险比为1.92（95%置信区间[CI] 1.83-2.01）。在调整了年龄、收入、城市居住地、医疗保健利用和既往存在的高血压、血脂异常、肥胖和心血管疾病后，风险比为1.77（95%CI 1.68-1.86）。解释：新诊断的糖尿病成人似乎有更高的晚期肝病风险，也称为糖尿病肝病。这是否反映了非酒精性脂肪肝疾病或肝脏的直接血糖损伤仍有待确定。
Background: The negative impact of diabetes mellitus is well recognized, yet little is known about the effect of this disease on the liver, an organ susceptible to nonalcoholic fatty liver disease related to insulin resistance. We evaluated whether adults with newly diagnosed diabetes were at increased risk of serious liver disease.Methods: We used administrative health databases for the province of Ontario (1994-2006) to perform a population-based matched retrospective cohort study. The exposed group comprised 438 069 adults with newly diagnosed diabetes. The unexposed comparison group-those without known diabetes-consisted of 2 059 708 individuals, matched 5:1 to exposed persons, by birth year, sex and local health region. We excluded individuals with preexisting liver or alcohol-related disease. The primary study outcome was the subsequent development of serious liver disease, namely, liver cirrhosis, liver failure and its sequelae, or receipt of a liver transplant.Results: The incidence rate of serious liver disease was 8.19 per 10 000 person-years among those with newly diagnosed diabetes and 4.17 per 10 000 person-years among those without diabetes. The unadjusted hazard ratio was 1.92 (95% confidence interval [CI] 1.83-2.01). After adjustment for age, income, urban residence, health care utilization and pre-existing hypertension, dyslipidemia, obesity and cardiovascular disease, the hazard ratio was 1.77 (95% CI 1.68-1.86).Interpretation: Adults with newly diagnosed diabetes appeared to be at higher risk of advanced liver disease, also known as diabetic hepatopathy. Whether this reflects nonalcoholic fatty liver disease or direct glycemic injury of the liver remains to be determined.