Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Pathology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Liver Int. 2018 Jun;38(6):1064-1073. doi: 10.1111/liv.13633. Epub 2017 Dec 12.
BACKGROUND & AIMS: Diabetes mellitus (DM) has been found to be strongly associated with an increased risk of hepatocellular carcinoma (HCC) among chronic hepatitis C (CHC) patients. Several studies have also found an association between metabolic steatosis and the risk of HCC in CHC patients, whether this latter association has been accounted for by the known relationship between DM and HCC is still unknown.
A cohort consisting of 976 non-genotype 3 patients histologically proven to have CHC and treated with interferon and ribavirin was studied. Cumulative incidence and HCC risk were analysed using the Kaplan-Meier method and Cox proportional hazard analysis.
Hepatocellular carcinoma developed in 140 subjects over a median follow-up period of 97.3 months, while 699 patients achieved sustained virological response (SVR). According to multivariate analyses, age ≥ 60 years, advanced fibrosis and genotype 1 were identified as independent factors significantly associated with HCC development in SVR patients. Furthermore, using the absence of steatosis and absence of DM as references, the presence of steatosis without DM (HR = 2.09, 95% CI = 1.12-3.9, P = .021), the presence of DM without steatosis (HR = 2.78, 95% CI = 1.3-5.92, P = .008) and the combined presence of steatosis and DM (HR = 3.25, 95% CI = 1.44-7.33, P = .004) were identified as independent factors significantly associated with HCC development in the SVR patients. In contrast, steatosis alone, DM alone and the combined presence of steatosis and DM were not associated with HCC development in non-SVR patients.
Steatosis and DM may be associated with HCC development in non-genotype 3 CHC patients with SVR.
糖尿病（DM）与慢性丙型肝炎（CHC）患者发生肝细胞癌（HCC）的风险增加密切相关。几项研究还发现，在 CHC 患者中，代谢性脂肪变性与 HCC 的风险之间存在关联，而后者与 DM 和 HCC 之间的已知关系是否有关，目前尚不清楚。
研究了一组 976 名经组织学证实患有 CHC 且接受干扰素和利巴韦林治疗的非基因型 3 患者。使用 Kaplan-Meier 方法和 Cox 比例风险分析对累积发病率和 HCC 风险进行分析。
在中位随访 97.3 个月期间，140 例患者发生 HCC，699 例患者获得持续病毒学应答（SVR）。多变量分析显示，年龄≥60 岁、晚期纤维化和基因型 1 是 SVR 患者 HCC 发生的独立危险因素。此外，以无脂肪变性和无糖尿病为参考，无脂肪变性但有糖尿病（HR=2.09，95%CI=1.12-3.9，P=0.021）、无脂肪变性但有糖尿病（HR=2.78，95%CI=1.3-5.92，P=0.008）和脂肪变性和糖尿病并存（HR=3.25，95%CI=1.44-7.33，P=0.004）被确定为 SVR 患者 HCC 发生的独立危险因素。相比之下，在非 SVR 患者中，单独的脂肪变性、单独的糖尿病以及脂肪变性和糖尿病的并存均与 HCC 发展无关。
在获得 SVR 的非基因型 3 CHC 患者中，脂肪变性和糖尿病可能与 HCC 的发生有关。
