肝硬化及其失代偿的慢性乙型肝炎患者初诊糖尿病风险增加

StephenW

Increased Risk of Cirrhosis and Its Decompensation in Chronic Hepatitis B Patients With Newly Diagnosed Diabetes: A Nationwide Cohort Study

    Yi-Wen Huang 1,2,3,4,
    Ting-Chuan Wang 5,
    Shih-Chang Lin 5,
    Han-Yu Chang 1,
    Ding-Shinn Chen 3,4,
    Jui-Ting Hu 1,6,
    Sien-Sing Yang 1,6, and
    Jia-Horng Kao 3,4,7,8

+ Author Affiliations

    1Liver Center, Cathay General Hospital Medical Center
    2School of Medicine, Taipei Medical University
    3Division of Gastroenterology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital
    4Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine
    5Department of Medical Research, Cathay General Hospital Medical Center
    6School of Medicine, Fu-Jen Catholic University College of Medicine
    7Hepatitis Research Center
    8Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan

    Correspondence: Jia-Horng Kao, MD, PhD, Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, No. 1, Chang-Te St, Taipei 10002, Taiwan ([email protected]).

    Presented in part: 62nd Annual Meeting of the American Association for the Study of Liver Diseases, San Francisco, California, 4–8 November 2011. Oral presentation; and 22nd Conference of the Asian Pacific Association for the Study of the Liver, Taipei, Taiwan, 16–19 February 2012. Poster presentation.

Abstract

Background. The impact of diabetes on cirrhosis, its decompensation, and their time relationship in patients with chronic hepatitis B (CHB) remain unclear.

Methods. We conducted a nationwide cohort study by using the Taiwanese National Health Insurance Research Database, which was comprised of data from >99% of the entire population. Among 1 million randomly sampled enrollees, 14 523 adult CHB patients were identified from 1997 to 2009. Diabetes was defined as newly diagnosed in CHB patients who were given the diagnosis in the years 1998–2001 but not in 1996–1997 and with physician visits of at least twice per year. The cohorts of CHB with newly diagnosed diabetes (n = 351) and without diabetes (n = 7886) were followed up from the diagnosis of diabetes and from 2000 in the patients without diabetes until development of cirrhosis or its decompensation, withdrawal from insurance, or December 2009.

Results. Kaplan-Meier survival analysis showed a significantly higher cumulative incidence of cirrhosis (relative risk [RR] = 3.43; 95% confidence interval [CI], 2.62–4.49; P < .001, log-rank test) and decompensated cirrhosis (RR = 4.11; 95% CI, 2.95–5.70; P < .001, log-rank test) among patients with newly developed diabetes compared with those without diabetes. After adjustment for age, sex, CHB treatment, hepatocellular carcinoma, and comorbidity index by Cox proportional hazards model, diabetes was still an independent predictor for cirrhosis (hazard ratio [HR] = 2.015; 95% CI, 1.393–2.915; P < .001) and its decompensation (HR = 1.792; 95% CI, 1.192–2.695; P = .005).

Conclusions. Patients with CHB who develop diabetes are at an increased risk of liver cirrhosis and its decompensation over time.

StephenW

肝硬化及其失代偿的慢性乙型肝炎患者初诊糖尿病风险增加：一项全国范围的队列研究

    易文Huang1 ， 2,3,4 ，
    亭川Wang5 ，
    施昌LIN5 ，
    汉宇Chang1 ，
    鼎希恩Chen3 ， 4 ，
    瑞婷虎1 ， 6 ，
    思恩星洋1 ， 6 ，和
    嘉宏Kao3 ， 4,7,8

+作者所属机构

    1Liver中心，国泰综合医院医疗中心
    医药，台北医学大学2School
    消化内科，内科，医学和医院的国立台湾大学系3Division
    临床医学4Graduate学院，医学院，国立台湾大学
    医学研究，国泰综合医院医学中心的5Department
    6School医学，医学辅仁大学
    7Hepatitis研究中心
    8Department医学研究，台大医院，台北，台湾

    通讯：嘉鸿高，博士，临床医学研究所，医学， 1号，昌德街，台北10002 ，台湾（ [email protected] ）国立台湾大学医学院。

    呈现部分：肝病2011年11月4-8研究，旧金山，加州，美国协会的第62届年会。口头陈述，以及亚太肝脏研究协会，台湾台北， 2012年2月16-19研究的第22届会议。海报介绍。

摘要

背景。糖尿病对肝硬化，失代偿的，而在慢性乙型肝炎（CHB ）的时间关系的影响仍不清楚。

方法。我们利用台湾全民健康保险研究资料库，这是由来自> 99 ％的整个人口的数据，在全国范围内进行队列研究。其中100万随机抽样参保， 14 523成年慢性乙型肝炎患者进行鉴定2097至09年。糖尿病被定义为新诊断的谁被给予诊断在1998-2001年，但没有在1996-1997年至少为每年两次就诊慢性乙型肝炎患者。慢性乙型肝炎的新诊断糖尿病患者（N = 351）和非糖尿病患者（N = 7886 ）的队列随访糖尿病的诊断，并从2000年在非糖尿病患者直到肝硬化及其失代偿，保险撤退，或发展2009年12月。

结果。 Kaplan-Meier生存分析显示肝硬化的显著更高的累计发生率（相对风险[RR ] = 3.43 ，95 ％可信区间[CI] ， 2.62-4.49 ，P <0.001 ， log-rank检验）和失代偿性肝硬化（ RR = 4.11 ，95％CI ， 2.95-5.70 ，P <0.001 ， log-rank检验）患者之间新开发的糖尿病患者与非糖尿病患者相比。在校正年龄，性别，慢性乙型肝炎的治疗，肝癌，并通过Cox比例风险模型合并症指数，糖尿病仍是肝硬化的独立预测因子（风险比[HR ] = 2.015 ，95 ％ CI为1.393-2.915 ，P < 。 001 ） ，其失代偿（ HR = 1.792 ，95 ％ CI为1.192-2.695 ，P = 0.005） 。

结论。谁开发与糖尿病的慢性乙肝患者处于肝硬化和失代偿其随时间推移的风险增加。