肝癌及乙肝患者近5年空腹高血糖发病状况对照研究

The Control Study of the Incidence of Fasting Hyperglycemia between Hepatocellular Carcinoma and Hepatitis B Patients in Recent Five Years

目的：以乙肝患者为对照，对近5年来肝细胞肝癌（HCC）空腹高血糖发病状况作对照研究。方法：HCC的男性患者468例（①HCC组，其DM先于HCC确诊者25．9％），对照人群1046例分为慢乙肝／肝硬化（②CHB／LC）组、③脂肪肝组和B超提示肝“正常”图像组（④肝“正常”组）。以常规方法进行HBV标志物、抗-HCV、空腹血糖、身体质量指数（BMI）、血压检测等。结果：HCC组中：HBV阳性者空腹血糖受损阶段（IF、G）和糖尿病（DM）发病率17．2％和17．O％；HBV阴性者抗-HCV均为阴性，其IFG和DM分别为15．4M和17．9％，两者间IFG和DM发病率无显著性差异（P〉0．05）；HCC的DM发病率与HBV相关性r=-0．007。各组中：WG发生率在各组间均相似，（P〉0．05）；DM发病率在①～④组分别为17．3%、16．7％、26．2％和9．1％，①组与②组、③组和④组相比P〉0．05、P=0．008和P=0．001。BMI均值：①组、②组和④组在23．0～23．7kg／m^2之间，显著低于③组（30．3kg／m2）；血压均值：①和②组相似，显著低于③组和④组（P〈0．005）。在各组内未显示有明显的IFG高发年龄段（P〉0．05）；DM在各组高发年龄段：①组、③组和④组均为60-69岁（26．4％、35．1％和12．2％）；②组为50-59岁（22．5％）。结论：HCC患者发生DM与HBV感染无关，与慢乙肝、肝硬化密切相关。乙肝伴脂肪肝者发生DM的风险较高，超重或肥胖为主要因素；HCC和CHB／LC患者的病情严重性可能加速了IFG阶段发展为DM的过程。

Objective： To study the incidence of fasting hyperglycemia between hepatocellular carcinoma （HCC）and hepatitis B patients in recent five years. Methods： 468 male patients with HCC were selected for our study （group 1, rate of DM precedes HCC patients was 25. 9%）. We divided 1 046 HBV patients into the chronic hepatitis B/cirrhosis （group 2）, the fatty liver （group 3） and the B ultrasound image hepatic＂normal＂（group 4） as control. HBV markers, anti-HCV, FBG, BMI and blood pressure were detected. Results： In group 1：rate of impaired fasting glucose （IFG） and diabetes mellitus （DM） were 17.2% and 17% respectively（P〉0. 05） in HBsAg-positive patients; those were 15.4% and 17.9% （P〉0. 05） in HBsAg-negative; there were no correlation between DM and HBV infection （r=-0. 007）. In the four groups：The incidence of IFG were similar in each group （P〉0. 05）;the rate of DM in four groups were 17.3%, 16.7%,26.2% and 9.1% respectively. There were no difference between Group 1 and 2 （P〉0. 05）, yet statistical differences between 1 and 3/4（P=0. 008,P=0. 001）. BMI in group 1,2,4 was lower than group 3. The blood pressure in group 1 and group 2 were significantly lower than that in group 3 and the group 4 （P〈0. 005）. There were no significant difference of IFG between the four group（P〉0. 05）. The risk age of DM is 60469 years old in group 1 （26. 4%）,group 3 （35.1%）,group 4 （12.2%）,but 50-59 years old in group 2 （22. 5%）. Conclusion：There are no correlation in DM and HBV in HCC patients,but in CHB and LC. Hepatitis B associated with fatty liver is higher risk of DM, overweight or obese is the main factors. In patients with HCC, CHB and LC, severity of Liver disease may accelerate the process from IFG to DM.