Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Hepatology. 2018 Oct;68(4):1308-1318. doi: 10.1002/hep.30083.
The prevalence of diabetes is increasing rapidly in China. However, evidence is limited about its effects on chronic liver diseases and liver cancer. We examined the associations of diabetes with chronic liver diseases and liver cancer and of random plasma glucose (RPG) with these liver diseases among participants without diabetes in Chinese adults and the possible interaction by hepatitis B virus (HBV) infection. The prospective China Kadoorie Biobank recruited 512,891 adults. During 10 years of follow-up, 2,568 liver cancer, 2,082 cirrhosis, 1,298 hospitalized nonalcoholic fatty liver disease (NAFLD), and 244 hospitalized alcoholic liver disease (ALD) cases were recorded among 503,993 participants without prior history of cancer or chronic liver diseases at baseline. Cox regression was used to estimate hazard ratios (HRs) for each disease by diabetes status (previously diagnosed or screen-detected) and, among those without previously diagnosed diabetes, by levels of RPG. Overall 5.8% of participants had diabetes at baseline. Compared to those without diabetes, individuals with diabetes had adjusted HRs of 1.49 (95% confidence interval 1.30-1.70) for liver cancer, 1.81 (1.57-2.09) for cirrhosis, 1.76 (1.47-2.16) for NAFLD, and 2.24 (1.42-3.54) for ALD. The excess risks decreased but remained elevated in those with longer duration. Among those without previously diagnosed diabetes, RPG was positively associated with liver diseases, with adjusted HRs per 1 mmol/L higher RPG of 1.04 (1.03-1.06) for liver cancer, 1.07 (1.05-1.09) for cirrhosis, 1.07 (1.05-1.10) for NAFLD, and 1.10 (1.05-1.15) for ALD. These associations did not differ by HBV infection.
In Chinese adults, diabetes and higher blood glucose levels among those without known diabetes are associated with higher risks of liver cancer and major chronic liver diseases.
在中国，糖尿病的患病率正在迅速上升。然而，关于糖尿病对慢性肝病和肝癌的影响的证据有限。我们研究了糖尿病与慢性肝病和肝癌的关系，以及在无糖尿病的中国成年人中随机血浆葡萄糖（RPG）与这些肝病的关系，以及乙型肝炎病毒（HBV）感染的可能交互作用。前瞻性的中国科克伦生物库招募了 512891 名成年人。在 10 年的随访期间，在 503993 名基线时无癌症或慢性肝病既往史的参与者中，记录了 2568 例肝癌、2082 例肝硬化、1298 例住院非酒精性脂肪性肝病（NAFLD）和 244 例住院酒精性肝病（ALD）病例。Cox 回归用于根据糖尿病状态（先前诊断或筛查发现）和无先前诊断糖尿病的参与者中 RPG 水平估算每种疾病的风险比（HR）。参与者中总体有 5.8%患有糖尿病。与无糖尿病的参与者相比，患有糖尿病的个体患肝癌的调整后 HR 为 1.49（95%置信区间 1.30-1.70），肝硬化为 1.81（1.57-2.09），NAFLD 为 1.76（1.47-2.16），ALD 为 2.24（1.42-3.54）。在病程较长的患者中，风险比虽有所下降，但仍处于较高水平。在无先前诊断糖尿病的患者中，RPG 与肝病呈正相关，每升高 1mmol/L RPG，肝癌的调整后 HR 为 1.04（1.03-1.06），肝硬化为 1.07（1.05-1.09），NAFLD 为 1.07（1.05-1.10），ALD 为 1.10（1.05-1.15）。这些关联在 HBV 感染中没有差异。
在中国成年人中，糖尿病和无已知糖尿病的个体中较高的血糖水平与肝癌和主要慢性肝病的风险增加相关。
