Nderitu Paul, Bosco Cecilia, Garmo Hans, Holmberg Lars, Malmström Håkan, Hammar Niklas, Walldius Göran, Jungner Ingmar, Ross Paul, Van Hemelrijck Mieke
Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
King's College London, Division of Cancer Studies, Translational Oncology & Urology Research (TOUR), London, United Kingdom.
Int J Cancer. 2017 Sep 15;141(6):1148-1160. doi: 10.1002/ijc.30818. Epub 2017 Jun 21.
Metabolic syndrome (MetS) is associated with non-alcoholic fatty liver disease, which may progress to cirrhosis, a significant risk factor of hepatocellular carcinoma (HCC), the commonest malignant primary liver cancer (PLC). We investigated the association between the individual components of MetS (lipids, apolipoproteins, raised glucose, diabetes and obesity), PLC and cirrhosis. A total of 509,436 participants from the Swedish AMORIS cohort, recruited between January 1985 and December 1996 (end-date December 2011), aged ≥20 with baseline triglycerides (TG), total cholesterol (TC), glucose and liver enzymes were included. Those with baseline benign liver tumours, PLC or cirrhosis were excluded. Multivariate Cox regression, adjusted for age, gender, socio-economic status, liver disease (excluding cirrhosis) and MetS factors were used to estimate the association with PLC and cirrhosis. There were 766 PLC and 2,775 cirrhosis cases over 13 years. Raised TG, low TC, raised glucose, diabetes and low HDL were associated with an increased risk of developing PLC and cirrhosis. ApoB/ApoA-I ratio were also associated with PLC, whilst low LDL, raised TG/HDL, low ApoA-I and low ApoB were associated with cirrhosis. Obesity was significantly associated with PLC but not cirrhosis. Raised TG, low TC, raised glucose and diabetes showed stronger associations with PLC in participants with cirrhosis but many participants developed PLC without cirrhosis. Individual components of MetS (lipids, apolipoproteins, raised glucose, diabetes and obesity) were associated with an increased risk of developing PLC or cirrhosis. MetS components were more strongly associated with PLC with preceding cirrhosis history but many participants developed PLC without cirrhosis.
代谢综合征（MetS）与非酒精性脂肪性肝病相关，后者可能进展为肝硬化，而肝硬化是肝细胞癌（HCC）的一个重要危险因素，肝细胞癌是最常见的原发性肝癌（PLC）。我们研究了代谢综合征的各个组成部分（血脂、载脂蛋白、血糖升高、糖尿病和肥胖）与原发性肝癌及肝硬化之间的关联。纳入了瑞典AMORIS队列中1985年1月至1996年12月（截止日期为2011年12月）招募的509436名年龄≥20岁且有基线甘油三酯（TG）、总胆固醇（TC）、血糖和肝酶数据的参与者。排除有基线良性肝肿瘤、原发性肝癌或肝硬化的参与者。采用多因素Cox回归分析，并对年龄、性别、社会经济状况、肝病（不包括肝硬化）和代谢综合征因素进行校正，以评估与原发性肝癌和肝硬化的关联。在13年中，共有766例原发性肝癌和2775例肝硬化病例。甘油三酯升高、总胆固醇降低、血糖升高、糖尿病和高密度脂蛋白降低与发生原发性肝癌和肝硬化的风险增加相关。载脂蛋白B/载脂蛋白A-I比值也与原发性肝癌相关，而低密度脂蛋白降低、甘油三酯/高密度脂蛋白升高、载脂蛋白A-I降低和载脂蛋白B降低与肝硬化相关。肥胖与原发性肝癌显著相关，但与肝硬化无关。甘油三酯升高、总胆固醇降低、血糖升高和糖尿病在有肝硬化的参与者中与原发性肝癌的关联更强，但许多参与者在没有肝硬化的情况下也发生了原发性肝癌。代谢综合征的各个组成部分（血脂、载脂蛋白、血糖升高、糖尿病和肥胖）与发生原发性肝癌或肝硬化的风险增加相关。代谢综合征各组成部分与有肝硬化病史的原发性肝癌的关联更强，但许多参与者在没有肝硬化的情况下也发生了原发性肝癌。
