2型糖尿病对乙肝患者原发性肝癌发病风险及肝癌患者肿瘤标志物水平的影响

Effect of Type 2 Diabetes on the Risk of Primary Hepatic Carcinoma in Hepatitis B Patients and the Level of Tumor Markers in Hepatic Carcinoma Patients

目的探讨2型糖尿病对乙肝患者原发性肝癌发病风险及肝癌患者肿瘤标志物水平的影响。方法以2018年1月至2019年9月在郑州大学第一附属医院感染科住院的562例慢性乙型肝炎患者为研究对象,其中223例患原发性肝癌,52例合并糖尿病。比较糖尿病组(52例)与非糖尿病组(510例)肝癌患病率并计算相对危险度(RR),比较肝癌患者中糖尿病亚组(32例)与非糖尿病亚组(191例)血清各肿瘤标志物水平。结果糖尿病组与非糖尿病组肝癌患病率分别为61.5%(32/52)、37.5%(191/510),糖尿病组肝癌患病率高于非糖尿病组(P<0.05)。2型糖尿病会增加乙肝患者肝癌发病风险(RR=1.643,95%CI为1.289~2.094,P=0.001)。糖尿病亚组血清甲胎蛋白(AFP)、甲胎蛋白异质体L3(AFP-L3)水平低于非糖尿病亚组(P<0.05),AFP阴性率高于非糖尿病亚组(P<0.05)。两组血清异常凝血酶原(PIVKA-Ⅱ)、α-岩藻糖苷酶(AFU)、高尔基体蛋白73(GP73)、糖类抗原19-9(CA19-9)、5’核苷酸酶(5’-NT)水平差异无统计学意义(P>0.05)。结论2型糖尿病会增加乙肝患者肝癌的发病风险。合并2型糖尿病的肝癌患者血清AFP及AFP-L3水平较低,AFP阴性率较高,这可能会影响肝癌的早期诊断而使患者错过最佳治疗时机。

Objective To investigate the effect of type 2 diabetes on the risk of primary hepatic carcinoma in hepatitis B patients and the level of tumor markers in hepatic carcinoma patients.Methods A total of 562 patients with chronic hepatitis B who were hospitalized in the Department of Infectious Diseases,First Affiliated Hospital of Zhengzhou University from January 2018 to September 2019 were selected as the research subjects.Among them,223 patients had primary hepatic carcinoma and 52 patients had diabetes.The prevalence of hepatic carcinoma was compared between diabetic group(52 cases)and non-diabetic group(510 cases)and the relative risk(RR)was calculated.The serum tumor marker levels in diabetic subgroup(32 cases)and non-diabetic subgroup(191 cases)of hepatic carcinoma patients were compared.Results The prevalence of hepatic carcinoma in diabetic and non-diabetic group was 61.5%(32/52)and 37.5%(191/510),respectively.The prevalence of hepatic carcinoma in diabetic group was higher than that in non-diabetic group(P<0.05).Type 2 diabetes would increase the risk of hepatic carcinoma in patients with hepatitis B(RR=1.643,95%CI 1.289~2.094,P=0.001).Serum alpha-fetoprotein(AFP)and alpha-fetoprotein-L3(AFP-L3)levels in diabetic subgroup were lower than those in non-diabetic subgroup(P<0.05).The negative rate of AFP in diabetic subgroup was higher than that in non-diabetic subgroup(P<0.05).There was no statistical difference in serum abnormal prothrombin(PIVKA-Ⅱ),α-fucosidase(AFU),Golgi protein 73(GP73),carbohydrate antigen 19-9(CA19-9)and 5’nucleotide enzyme(5’-NT)between the two subgroups(P>0.05).Conclusion Type 2 diabetes could increase the risk of hepatic carcinoma in hepatitis B patients.Hepatic carcinoma patients with type 2 diabetes have lower serum levels of AFP and AFP-L3,and higher AFP negative rate,which may affect the early diagnosis of hepatic carcinoma and make patients miss the best treatment opportunity.