Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, Department of Hepato-Gastroenterology and Paris-Nord University, Centre de Recherche en Nutrition Humaine de l'Ile-de-France (CRNH-IdF), 93143 Bondy, France.
J Clin Endocrinol Metab. 2011 Aug;96(8):2601-8. doi: 10.1210/jc.2010-2415. Epub 2011 Jul 13.
Insulin resistance plays a role in hepatocarcinogenesis and is decreased by metformin treatment.
The aim of the study was to assess the influence of metformin treatment on the prognosis of compensated hepatitis C virus (HCV) cirrhosis in patients with type 2 diabetes.
We studied an observational prospective cohort (1988-2007) at a university hospital referral center.
A total of 100 consecutive diabetic patients (53 men, age 61 ± 11 yr) with ongoing HCV cirrhosis and no contraindication for metformin were included in a screening program for hepatocellular carcinoma (HCC).
The patients were prospectively followed up for HCC incidence, liver-related death, or hepatic transplantation.
The level of platelet count was significantly lower in patients treated with metformin (n = 26) compared with those not treated with metformin (n = 74) [117 (interquartile range, 83-166) vs. 149 (105-192) Giga/liter, P = 0.045]. During a median follow-up of 5.7 (3.8-9.5) yr, one patient was lost to follow-up, 39 developed a HCC, and 33 died from liver causes or were transplanted. The 5-yr incidence of HCC was 9.5 and 31.2% (P = 0.001) and of liver-related death/transplantation, 5.9 and 17.4% (P = 0.013), in patients who received metformin treatment and in those who did not, respectively. In multivariate analysis, metformin treatment was independently associated with a decrease in HCC occurrence [hazard ratio, 0.19 (95% confidence interval, 0.04-0.79); P = 0.023] and liver-related death or transplantation [hazard ratio, 0.22 (95% confidence interval, 0.05-0.99); P = 0.049].
In patients with type 2 diabetes and HCV cirrhosis, use of metformin is independently associated with reduced incidence of HCC and liver-related death/transplantation.
胰岛素抵抗在肝癌发生中起作用，并可通过二甲双胍治疗来降低。
本研究旨在评估二甲双胍治疗对 2 型糖尿病合并代偿性丙型肝炎病毒（HCV）肝硬化患者预后的影响。
我们在一家大学医院转诊中心进行了一项观察性前瞻性队列研究（1988-2007 年）。
共有 100 例连续的糖尿病患者（53 名男性，年龄 61 ± 11 岁）患有持续的 HCV 肝硬化且无二甲双胍使用禁忌证，被纳入肝细胞癌（HCC）筛查计划。
前瞻性随访 HCC 发生率、肝脏相关死亡或肝移植。
与未接受二甲双胍治疗的患者（n = 74）相比，接受二甲双胍治疗的患者（n = 26）的血小板计数水平显著降低[117（四分位距，83-166）vs. 149（105-192）Giga/l，P = 0.045]。在中位随访 5.7（3.8-9.5）年后，1 例患者失访，39 例发生 HCC，33 例死于肝脏原因或接受肝移植。接受二甲双胍治疗的患者和未接受二甲双胍治疗的患者的 HCC 发生率分别为 9.5%和 31.2%（P = 0.001），肝脏相关死亡/移植率分别为 5.9%和 17.4%（P = 0.013）。多变量分析显示，二甲双胍治疗与 HCC 发生率降低独立相关[风险比，0.19（95%置信区间，0.04-0.79）；P = 0.023]和肝脏相关死亡或移植[风险比，0.22（95%置信区间，0.05-0.99）；P = 0.049]。
在 2 型糖尿病合并 HCV 肝硬化患者中，使用二甲双胍与 HCC 发生率降低和肝脏相关死亡/移植率降低独立相关。
