Sci Rep:每多一个代谢「筹码」,MAFLD-HCC就更近一步!患癌风险最高可增至5.9倍!

2022-08-19 MedSci原创 MedSci原创

Sci Rep:代谢特征与代谢相关性脂肪肝相关肝癌风险的相关性分析

代谢相关性脂肪肝病(MAFLD)是一种与代谢综合征相关的慢性脂肪肝疾病,其发病率在过去二十年中迅速增加。MAFLD现在影响着世界人口的25%,已成为最常见的慢性肝病,被认为是发达国家肝细胞癌(HCC)的主要原因。

肝细胞癌是世界上第五大常见肿瘤,也是癌症相关死亡的第三大原因。与其他原因引起的肝细胞癌不同,MAFLD-HCC的病因尚不清楚,但发病率持续增加,治疗方法稀缺。因此,研究这种疾病的病因和危险因素有助于筛查、监测和预防早期肝细胞癌。

为了研究亚洲人MAFLD-HCC的病因及其与代谢综合征的关系,本分析进行了回顾性队列研究,以评估代谢特征对疾病的独立和组合影响。

研究人员分析了20151月至202012月在昆明医科大学第二附属医院就诊的135MAFLD-HCC患者和135MAFLD患者作为对照组,评估代谢性状对肝细胞癌风险的独立和联合影响。

本研究共纳入2965例肝细胞癌患者,135MAFLD-HCC患者符合研究标准。对照组共纳入5889MAFLD患者,随机选择135名仅具有MAFLD的匹配患者作为对照队列。

两组患者的平均年龄或性别/纤维化比率无显著差异(p >0.05)。在MAFLD-HCC患者中,26例患有肝硬化(19.3%),31例患有T2DM(23%),46例患有糖尿病前期(34.1%),110例患有肥胖症(81.5%),74例患有高血压(54.8%),38例(28.1%)患有晚期纤维化。有91例患者(61.4%)患有血脂异常,其中62例(45.9%)患有高甘油三酯血症,64例(47.4%)患有低HDL。与对照组相比,MAFLD-HCC患者的糖尿病前期、肥胖、高血压、血脂异常和晚期纤维化的患病率较高,差异有统计学意义(p <0.05),但T2 DM患病率无统计学意义差异(p = 0.224)。两组患者的生化指标显示MAFLD-HCC患者的肝功能较差(p <0.05)(表1)。

每个代谢特征与MAFLD-HCC风险增加显着相关(p <0.05)。肥胖、糖尿病前期或T2DM、高血压和血脂异常患者发生 MAFLD-HCC 的风险3.5 倍(95% 可信区间 [CI] 2.03–6.11)、2.1 倍(95% CI 1.26–3.34)、2.2 倍(95% CI 1.35–3.59)和 2.5 倍 (95% CI 1.53–4.11)(表 2)。在多变量模型中,肥胖、血脂异常调整后的疾病风险增加:与无疾病患者相比,风险分别增加了3.6倍(95% CI 1.99–6.62)、2.6倍(95% CI 1.49–4.46)和2.3倍(95% CI 1.30–3.88)。调整后糖尿病前期或T2 DM患者的风险比无疾病患者高2倍(95%CI 1.17-3.44)(图2)。

在具有叠加特征的患者中,HCC风险较高,代谢特征较多(p <0.05)。无肝硬化或晚期纤维化患者的代谢特征与MAFLD-HCC风险之间的相关性与整体分析基本一致。代谢特征增加 MAFLD-HCC 的风险,并且风险与代谢特征的数量呈正相关。与具有一种或没有性状的患者相比,具有2性和3/4性状的MAFLD-HCC的风险分别增加到2.8(95%CI 1.55-5.20)和5.9倍(95%CI 3.00-11.46)(表4,图3)。肥胖与肝细胞癌的相关性最强。

综上所述,研究发现代谢特征增加了MAFLD-HCC的风险,并且这种风险与代谢特征的数量呈正相关。无论是否存在肝硬化或晚期纤维化,肥胖与MAFLD-HCC风险的相关性最强。结果表明,监测糖尿病前期或T2DM,高血压,血脂异常和肥胖可用于全面评估HCC的风险,这反过来又有助于建立合理,具有成本效益的风险分层和精确的筛查策略。

原文来源:

Xie, X., Zheng, M., Guo, W. et al. Correlation analysis of metabolic characteristics and the risk of metabolic-associated fatty liver disease - related hepatocellular carcinoma. Sci Rep 12, 13969 (2022). https://doi.org/10.1038/s41598-022-18197-6

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    2022-12-13 sjq027
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    2023-02-22 lvygwyt2781
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    2022-08-21 jiyangfei
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    2022-08-21 neizongke
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    2022-08-21 lq0307

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