El-Serag H B, Richardson P A, Everhart J E
Sections of Gastroenterology and Health Services Research, The Houston Veterans Affairs Medical Center and Baylor College of Medicine, Texas 77030, USA.
Am J Gastroenterol. 2001 Aug;96(8):2462-7. doi: 10.1111/j.1572-0241.2001.04054.x.
Diabetes mellitus (DM) has been reported to increase the risk of hepatocellular carcinoma (HCC). We carried out a case-control study to examine the role of DM while controlling for several known risk factors of HCC.
All hospitalized patients with primary liver cancer (PLC) during 1997-1999 were identified in the computerized database of the Department of Veterans Affairs, the Patient Treatment File. Controls without cancer were randomly assigned from the Patient Treatment File during the same time period. The inpatient and outpatient files were searched for several conditions including DM, hepatitis C virus (HCV), hepatitis B virus (HBV), alcoholic cirrhosis, autoimmune hepatitis, hemochromatosis, and nonspecific cirrhosis. Adjusted odds ratios (OR) were calculated in a multivariable logistic regression model.
We identified 823 patients with PLC and 3459 controls. The case group was older (62 yr [+/-10] vs 60 [+/-11], p < 0.0001), had more men (99% vs 97%, 0.0004), and a greater frequency of nonwhites (66% vs 71%, 0.0009) compared with controls. However, HCV- and HBV-infected patients were younger among cases than controls. Risk factors that were significantly more frequent among PLC cases included HCV (34% vs 5%, p < 0.0001), HBV (11% vs 2%, p < 0.0001), alcoholic cirrhosis (47% vs 6%, p < 0.0001), hemochromatosis (2% vs 0.3%, p < 0.0001), autoimmune hepatitis (5% vs 0.5%, p < 0.0001), and diabetes (33% vs 30%, p = 0.059). In the multivariable logistic regression, diabetes was associated with a significant increase in the adjusted OR of PLC (1.57, 1.08-2.28, p = 0.02) in the presence of HCV, HBV, or alcoholic cirrhosis. Without markers of chronic liver disease, the adjusted OR for diabetes and PLC was not significantly increased (1.08, 0.86-1.18, p = 0.4). There was an increase in the HCV adjusted OR (17.27, 95% Cl = 11.98-24.89) and HBV (9.22, 95% CI = 4.52-18.80) after adjusting for the younger age of HCV- and HBV-infected cases. The combined presence of HCV and alcoholic cirrhosis further increases the risk with an adjusted OR of 79.21 (60.29-103.41). The population attributable fraction for HCV among hospitalized veterans was 44.8%, whereas that of alcoholic cirrhosis was 51%.
DM increased the risk of PLC only in the presence of other risk factors such as hepatitis C or B or alcoholic cirrhosis. Hepatitis C infection and alcoholic cirrhosis account for most of PLC among veterans.
据报道，糖尿病（DM）会增加肝细胞癌（HCC）的发病风险。我们开展了一项病例对照研究，以探讨糖尿病在控制多种已知肝细胞癌风险因素的情况下所起的作用。
在退伍军人事务部的计算机化数据库“患者治疗档案”中识别出1997 - 1999年间所有住院的原发性肝癌（PLC）患者。在同一时期从“患者治疗档案”中随机分配无癌症的对照者。在住院和门诊档案中查找包括糖尿病、丙型肝炎病毒（HCV）、乙型肝炎病毒（HBV）、酒精性肝硬化、自身免疫性肝炎、血色素沉着症和非特异性肝硬化等多种病症。在多变量逻辑回归模型中计算调整后的比值比（OR）。
我们识别出823例原发性肝癌患者和3459名对照者。病例组年龄更大（62岁[±10]对60岁[±11]，p < 0.0001），男性更多（99%对97%，p = 0.0004），非白人比例更高（66%对71%，p = 0.0009）。然而，丙型肝炎病毒和乙型肝炎病毒感染患者在病例组中比对照组更年轻。在原发性肝癌病例中显著更常见的风险因素包括丙型肝炎病毒（34%对5%，p < 0.0001）、乙型肝炎病毒（11%对2%，p < 0.0001）、酒精性肝硬化（47%对6%，p < 0.0001）、血色素沉着症（2%对0.3%，p < 0.0001）、自身免疫性肝炎（5%对0.5%，p < 0.0001）以及糖尿病（33%对30%，p = 0.059）。在多变量逻辑回归中，在存在丙型肝炎病毒、乙型肝炎病毒或酒精性肝硬化的情况下，糖尿病与原发性肝癌调整后的OR显著增加相关（1.57，1.08 - 2.28，p = 0.02）。在没有慢性肝病标志物的情况下，糖尿病与原发性肝癌的调整后OR没有显著增加（1.08，0.86 - 1.18，p = 0.4）。在对丙型肝炎病毒和乙型肝炎病毒感染病例的年轻年龄进行调整后，丙型肝炎病毒调整后的OR增加（17.27，95%可信区间 = 11.98 - 24.89），乙型肝炎病毒调整后的OR增加（9.22，95%可信区间 = 4.52 - 18.80）。丙型肝炎病毒和酒精性肝硬化同时存在会进一步增加风险，调整后的OR为79.21（60.29 - 103.41）。住院退伍军人中丙型肝炎病毒的人群归因分数为44.8%，而酒精性肝硬化的人群归因分数为51%。
糖尿病仅在存在丙型或乙型肝炎或酒精性肝硬化等其他风险因素时才会增加原发性肝癌的风险。丙型肝炎感染和酒精性肝硬化在退伍军人的原发性肝癌中占大多数。
