Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma
Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma
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DOI：
10.1053/j.gastro.2003.10.065
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发表时间：
2004-02-01
期刊：
影响因子：
29.4
通讯作者：
Everhart, JE
中科院分区：
文献类型：
--
作者：
El-Serag, HB;Tran, T;Everhart, JE
背景与目的：据报道，糖尿病与慢性肝病之间存在关联。 However, the temporal relationship between these conditions remains unknown.方法：我们利用退伍军人事务部的计算机记录，确定了 1985 年至 1990 年间所有出院诊断为糖尿病的患者。我们为每位糖尿病患者随机分配了 3 位非糖尿病患者。我们排除了伴有肝病的患者。其余队列的慢性非酒精性肝病 (CNLD) 和肝细胞癌 (HCC) 的发生情况一直持续到 2000 年。风险率比 (HRR) 在 Cox 比例风险生存分析中确定。结果：研究队列包括 173,643 名糖尿病患者和 650,620 名非糖尿病患者。大多数是男性（98%）。糖尿病患者比非糖尿病患者年龄更大（62 岁与 54 岁）。糖尿病患者慢性非酒精性肝病的发病率显着较高（发病率分别为：18.13/10,000 人年 vs. 9.55/10,000 人年，P < 0.0001）。 HCC 也获得了类似的结果（发病率：分别为每 10,000 人年 2.39 比 0.87，P < 0.0001）。糖尿病与 CNLD 的 HRR 为 1.98（95% Cl：1.88 至 2.09，P < 0.0001）和肝细胞癌的 HRR 为 2.16（1.86 至 2.52，P < 0.0001）相关。随访时间超过 10 年的患者中，糖尿病风险最高。结论：在患有糖尿病的男性中，CNLD 和 HCC 的风险加倍。这种风险的增加与酒精性肝病、病毒性肝炎或人口特征无关。
Background & Aims: An association between diabetes and chronic liver disease has been reported. However, the temporal relationship between these conditions remains unknown. Methods: We identified all patients with a hospital discharge diagnosis of diabetes between 1985 and 1990 using the computerized records of the Department of Veterans Affairs. We randomly assigned 3 patients without diabetes for every patient with diabetes. We excluded patients with concomitant liver disease. The remaining cohort was followed through 2000 for the occurrence of chronic nonalcoholic liver disease (CNLD) and hepatocellular carcinoma (HCC). Hazard rate ratios (HRR) were determined in Cox proportional hazard survival analysis. Results: The study cohort comprised 173,643 patients with diabetes and 650,620 patients without diabetes. Most were men (98%). Patients with diabetes were older (62 vs. 54 years) than patients without diabetes. The incidence of chronic nonalcoholic liver disease was significantly higher among patients with diabetes (incidence rate: 18.13 vs. 9.55 per 10,000 person-years, respectively, P < 0.0001). Similar results were obtained for HCC (incidence rate: 2.39 vs. 0.87 per 10,000 person-years, respectively, P < 0.0001). Diabetes was associated with an HRR of 1.98 (95% Cl: 1.88 to 2.09, P < 0.0001) of CNLD and an HRR of 2.16 (1.86 to 2.52, P < 0.0001) of hepatocellular carcinoma. Diabetes carried the highest risk among patients with longer than 10 years of follow-up. Conclusions: Among men with diabetes, the risk of CNLD and HCC is doubled. This increase in risk is independent of alcoholic liver disease, viral hepatitis, or demographic features.