Department of Medicine, University of Toronto, the Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario.
CMAJ. 2010 Aug 10;182(11):E526-31. doi: 10.1503/cmaj.092144. Epub 2010 Jun 21.
The negative impact of diabetes mellitus is well recognized, yet little is known about the effect of this disease on the liver, an organ susceptible to nonalcoholic fatty liver disease related to insulin resistance. We evaluated whether adults with newly diagnosed diabetes were at increased risk of serious liver disease.
We used administrative health databases for the province of Ontario (1994-2006) to perform a population-based matched retrospective cohort study. The exposed group comprised 438 069 adults with newly diagnosed diabetes. The unexposed comparison group--those without known diabetes--consisted of 2 059 708 individuals, matched 5:1 to exposed persons, by birth year, sex and local health region. We excluded individuals with pre-existing liver or alcohol-related disease. The primary study outcome was the subsequent development of serious liver disease, namely, liver cirrhosis, liver failure and its sequelae, or receipt of a liver transplant.
The incidence rate of serious liver disease was 8.19 per 10 000 person-years among those with newly diagnosed diabetes and 4.17 per 10 000 person-years among those without diabetes. The unadjusted hazard ratio was 1.92 (95% confidence interval [CI] 1.83-2.01). After adjustment for age, income, urban residence, health care utilization and pre-existing hypertension, dyslipidemia, obesity and cardiovascular disease, the hazard ratio was 1.77 (95% CI 1.68-1.86).
Adults with newly diagnosed diabetes appeared to be at higher risk of advanced liver disease, also known as diabetic hepatopathy. Whether this reflects nonalcoholic fatty liver disease or direct glycemic injury of the liver remains to be determined.
糖尿病的负面影响众所周知，但人们对这种疾病对肝脏的影响知之甚少，肝脏容易发生与胰岛素抵抗相关的非酒精性脂肪性肝病。我们评估了新诊断为糖尿病的成年人患严重肝病的风险是否增加。
我们使用安大略省的行政健康数据库（1994-2006 年）进行了一项基于人群的匹配回顾性队列研究。暴露组包括 438069 名新诊断为糖尿病的成年人。未暴露的对照组（无已知糖尿病）由 2059708 人组成，通过出生年份、性别和当地卫生区域与暴露者 5:1 匹配。我们排除了有预先存在的肝脏或酒精相关疾病的个体。主要研究结果是随后发生严重肝脏疾病，即肝硬化、肝功能衰竭及其后果，或接受肝脏移植。
新诊断为糖尿病的患者中严重肝脏疾病的发生率为每 10000 人年 8.19 例，而无糖尿病的患者中为每 10000 人年 4.17 例。未调整的危险比为 1.92（95%置信区间 [CI] 1.83-2.01）。在调整年龄、收入、城市居住、医疗保健利用以及预先存在的高血压、血脂异常、肥胖和心血管疾病后，危险比为 1.77（95%CI 1.68-1.86）。
新诊断为糖尿病的成年人似乎患晚期肝病（也称为糖尿病性肝病变）的风险更高。这是否反映了非酒精性脂肪性肝病还是直接的血糖对肝脏的损害仍有待确定。
