乙型肝炎肝硬化合并2型糖尿病发生原发性肝癌的风险研究

Study on the risk of hepatitis B-related cirrhosis combined with type 2 diabetes mellitus for the occurrence of primary hepatocellular carcinoma

目的探讨2型糖尿病是否增加乙型肝炎肝硬化发生原发性肝癌的风险,比较糖尿病的不同病程、不同降糖药对该风险的影响。方法采用回顾性病例对照研究方法。(1)收集乙型肝炎肝硬化并发原发性肝癌患者325例为研究组,乙型肝炎肝硬化患者601例为对照组,用多因素logistic回归分析研究糖尿病与原发性肝癌发病风险的关系。(2)收集研究组与对照组合并2型糖尿病患者,用多因素logistic回归分析研究糖尿病相关因素与原发性肝癌发病风险的关系。结果研究组糖尿病的发病率为14.2%,对照组糖尿病的发病率为6.0%,两组比较,差异有统计学意义(P < 0.05)。多因素logistic回归分析结果显示2型糖尿病为肝癌的独立危险因素,增加肝癌发病风险(调整比值比:1.982,95% CI:1.224~3.210)。与糖尿病病程<10年者相比,糖尿病病程≥10年(调整比值比:6.011,95% CI:1.659~21.777)者肝癌发病的风险明显增加。二甲双胍(调整比值比:0.188,95% CI:0.052~0.688)降低该风险,胰岛素(调整比值比:6.682,95% CI:1.899~23.510)可能增加该风险。结论2型糖尿病是原发性肝癌的独立危险因素之一,能增加乙型肝炎肝硬化发生原发性肝癌的风险,且与糖尿病的病程有关,病程≥10年者肝癌发病风险更高,二甲双胍降低该风险。

Objective To investigate whether type 2 diabetes mellitus increases the risk of hepatitis B-related cirrhosis combined with type 2 diabetes mellitus for the occurrence of primary hepatocellular carcinoma, and to compare the effects of different nature of diabetes duration on the risk of different anti-diabetic drugs. Methods A retrospective case-control study was conducted.(1) 325 cases with hepatitis B-related cirrhosis complicated with primary hepatocellular carcinoma were selected as the study group and 601 patients with hepatitis B cirrhosis as the control group. The relationship between diabetes mellitus and the risk of primary liver cancer was analyzed by multivariate logistic regression analysis.(2) Selected the study group and control group combined with type 2 diabetes mellitus, and used multivariate logistic regression analysis to study the relationship between diabetes-related factors and the risk of primary liver cancer. Results The incidence of diabetes was 14.2% in the study group and 6.0% in the control group, and the difference was statistically significant between the two groups (P < 0.05). Multivariate logistic regression analysis showed that type 2 diabetes was one of the independent risk factors for primary hepatocellular carcinoma, which had increased the risk of primary hepatocellular carcinoma (adjusted odds ratio (AOR): 1.982, 95% CI: 1.224-3.210). Patients with diabetes > 10 years (adjusted ratio: AOR value 6.011, 95% CI: 1.659-21.777) were at significantly higher risk for primary hepatocellular carcinoma than that of patients with diabetes < 10 years. Metformin (adjusted odds ratio: AOR 0.188, 95% CI: 0.052-0.688) had reduced the risk, while insulin (adjusted odds ratio: AOR 6.682, 95% CI: 1.899-23.510) had increased the risk. Conclusion Type 2 diabetes mellitus is one of the independent risk factors for primary HCC, which can increase the risk of hepatocellular carcinoma in hepatitis B cirrhosis in relation to the duration of diabetes mellitus. The risk of hepatocellular carcinoma is higher in patients with duration of diabetes > 10 years and metformin reduces the risk.