University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, P.O. Box 480, Fremantle, Western Australia 6959, Australia.
J Clin Endocrinol Metab. 2012 May;97(5):1581-8. doi: 10.1210/jc.2011-3232. Epub 2012 Feb 22.
Few studies have examined morbidity and mortality associated with hepatobiliary disease in diabetes. Most have used administrative databases and/or have had limited/incomplete data including recognized risk factors for hepatobiliary disease.
The objective of the study was to explore the relationship between type 2 diabetes and hepatobiliary disease in well-characterized patients with detailed risk factor data including viral hepatitis status and hemochromatosis genotype.
This was a community-based longitudinal observational study.
The study was conducted in an urban Australian community.
The study included 1294 patients of mean ± SD aged 64.1 ± 11.3 yr and 5156 age-, gender-, and ZIP code-matched nondiabetic controls.
Prevalent and incident hepatobiliary disease and hepatobiliary disease-related death were measured. Competing risks proportional hazard models provided independent associates of these end points.
During 13,705 patient-years (mean 11.5 yr), 144 patients had an initial hepatobiliary disease-related hospitalization/cancer registration vs. 403 controls during 63,937 person-years of follow-up, an incidence rate ratio of 1.66 (95% confidence interval 1.37-2.02). Incident hepatobiliary disease was associated with a lower glycosylated hemoglobin and higher urinary albumin to creatinine ratio. Nearly half of the patients (49.9%) died during follow-up [crude mortality ratio vs. nondiabetic controls 1.97 (1.16-3.32)], and 21 (3.3%) from hepatobiliary disease including two cases of cirrhosis attributable to nonalcoholic steatohepatitis. Hepatobiliary disease-related death was independently predicted by prior hepatobiliary disease, hepatitis C seropositivity, retinopathy, and peripheral neuropathy; higher educational level and higher fasting serum glucose were protective.
Hepatobiliary disease and associated mortality are increased in type 2 diabetes. Multiple factors including fatty infiltration, microangiopathy, and direct glucotoxicity are likely to contribute, but hospitalization and death due to cirrhosis from nonalcoholic steatohepatitis appear uncommon.
很少有研究调查过肝胆疾病与糖尿病之间的发病率和死亡率。大多数研究使用了行政数据库，或者只收集了有限的、不完整的数据，包括肝胆疾病的公认危险因素。
本研究旨在探索在具有详细危险因素数据的特征明确的患者中，2 型糖尿病与肝胆疾病之间的关系，这些数据包括病毒肝炎状态和血色病基因型。
这是一项基于社区的纵向观察性研究。
该研究在澳大利亚一个城市社区进行。
研究纳入了 1294 名平均年龄为 64.1±11.3 岁的患者和 5156 名年龄、性别和邮政编码匹配的非糖尿病对照者。
测量了现患和新发肝胆疾病以及肝胆疾病相关死亡情况。使用竞争风险比例风险模型提供这些终点的独立相关因素。
在 13705 患者年（平均 11.5 年）期间，144 名患者首次出现肝胆疾病相关住院/癌症登记，而在 63937 人年的随访期间，403 名对照者中出现 1 例，发病率比为 1.66（95%置信区间 1.37-2.02）。新发肝胆疾病与糖化血红蛋白较低和尿白蛋白/肌酐比值较高相关。近一半的患者（49.9%）在随访期间死亡[粗死亡率比非糖尿病对照组为 1.97（1.16-3.32）]，其中 21 例（3.3%）死于肝胆疾病，包括 2 例归因于非酒精性脂肪性肝炎的肝硬化病例。既往肝胆疾病、丙型肝炎血清阳性、视网膜病变和周围神经病变；较高的教育水平和较高的空腹血糖水平是肝胆疾病相关死亡的独立预测因素。
2 型糖尿病患者的肝胆疾病和相关死亡率增加。多种因素，包括脂肪浸润、微血管病变和直接糖毒性，可能起作用，但由于非酒精性脂肪性肝炎导致的肝硬化导致的住院和死亡似乎并不常见。
