Hepatology:历时三十年、研究十五万人,2型糖尿病与肝细胞癌的关系终清晰

2018-04-04 佚名 肿瘤瞭望

肝细胞癌(HCC)在全球人类最常见的恶性肿瘤中名列第五、是第二大癌症致死原因,全球每年有50万人患HCC。在美国,约35%的HCC与非酒精性脂肪性肝病(NAFLD)或代谢综合征有关。预计未来HCC疾病负担仍将继续增加,并且与糖尿病和肥胖的流行平行。已有一些研究提示,2型糖尿病是HCC发病和死亡的独立危险因素。在这项最新研究中,美国学者前瞻性地研究了2型糖尿病及其病程,以及代谢综合征其他组分与HCC

肝细胞癌(HCC)在全球人类最常见的恶性肿瘤中名列第五、是第二大癌症致死原因,全球每年有50万人患HCC。在美国,约35%的HCC与非酒精性脂肪性肝病(NAFLD)或代谢综合征有关。预计未来HCC疾病负担仍将继续增加,并且与糖尿病和肥胖的流行平行。已有一些研究提示,2型糖尿病是HCC发病和死亡的独立危险因素。在这项最新研究中,美国学者前瞻性地研究了2型糖尿病及其病程,以及代谢综合征其他组分与HCC风险的关系。

研究者对两项前瞻性队列研究的数据进行了汇总分析,分别来自护士健康研究(Nurses' Health Study,NHS),取1980年美国登记注册的120,826名女性护士资料为基线,以及医疗从业者随访研究(Health Professionals Follow‐up Study,HPFS),取1986年入组的50,284名男性医疗从业者资料为基线,随访至2012年。

在32年的随访中(共计4,488,410个患者-年),共记录到112例肝细胞癌病例(69例为女性,43例为男性)。分析显示,2型糖尿病与HCC风险增加有关(年龄校正HR为4.77,多因素分析HR为4.59),如表1。糖尿病与HCC的这一关系,在无肝硬化的人群中同样是存在的。

表1.  NHS和HPFS队列中2型糖尿病与HCC的关系


糖尿病病程长也与HCC风险增加有关(趋势检验P值<0.001)。与无糖尿病人群相比,糖尿病病程为0~2年、2~10年和10年以上的人群发生HCC的多因素HR依次为:2.96、6.08和7.52。

合并的代谢综合征组分(2型糖尿病、肥胖、高血压和血脂紊乱)数量越多,HCC风险越高(趋势检验P值<0.001)。与没有代谢综合征的人群相比,4个组分均合并的人群发生HCC的风险升高了8.1倍(下图)。


图. 代谢综合征组分数量与HCC的发生风险

另外,分析显示,2型糖尿病患者中,注射胰岛素或口服降糖药都与HCC风险无关(HR分别为2.04和1.45)。

研究者表示,2型糖尿病与HCC风险增加独立相关,并且至少在这个研究队列中,糖尿病病程越长,以及同时合并其他代谢综合征组分,患者发生HCC的风险越高。这提示了胰岛素抵抗和代谢综合征在HCC发病机制中的重要作用。

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    2018-06-22 xjy02
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    2018-04-06 gwc384
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    2018-04-05 Jackie Li

    学习

    0

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    2018-04-04 李东泽

    很好的学习材料.对临床和科研都有很大帮助作用.水滴石穿.不断积累.

    0

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哈佛大学(Harvard University)医学院的研究人员对穴居的丽脂鲤(Astyanax mexicanus)的研究发现,它们在胰岛素受体中携带一种突变可以让它们对胰岛素产生抗性。这会导致这些穴居鱼出现高血糖,并且体重比在河里生存的同类更高。

JCEM:肢端肥大患者的糖尿病及高血压患病率如何

大家都知道糖尿病和高血压是肢端肥大症的常见并发症,而近日在JCEM上发表的一篇文章则旨在研究大型肢端肥大症患者中诊断时和多模式治疗后糖尿病和高血压的病程。

Diabetic Med:与低血糖1型和胰岛素治疗的2型糖尿病患者的常见护理相比,心理-教育混合干预的成本效益如何?

近日,国际杂志 《Diabetic Med》上在线发表一项关于与存在低血糖问题的1型和胰岛素治疗的2型糖尿病患者的常见护理相比,心理-教育混合(团体和在线)干预的成本效益如何的分析随机对照试验的研究。 研究人员为了评估HypoAware的成本效益,从社会和医疗的角度进行了一项经济评估,使用了一项为期6个月的多中心,集群随机对照试验(n=137)的数据。这是基于循证血糖意识训练的混合(团体和在