糖尿病与HBsAg血清学清除后HCC风险升高有关

StephenW

                01-02-2018 | HBV | News | Article                                                        

Diabetes linked to elevated HCC risk after HBsAg seroclearancemedwireNews: Diabetes remains an independent risk factor for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection even after hepatitis B surface antigen (HBsAg) seroclearance, findings indicate.
But glycemic control appears to mitigate this risk, the researchers from The Chinese University of Hong Kong say in Clinical Gastroenterology and Hepatology.
They explain that diabetes has been shown to be associated with a twofold increased HCC risk among chronic HBV patients, but it is not clear what role diabetes plays once individuals achieve HBsAg seroclearance, which is considered “a surrogate of ultimate immune control” in these patients.
The team drew on the Clinical Data Analysis and Reporting System of the Hospital Authority, Hong Kong, to identify 4568 patients who cleared HBsAg between 2000 and 2016. Of these, just over a third (34.2%) had diabetes, defined on the basis of the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, glycated hemoglobin (HbA1c) levels of at least 6.5%, fasting glucose levels of 7 mmol/L or more, and/or exposure to any antidiabetic agent.
During a median follow-up of 3.4 years, 1.9% of chronic HBV patients with diabetes developed HCC, as did 0.8% of those without diabetes.
Among participants with diabetes, the cumulative incidence of HCC was 1.1% at 1 year after HBsAg seroclearance , rising to 2.1% at 3 years and 2.6% at 5 years. The corresponding rates for nondiabetic participants were 0.8%, 0.9%, and 0.9%, with the between-group differences reaching significance (p=0.001).
And in multivariate analysis accounting for factors such as age, male sex, and presence of cirrhosis, diabetes was an independent and significant risk factor for HCC, at a hazard ratio of 1.85.
Grace Lai-Hung Wong and co-authors also found that suboptimal glycemic control over time was linked to an increased HCC risk. Specifically, after adjusting for variables including age at HBsAg seroclearance and statin use, a time-weighted average HbA1c of 7.0% or more versus below 6.5% was a significant predictor of HCC risk (HR=3.71, p=0.011), whereas time-weighted mean HbA1c levels of at least 6.5% but less than 7.0% were not.
In the same analysis, use of oral hypoglycemic agents was associated with a significantly reduced risk for HCC (p=0.005).
The study authors therefore suggest that “[p]revention of [diabetes] and good diabetic control may further reduce the risk of HCC in this population.”
By Shreeya Nanda
medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group
See also:

• High metabolic risk burden increases HCC risk in HBV patients
  

StephenW

01-02-2018 | HBV |新闻|文章
糖尿病与HBsAg血清学清除后HCC风险升高有关

medwireNews：发现乙型肝炎表面抗原（HBsAg）血清学清除后，糖尿病仍然是慢性乙型肝炎病毒（HBV）感染患者肝细胞癌（HCC）的独立危险因素。

但香港中文大学的研究人员在临床胃肠病学和肝病学上说，血糖控制似乎可以减轻这种风险。

他们解释说，糖尿病已经被证明与慢性HBV患者中HCC风险增加了两倍有关，但是一旦个体达到HBsAg血清学清除，糖尿病在这些患者中被认为是“最终免疫控制的替代物” 。

该团队利用香港医院管理局的临床资料分析及报告系统，在二零零零年至二零一六年间，确定了4568名清除乙肝表面抗原的病人，其中超过三分之一（34.2％）患有糖尿病，定义为国际疾病分类，第九修订版，临床修改诊断代码，至少6.5％的糖化血红蛋白（HbA1c）水平，7mmol / L或更高的空腹血糖水平和/或暴露于任何抗糖尿病剂。

在平均3。4年的随访期间，1.9％的慢性乙型肝炎患者发生HCC，0.8％的非糖尿病患者发生HCC。

在糖尿病患者中，HBsAg清除后1年HCC累积发生率为1.1％，3年时上升至2.1％，5年时为2.6％。非糖尿病患者的相应比率分别为0.8％，0.9％和0.9％，组间差异达到显着性水平（p = 0.001）。

在多因素分析中，由于年龄，男性和肝硬化等因素的影响，糖尿病是HCC的独立危险因素，风险比为1.85。

Grace Lai-Hung Wong及其合着者也发现，随着时间的推移，不理想的血糖控制与HCC风险增加有关。具体而言，调整HBsAg血清学清除率和使用他汀类药物年龄等变量后，HCC风险（HR = 3.71，p = 0.011）的时间加权平均HbA1c为7.0％或更高，低于6.5％加权平均HbA1c水平至少6.5％但小于7.0％不是。

在同一分析中，使用口服降糖药可显着降低HCC的风险（P = 0.005）。

因此，研究人员提出，“[糖尿病]的治疗和良好的糖尿病控制可能会进一步降低该人群中HCC的风险。”

由Shreeya南达

medwireNews是由Springer Healthcare提供的独立医疗新闻服务。斯普林格医疗保健部分属于斯普林格自然组

也可以看看：

    高代谢风险负担增加了HBV患者的HCC风险