Prevalence, Incidence, and Prognosis of Hepatobiliary Disease in Community-Based Patients with Type 2 Diabetes: The Fremantle Diabetes Study
Prevalence, Incidence, and Prognosis of Hepatobiliary Disease in Community-Based Patients with Type 2 Diabetes: The Fremantle Diabetes Study
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DOI：
10.1210/jc.2011-3232
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发表时间：
2012-05-01
影响因子：
5.8
通讯作者：
Davis, Wendy A.
中科院分区：
文献类型：
--
作者：
Davis, Timothy M. E.;Peters, Kirsten E.;Davis, Wendy A.
背景：很少有研究探讨糖尿病患者肝胆疾病的发病率和死亡率。大多数人使用管理数据库和/或有有限/不完整的数据，包括公认的肝胆疾病的危险因素。目的：本研究的目的是探讨2型糖尿病和肝胆疾病之间的关系，在特征良好的患者中有详细的危险因素数据，包括病毒性肝炎状态和血色素沉着症基因型。设计：这是一项以社区为基础的纵向观察性研究。这项研究是在澳大利亚城市community.Patients：这项研究包括1294例患者的平均值+/- SD年龄64.1 +/- 11.3岁和5156年龄，性别和邮政编码匹配的非糖尿病controls.Main结果措施：流行和发病肝胆疾病和肝胆疾病相关的死亡进行了测量。竞争风险比例风险模型提供了这些终点的独立关联。在13，705患者年（平均11.5年）的随访期间，144例患者有初始肝胆疾病相关住院/癌症登记，而在63，937人年的随访期间，403例对照患者有初始肝胆疾病相关住院/癌症登记，发生率比为1.66（95%置信区间1.37-2.02）。肝胆疾病的发生与较低的糖化血红蛋白和较高的尿白蛋白/肌酐比值有关。近一半的患者（49.9%）在随访期间死亡[与非糖尿病对照组的粗死亡率比为1.97（1.16-3.32）]，21例（3.3%）死于肝胆疾病，包括2例可归因于非酒精性脂肪性肝炎的肝硬化。肝胆疾病相关的死亡是独立预测的先前肝胆疾病，丙型肝炎血清阳性，视网膜病变，周围神经病变;较高的教育水平和较高的空腹血糖是protective.Conclusions：肝胆疾病和相关的死亡率增加2型糖尿病。包括脂肪浸润、微血管病变和直接葡萄糖毒性在内的多种因素可能是促成因素，但非酒精性脂肪性肝炎肝硬化导致的住院和死亡似乎不常见。（《临床内分泌代谢杂志》97：1581-1588，2012年）
Context: Few studies have examined morbidity and mortality associated with hepatobiliary disease in diabetes. Most have used administrative databases and/or have had limited/incomplete data including recognized risk factors for hepatobiliary disease.Objective: The objective of the study was to explore the relationship between type 2 diabetes and hepatobiliary disease in well-characterized patients with detailed risk factor data including viral hepatitis status and hemochromatosis genotype.Design: This was a community-based longitudinal observational study.Setting: The study was conducted in an urban Australian community.Patients: The study included 1294 patients of mean +/- SD aged 64.1 +/- 11.3 yr and 5156 age-, gender-, and ZIP code-matched nondiabetic controls.Main Outcome Measures: Prevalent and incident hepatobiliary disease and hepatobiliary disease-related death were measured. Competing risks proportional hazard models provided independent associates of these end points.Results: During 13,705 patient-years (mean 11.5 yr), 144 patients had an initial hepatobiliary disease-related hospitalization/cancer registration vs. 403 controls during 63,937 person-years of follow-up, an incidence rate ratio of 1.66 (95% confidence interval 1.37-2.02). Incident hepatobiliary disease was associated with a lower glycosylated hemoglobin and higher urinary albumin to creatinine ratio. Nearly half of the patients (49.9%) died during follow-up [crude mortality ratio vs. nondiabetic controls 1.97 (1.16-3.32)], and 21 (3.3%) from hepatobiliary disease including two cases of cirrhosis attributable to nonalcoholic steatohepatitis. Hepatobiliary disease-related death was independently predicted by prior hepatobiliary disease, hepatitis C seropositivity, retinopathy, and peripheral neuropathy; higher educational level and higher fasting serum glucose were protective.Conclusions: Hepatobiliary disease and associated mortality are increased in type 2 diabetes. Multiple factors including fatty infiltration, microangiopathy, and direct glucotoxicity are likely to contribute, but hospitalization and death due to cirrhosis from nonalcoholic steatohepatitis appear uncommon. (J Clin Endocrinol Metab 97: 1581-1588, 2012)