AASLD2018[2110]血糖之间的J形关联 控制和肝细胞癌的风险 慢性

StephenW

2110
J-Shaped Association between Glycemic
Control and the Risk of Hepatocellular
Carcinoma in Chronic Hepatitis B Patients
with Diabetes Mellitus - a Territory-Wide Cohort
Study of 29,221 Subjects.
Cheuk Fung Yip1, Vincent Wai Sun Wong2, Henry Lik Yuen
Chan2, Yee-Kit Tse1 and Grace Lai2, (1)Institute of Digestive
Disease, and Department of Medicine and Therapeutics, The
Chinese University of Hong Kong, Hong Kong, (2)Institute of
Digestive Disease, Department of Medicine and Therapeutics,
and State Key Laboratory of Digestive Disease, The Chinese
University of Hong Kong, Hong Kong
Background: Diabetes mellitus (DM) doubles the risk of
hepatocellular carcinoma (HCC) in patients with chronic
hepatitis B (CHB). This territory-wide cohort study evaluated
the impact of glycemic control over time on HCC development
in CHB patients with DM. Methods: We performed a
retrospective study on all CHB patients with DM who received
medical care from January 2000 to December 2017 in Hospital
Authority, Hong Kong. The presence of DM was defined
by International Classification of Diseases, Ninth Revision,
Clinical Modification diagnosis code, hemoglobin A1c (HbA1c)
≥6.5%, fasting glucose ≥7mmol/L in two measurements or
≥11.1mmol/L in one measurement, and/or treatment with any
anti-diabetic agents. Patients’ demographics, comorbidities,
medication, laboratory parameters and HCC diagnosis
were captured and analyzed. Overall glycemic control was
summarized by time-weighted mean HbA1c during follow-up.
The nonlinear relationship between time-weighted mean
HbA1c and HCC was evaluated by restricted cubic spline
with three knots. Patients with follow-up <6 months, renal
replacement therapy, and estimated glomerular filtration rate
<30 mL/min/1.73 m2 at baseline were excluded. Results:
We identified 29,221 CHB patients with DM; their mean
age was 57.7±11.7 years; 61.1% were male and 11.4%
had liver cirrhosis. The median (interquartile range [IQR])
number of HbA1c measurements during follow-up was 10
(5–17); the time-weighted mean HbA1c was 7.2±1.2%. At
a median (IQR) follow-up of 7.2 (3.8–11.9) years, 2,703
(9.3%) patients developed HCC. The 15-year cumulative
incidence of HCC was 16.7% (95% confidence interval [CI]
16.0%–17.4%). A J-shaped curvilinear association between
time-weighted mean HbA1c and HCC development was
observed; patients with HbA1c between 7% and 8% over time
had the lowest risk of HCC after adjustment of age, gender,
cirrhosis, laboratory parameters, use of anti-diabetic agents,
statins, antihypertensives, antiplatelets, and antiviral therapy.
Compared to time-weighted mean HbA1c of 7–8%, the risk of
HCC increased significantly in patients with time-weighted
mean HbA1c ≥10% (adjusted hazard ratio 1.22, 95% CI 1.07–
1.40; P=0.003); the risk of HCC was also significantly higher
in patients with time-weighted mean HbA1c of 6–6.5% (1.11,
1.04–1.18; P=0.003) (Figure 1). Conclusion: Poor glycemic
control is a risk factor of HCC in CHB diabetic patients;
excessively low HbA1c levels over time may be potentially
harmful.
Disclosures:
Henry Lik Yuen Chan – AbbVie: Advisory Committee or Review Panel; AbbVie:
Speaking and Teaching; Arbutus: Advisory Committee or Review Panel; Gilead:
Advisory Committee or Review Panel; Gilead: Speaking and Teaching; Roche:
Advisory Committee or Review Panel; Vir Biotechnology: Advisory Committee
or Review Panel; Intellia: Advisory Committee or Review Panel; Me
The following people have nothing to disclose: Cheuk Fung Yip, Grace Lai
Disclosure information not available at the time of publication: Vincent Wai Sun
Wong, Yee-Kit Tse

StephenW

2110
血糖之间的J形关联
控制和肝细胞癌的风险
慢性乙型肝炎患者的癌症
与糖尿病Mellitus - 一个领土范围的队列
研究29,221名受试者。
Cheuk Fung Yip1，Vincent Wai Sun Wong，Henry Lik Yuen
Chan2，Yee-Kit Tse1和Grace Lai2，（1）消化系统研究所
疾病，医学和治疗学系，
香港中文大学，香港，（2）香港中文大学
消化系统疾病，医学和治疗学系，
中国消化病国家重点实验室
香港大学，香港
背景：糖尿病（DM）使患糖尿病的风险增加一倍
慢性乙型肝炎患者的肝细胞癌（HCC）
乙型肝炎（CHB）。这项全港性队列研究进行了评估
随着时间的推移，血糖控制对HCC发展的影响
在患有DM的CHB患者中。方法：我们进行了一次
所有接受糖尿病的CHB患者的回顾性研究
2000年1月至2017年12月在医院就诊
香港当局。确定了DM的存在
国际疾病分类，第九次修订，
临床修改诊断代码，血红蛋白A1c（HbA1c）
≥6.5％，两次测量或空腹血糖≥7mmol/ L.
一次测量≥11.1mmol/ L，和/或任何一次测量
抗糖尿病药。患者的人口统计学，合并症，
药物，实验室参数和HCC诊断
被捕获并分析。整体血糖控制是
在随访期间通过时间加权平均值HbA1c进行总结。
时间加权均值之间的非线性关系
通过限制性三次样条评估HbA1c和HCC
有三节。随访<6个月，肾脏的患者
替代疗法，估计肾小球滤过率
排除基线<30 mL / min / 1.73 m2。结果：
我们确定了29,221名患有DM的CHB患者;他们的意思
年龄为57.7±11.7岁; 61.1％为男性，11.4％
有肝硬化。中位数（四分位距[IQR]）
随访期间HbA1c测量的数量为10
（5-17）;时间加权平均值HbA1c为7.2±1.2％。在
中位数（IQR）随访7.2（3.8-11.9）年，2,703
（9.3％）患者发生HCC。累计15年
HCC发病率为16.7％（95％置信区间[CI]
16.0％-17.4％）。 J形曲线之间的关联
时间加权平均值HbA1c和HCC发展为
观测到的;随着时间的推移，HbA1c患者的比例在7％到8％之间
调整年龄，性别后，患HCC的风险最低
肝硬化，实验室参数，抗糖尿病药物的使用，
他汀类药物，抗高血压药，抗血小板药和抗病毒药物治疗。
与时间加权平均值相比，HbA1c为7-8％，风险为
HCC在时间加权患者中显着增加
平均HbA1c≥10％（校正风险比1.22,95％CI 1.07-
1.40; P = 0.003）; HCC的风险也明显增高
患者的时间加权平均HbA1c为6-6.5％（1.11，
1.04-1.18; P = 0.003）（图1）。结论：血糖不佳
控制是CHB糖尿病患者HCC的危险因素;
HbA1c水平随时间过低可能是潜在的
有害。
披露：
Henry Lik Yuen Chan - AbbVie：咨询委员会或审查小组;艾伯维：
口语与教学;杨梅：咨询委员会或审查小组;吉利德：
咨询委员会或审查小组;基列：口语和教学;罗氏：
咨询委员会或审查小组; Vir Biotechnology：咨询委员会
或审查小组; Intellia：咨询委员会或审查小组;我
以下人士没有透露任何内容：Cheuk Fung Yip，Grace Lai
发布时无法提供的披露信息：Vincent Wai Sun
Wong，Yee-Kit Tse