Effects of Diabetes and Glycemia Control on Risk of Hepatocellular Carcinoma After Seroclearance of Hepatitis B Surface Antigen
Tags:
Cirrhosis Diabetes Hepatitis Liver Cancer
Read/Add Comments | Email This | Print This | PubMed | Get Full Text
BACKGROUND & AIMS Diabetes is associated with a 2-fold increase in risk of hepatocellular carcinoma (HCC) among patients with chronic hepatitis B virus (HBV) infection. However, we know little about the effect of diabetes on HCC risk after seroclearance of hepatitis B surface antigen (HBsAg). We evaluated the effect of diabetes and glycemic control on HCC development after HBsAg seroclearance in a population-wide study in Hong Kong.
METHODS We performed a retrospective study of 4568 patients with chronic HBV infection who cleared HBsAg from January 2000 through August 2016, using the Clinical Data Analysis and Reporting System of the Hospital Authority, Hong Kong. We collected and analyzed data on patient demographics, comorbidities, medications, laboratory test results, and subsequent development of HCC. The presence of diabetes was defined by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code, with level of hemoglobin; A1c (HbA1c) above 6.5%, fasting glucose level of 7 mmol/L or more, and/or treatment with; any anti-diabetic agent.
RESULTS We identified 1560 patients with diabetes; 29 patients (1.9%) developed HCC after a median follow-up time of 3.4 years (interquartile range, 1.5-5.0 years). Diabetes was associated with increased risk of HCC after adjustment of age, sex, presence of cirrhosis, and the use of medications (adjusted hazard ratio, 1.85; 95% CI 1.04-3.28; P=.036). Among patients with diabetes, time-weighted average level of HbA1c was an independent risk factor for HCC, after adjustment for age at clearance, use of statins, and other important covariates (adjusted hazard ratio, 1.51, 95% CI 1.20-1.91; P<.001). A time-weighted average level of HbA1c of 7% or more was associated with a higher 5-year cumulative incidence of HCC (4.0%) than a time-weighted average HbA1c level below 7% (1.8%) (log-rank test P=.035).
CONCLUSIONS In a population-based analysis of patients with chronic HBV infection in Hong Kong, we found diabetes to be an independent risk factor for HCC after HBsAg seroclearance. However, glycemia control appears to reduce the risk of HCC. 作者: StephenW 时间: 2018-1-4 21:04
结果我们确定了1560例糖尿病患者;中位随访时间3。4年（四分位间距，1.5〜5。0年）29例（1.9％）发生HCC。调整年龄，性别，肝硬化和使用药物后，糖尿病与HCC风险增加有关（校正危险比1.85; 95％CI 1.04-3.28; P = 0.036）。在糖尿病患者中，HbA1c时间加权平均水平是调整年龄，使用他汀类药物和其他重要协变量后调整HCC的独立危险因素（校正危险比1.51,95％CI 1.20-1.91; P <0.001）。时间加权平均HbA1c水平为7％或更高与5年累积HCC发生率（4.0％）相比，时间加权平均HbA1c水平低于7％（1.8％）（log-rank test P = 0.035）。