糖尿病患者有这9种情况,肝癌风险最多或飙升37倍!

2021-12-20 LILYMD MedSci原创

PLOS ONE:2型糖尿病患者肝细胞癌的危险因素:一个发展中国家的双中心研究。

肝细胞癌(HCC)是全球癌症相关死亡最常见原因之一。根据全球统计数据,与HCC相关的死亡呈上升趋势。它目前是继肺癌和结直肠癌之后癌症相关死亡的第三大原因。此外,自1990年以来,HCC的发病率急剧上升了75%。

近来,继发于病毒性肝炎的HCC由于广泛接种乙型肝炎而缓慢下降。相比之下,由于人口老龄化和代谢性疾病患病率上升,代谢性疾病相关的HCC在全球范围内呈上升趋势。作为最常见的代谢性疾病之一,糖尿病(DM)与HCC有关。报告显示,与非糖尿病患者相比,2型糖尿病(T2DM)患者的HCC发展风险增加了2-3倍。有鉴于此,人们越来越有兴趣阐明被诊断HCC的糖尿病患者的预测因素,以增加已知的HCC危险因素。

然而,大多数研究是在病毒性肝炎发病率较高的国家进行的,或中度至高酒精消费率的国家。此外,发展中国家缺乏这方面的研究,这些国家承受着非传染性疾病和传染病的双重负担。而有效的公共卫生干预,如早期发现和及时管理,对于避免过早死亡是必要的。

本研究旨在确定T2DM患者中HCC的危险因素,为HCC风险分层提供必要的信息。

共有424名患者(212例和212例对照组)被纳入该研究。研究人群的年龄范围为37至92岁,平均年龄为66.9岁(SD 9.02)。病例年龄与对照组之间无显著差异。

表1提供患者人口统计学、临床和生化特征的描述性数据,以及单变量逻辑回归结果。单因素分析显示,男性、华裔、体重减轻、腹痛或不适、黄疸、病毒性肝炎、肝硬化、门静脉高压、输血史、恶性肿瘤家族史、他汀类药物、抗病毒药物(用于肝炎治疗)、饮酒史、吸烟史、白细胞 (WBC)、血小板以及总胆红素 (TBil)、碱性磷酸酶 (ALP)、丙氨酸转氨酶 (ALT)、 肌酐水平与HCC风险增加显着相关。所有p<为 0.25 的变量均纳入多变量分析中。五个变量(黄疸、肝硬化、门脉高压、恶性肿瘤家族史、抗病毒治疗)没有被选择。根据医学专家的意见,纳入DM相关变量(DM用药、糖化血红蛋白(HbA1c)、糖尿病持续时间),因为它们具有临床重要性。

表2显示针对年龄、性别、种族、DM 持续时间、体重减轻、食欲不振、腹痛/不适、病毒性肝炎、非酒精性脂肪肝、二甲双胍、格列齐特、胰岛素、他汀类药物、输血、酒精、吸烟、传统药物、HbA1c、WBC、红细胞计数、血小板计数、AGR、总胆红素、ALP、ALT、INR 和肌酐进行调整的发生 HCC 的独立预测因子。

与未出现该症状的患者相比,出现体重减轻的患者发生HCC的几率高出5.28(95%CI:2.29-12.19)。腹痛或不适的临床表现也导致被诊断为肝细胞癌的几率高出6.73倍(95%CI:3.34-13.34)。此外,有饮酒史的患者发生HCC的风险高出4.08(95%CI:1.81-9.22),NAFLD患者的HCC风险高出3.29倍(95%CI:1.40-7.76)。对于生化参数,低血小板计数(<150×103/μL),ALP(>129 IU / L)和ALT(≥25 IU / L)水平升高与发生HCC的几率较高相关(分别为AOR = 4.03,95%CI:1.90-8.55;AOR = 2.17, 95% CI: 1.17–4.00;AOR = 2.11,95% CI:1.16–3.86)。他汀类药物的使用是一个保护因素,与未使用他汀类药物的患者相比,HCC风险降低了63%(AOR = 0.37,95%CI:0.21-0.65)。此外,种族和病毒性肝炎之间也存在显着的相互作用。患有病毒性肝炎的马来人患HCC的几率最高,而华人在没有感染的情况下发生HCC的几率最高。

模型适应性相当好(Hosmer Lemeshow检验p值= 0.248),并且没有检测到多重共线性问题,因为所有变量的VIF都小于10。敏感性为84.0%,特异性为85.4%,ROC曲线(AUC)下面积为0.920。模型准确率为84.2%,Nagelkerke R Square为64.1%。阳性和阴性预测值分别为85.0%和83.4%。

表3显示变量"种族"和"病毒性肝炎"之间的双向相互作用。在没有病毒性肝炎感染的情况下,中国患者的肝癌风险最高,是印度人的4.55倍(95%CI:1.60-12.96)。然而,在存在肝炎感染的情况下,与印度人相比,马来患者发生HCC的风险最高(AOR = 48.27,95% CI:3.79-615.23),其次是中国患者(AOR = 31.28,95% CI:3.02-323.84)。

在同一种族内进行比较时,患病毒性肝炎的中国人患HCC的几率是没有感染的中国人的11.7倍。对于患病毒性肝炎的马来人来说,与没有病毒性肝炎的马来人相比,几率甚至更高,为35.84倍。然而,在有和没有病毒性肝炎感染的印度人之间的HCC发展中没有观察到显着差异。图2说明了基于病毒性肝炎状态的不同种族之间的相互作用模式。

综上,本研究是第一项确定与病毒性肝炎和饮酒相关的慢性肝病患病率较低的发展中国家T2DM患者中HCC危险因素的研究,这两者都是已知的HCC发展的重要贡献者。重要的危险因素包括感染病毒性肝炎的华人和马来人(分别为调整比值比[AOR] = 11.77, 95%CI: 1.39-99.79和AOR = 37.94, 95% CI: 3.92-367.61),体重减轻(AOR = 5.28, 95% CI: 2.29-12.19),腹痛/不适(AOR = 6.73, 95% CI:3.34-13.34),酒精(AOR = 4.08, 95% CI: 1.81-9.22),脂肪肝(AOR = 3.29, 95% CI: 1.40-7.76),低血小板(AOR = 4.03, 95% CI: 1.90-8.55),丙氨酸转氨酶(AOR =2.11, 95% CI: 1.16-3.86),碱性磷酸酶(ALP)(AOR = 2.17, 95% CI: 1.17-4.00)水平升高。他汀类药物降低了63%的HCC风险(AOR = 0.37, 95% CI: 0.21-0.65)。这些因素的识别有助于对 T2DM 患者进行 HCC 的风险分层,以便在初级保健机构的患者管理中进行早期发现和决策。

 

原文来源:

Noor Atika Azit, et al. Risk factors of hepatocellular carcinoma in type 2 diabetes patients: A two-centre study in a developing country.

 2021; 16(12): e0260675.
Published online 2021 Dec 9. doi: 10.1371/journal.pone.0260675

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    2022-04-26 屋顶瞄爱赏月

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    2022-10-31 sjq027
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    2021-12-21 洁巴子
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    2021-12-20 ms1000001486828020

    学习了

    0

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    2021-12-20 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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