Hepatology:降糖药和血糖控制情况对非酒精性脂肪肝患者肝癌风险的影响

2021-11-17 Nebula MedSci原创

二甲双胍可使肝细胞癌风险降低 20%,但胰岛素与其他口服药物联合使用时可使肝细胞癌风险增加 1.6-1.7 倍。

非酒精性脂肪性肝病 (NAFLD) 患者合并 2 型糖尿病 (DM)时进展成肝细胞癌 (HCC) 的风险很高。但是,迄今为止,这些患者中肝细胞癌风险的决定因素仍不明确。

本研究收集了 2004 年 1 月 1 日至 2008 年 12 月 31 日期间在退伍军人管理局的 130 家设施中确诊出的合并糖尿病的非酒精性脂肪性肝病患者的回顾性队列。从确诊非酒精性脂肪性肝病随访至患者罹患肝细胞癌、死亡或截止 2018 年 12 月 31 日。研究人员使用具有里程碑意义的 Cox 比例风险模型来确定降糖药物(二甲双胍、胰岛素、磺脲类)和血糖控制(HbA1c<7% 的随访时间百分比)对肝细胞癌风险的影响,同时根据人口统计学和其他代谢特征(高血压、肥胖、血脂异常)进行调整。

各种风险因素对肝癌风险的影响

共确定了 85963 位合并糖尿病的非酒精性脂肪性肝病患者。总体上,在平均 10.3 年的随访期间,有 524 位患者罹患肝细胞癌。最常见的降糖治疗是二甲双胍单药(19.7%),其次是二甲双胍磺脲类(19.6%)、磺脲类单药治疗(13.6%)和胰岛素(9.3%)。与不用药相比,二甲双胍可使肝细胞癌风险降低 20% (HR 0.80, 95% CI 0.93-0.98)。胰岛素对肝细胞癌风险没有影响(HR 1.02, 95% CI 0.85-1.22, p=0.85)。胰岛素与其他口服药物联合使用时可使肝细胞癌风险增加 1.6-1.7 倍。最后,良好的血糖控制与肝细胞癌风险降低 31% 相关(HR 0.69, 95% CI 0.62-0.78)。

综上所述,在这项关于合并糖尿病的非酒精性脂肪性肝病患者的队列研究中,使用二甲双胍与肝细胞癌风险降低相关,而联合降糖治疗与肝细胞癌风险增加相关。血糖控制情况可以作为合并糖尿病的非酒精性脂肪性肝病患者肝细胞癌风险分层的生物标志物。

原始出处:

Kramer Jennifer R,Natarajan Yamini,Dai Jianliang et al. Effect of diabetes medications and glycemic control on risk of hepatocellular cancer in patients with non-alcoholic fatty liver disease.[J] .Hepatology, 2021, https://doi.org/10.1002/hep.32244

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    2022-07-07 sjq027
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    2021-11-22 ms4000001809038213

    学习了

    0

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  7. [GetPortalCommentsPageByObjectIdResponse(id=1980613, encodeId=bb5419806133e, content=<a href='/topic/show?id=099f9548ed7' target=_blank style='color:#2F92EE;'>#酒精性脂肪肝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95487, encryptionId=099f9548ed7, topicName=酒精性脂肪肝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=26a9200, createdName=yangshch, createdTime=Wed Dec 22 19:06:48 CST 2021, time=2021-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1673703, encodeId=702216e370386, content=<a href='/topic/show?id=757b954e922' target=_blank style='color:#2F92EE;'>#酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95479, encryptionId=757b954e922, topicName=酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=398f26933958, createdName=huiwelcome, createdTime=Thu Dec 23 11:06:48 CST 2021, time=2021-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1676674, encodeId=bb1c16e6674e2, content=<a href='/topic/show?id=397299e19c7' target=_blank style='color:#2F92EE;'>#非酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99719, encryptionId=397299e19c7, topicName=非酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d18c27357544, createdName=Tommy1958, createdTime=Sat Jul 16 20:06:48 CST 2022, time=2022-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2062050, encodeId=8d3b20620501b, content=<a href='/topic/show?id=e6e1e15509f' target=_blank style='color:#2F92EE;'>#癌风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71550, encryptionId=e6e1e15509f, topicName=癌风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d58a435, createdName=sjq027, createdTime=Thu Jul 07 07:06:48 CST 2022, time=2022-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1072780, encodeId=568d10e2780ad, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ffe15705834, createdName=ms4000001809038213, createdTime=Mon Nov 22 10:51:28 CST 2021, time=2021-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270933, encodeId=85c812e0933ec, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Fri Nov 19 11:06:48 CST 2021, time=2021-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273057, encodeId=aa9f12e3057ab, content=<a href='/topic/show?id=2f468983351' target=_blank style='color:#2F92EE;'>#血糖控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89833, encryptionId=2f468983351, topicName=血糖控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef84111, createdName=whlxd, createdTime=Fri Nov 19 11:06:48 CST 2021, time=2021-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427573, encodeId=ca65142e5733c, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Fri Nov 19 11:06:48 CST 2021, time=2021-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1071274, encodeId=8e5e10e127459, content=症和危重症病人达到78,740例;全球新, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Thu Nov 18 08:03:19 CST 2021, time=2021-11-18, status=1, ipAttribution=)]
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    2021-11-19 gwc384
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    2021-11-18 查查佳佳

    症和危重症病人达到78,740例;全球新

    0

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