乙型肝炎表面抗原清除后糖尿病和血糖控制对肝癌发生风险

StephenW

Effects of Diabetes and Glycemia Control on Risk of Hepatocellular Carcinoma After Seroclearance of Hepatitis B Surface Antigen

Tags:
• Cirrhosis
• Diabetes
• Hepatitis
• Liver Cancer
  

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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.

StephenW

乙型肝炎表面抗原清除后糖尿病和血糖控制对肝癌发生风险的影响

    标签：
        肝硬化糖尿病肝炎肝癌

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背景与目的糖尿病与慢性乙型肝炎病毒（HBV）感染患者的肝细胞癌（HCC）风险增加2倍相关。然而，我们对乙型肝炎表面抗原（HBsAg）清除后糖尿病对HCC风险的影响知之甚少。我们在香港一项全人口研究中评估了糖尿病和血糖控制对HBsAg血清学清除后HCC发展的影响。

方法我们利用香港医院管理局的临床资料分析及报告系统，进行了一项由二零零零年一月至二零一六年八月清理乙肝病毒表面抗原的4568名慢性乙肝病毒感染者的回顾性研究。我们收集并分析了患者人口统计学资料，合并症，药物，实验室检查结果以及HCC随后的发展情况。糖尿病的存在由国际疾病分类，第九修订版，临床修改诊断代码定义，血红蛋白水平; A1c（HbA1c）6.5％以上，空腹血糖7 mmol / L或以上，和/或治疗;任何抗糖尿病药物。

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发生风险增加有关（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％）（对数秩检验P = 0.035）。

结论在香港慢性HBV感染患者的基于人口的分析中，我们发现糖尿病是HBsAg血清学清除后HCC的独立危险因素。但是，血糖控制似乎降低了HCC的风险。