慢性乙型肝炎患者的新发糖尿病患者肝癌的风险增加：全国

StephenW

Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with new onset diabetes: a nationwide cohort study

    S.-C. Fu1, Y.-W. Huang1,2,3,*, T.-C. Wang4, J.-T. Hu1,5, D.-S. Chen3,6,7 andS.-S. Yang1,5

Article first published online: 6 APR 2015

DOI: 10.1111/apt.13191

© 2015 John Wiley & Sons Ltd

Issue
Cover image for Vol. 41 Issue 9
Alimentary Pharmacology & Therapeutics

Early View (Online Version of Record published before inclusion in an issue)

Additional Information(Show All)


    1    Liver Center, Cathay General Hospital Medical Center, Taipei, Taiwan
    2    School of Medicine, Taipei Medical University, Taipei, Taiwan
    3    Division of Gastroenterology, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
    4    Department of Medical Research, Cathay General Hospital Medical Center, Taipei, Taiwan
    5    School of Medicine, Fu-Jen Catholic University College of Medicine, Taipei, Taiwan
    6    Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
    7    Genomics Research Center, Academia Sinica, Nankang, Taiwan

* Correspondence to:
Dr Y.-W. Huang, Liver Center and Health Management Center, Cathay General Hospital Medical Center, No. 280, Sec. 4, Jen-Ai Road, Taipei 10630, Taiwan.
E-mails: [email protected]; [email protected]

    This article was accepted for publication after full peer-review.


Summary
Background

Diabetes increases the risk of hepatocellular carcinoma (HCC), however, the time-relationship between hepatitis B virus and diabetes for the development of HCC remains unclear.
Aim

To explore the risk of HCC in chronic hepatitis B patients with newly diagnosed diabetes.
Methods

We conducted a nationwide cohort study by using Taiwanese National Health Insurance Research Database, which covers over 99% of entire population. Among randomly sampled one million enrollees, 14 523 chronic hepatitis B patients were diagnosed in years 1997–2009. We defined new onset diabetes as patients who were given the diagnosis in the years 1999–2009, but not in 1997–1998. The cohorts of chronic hepatitis B with new onset diabetes (n = 2099) and 1:1 ratio age-, gender- and inception point (onset date of diabetes)- matched nondiabetes (n = 2080) were followed up from the inception point until development of HCC, withdrawal from insurance or December 2009.
Results

After adjustment for competing mortality, patients with new onset diabetes had a significantly higher cumulative incidence of HCC [relative risk = 1.628, 95% confidence interval (CI) = 1.114–2.378, modified log-rank test, P = 0.012] as compared to nondiabetes patients. After adjustment for age, gender, hyperlipidaemia, chronic hepatitis B treatment, statins therapy, cirrhosis, comorbidity index and obesity, diabetes was still an independent predictor for HCC (hazard ratio = 1.798, 95% CI = 1.194–2.707, P = 0.005).
Conclusion

Chronic hepatitis B patients with newly diagnosed diabetes have an increased risk of hepatocellular carcinoma over time.

StephenW

慢性乙型肝炎患者的新发糖尿病患者肝癌的风险增加：全国范围的队列研究

    S.-C. FU1，Y.-W. Huang1,2,3，*，T.-C。 Wang4，J.-T. Hu1,5，D-S. Chen3,6,7 andS.-S. Yang1,5

文章首次在网上公布：2015年4月6日

DOI：10.1111 / apt.13191

©2015年约翰·威利父子有限公司

问题
封面图片的卷。 41第9期
消化系统药理学与治疗学

早观（包含之前录制的网上版本出版中的问题）

其他信息（显示所有）


    1肝脏中心，国泰医院医疗中心，台北，台湾
    医药，台北医学大学，台北，台湾2学校
    胃肠科3，内科，医学国立台湾大学，台北，台湾
    医学研究，国泰医院医疗中心，台北，台湾的4部
    医学，医学辅仁大学，台北，台湾5校
    6肝炎研究中心，台大医院，台北，台湾
    7基因组学研究中心，中央研究院，南康，台湾

*通讯作者：
医生Y.-W.黄，肝病中心及健康管理中心，国泰医院医疗中心，280号，二段。 4，仁爱路，台北10630，台湾。
电子邮件：[email protected]; [email protected]

    这篇文章被接受后，全面同行评审的出版物。


总结
背景

糖尿病增加肝细胞癌（HCC）的风险，然而，B型肝炎病毒和糖尿病之间为肝癌发展的时间关系尚不清楚。
目的

探索肝癌在慢性乙肝患者初诊糖尿病的风险。
方法：

我们利用台湾全民健康保险研究资料库，涵盖整个人口的99％，在全国范围内进行队列研究。其中随机抽取百万参保，14 523慢性乙型肝炎患者在确诊1997-2009年。我们定义的新发糖尿病作为谁被赋予诊断在1999-2009年的病人，而不是在1997-1998年。慢性乙型肝炎新发糖尿病的同伙（N = 2099）和1：1的比例年龄，性别和开始点（糖尿病的发病日期） - 匹配nondiabetes（N = 2080），随访以来，直到点HCC的发展，从保险或2009年12月撤离。
结果

调整为竞争死亡率后，患者的新发作糖尿病的HCC [相对危险= 1.628，95％置信区间（CI）= 1.114-2.378，改性数秩检验，P = 0.012]的显著更高的累积发生率相比nondiabetes患者。在调整了年龄，性别，高脂血症，慢性乙型肝炎的治疗，他汀类药物治疗，肝硬化合并症指数，肥胖，糖尿病仍然是一个独立预测HCC（危险比= 1.798，95％CI = 1.194-2.707，P = 0.005）后。
结论

慢性乙型肝炎患者的初诊糖尿病患者有肝癌的风险增加随着时间的推移。