Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea.
Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea; Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Eur J Cancer. 2018 Oct;102:103-113. doi: 10.1016/j.ejca.2018.07.008. Epub 2018 Sep 4.
It is unclear whether elevated fasting serum glucose level and type 2 diabetes (T2DM) are associated with an increased risk of hepatocellular carcinoma (HCC), irrespective of obesity in patients with chronic hepatitis B.
Our study population comprised 214,167 Korean men with chronic hepatitis B in the National Health Insurance Service (NHIS) database between January 2002 and December 2006. Data on new events of HCC were obtained by records of the NHIS during the follow-up. We used Cox proportional hazards models adjusted for sociodemographic, lifestyle, health status and clinical conditions to estimate the hazard ratio (HR) and 95% confidence intervals (95% CIs) of HCC associated with different categories of fasting serum glucose level and T2DM, using fasting serum glucose <90 mg/dL as reference.
During the 8 years of follow-up, there were 11,241 HCCs in men with chronic hepatitis B. Compared with the reference group, fasting serum glucose level of more than 140 mg/dL (HR = 1.46; 95% CI: 1.36-1.57; p < 0.001) and presence of T2DM (HR = 1.23; 95% CI: 1.15-1.34; p < 0.001) were associated with an increased risk of HCC after controlling for potential confounders. Significant association with fasting serum glucose and HCC was found for both non-obese (<25 kg/m) and obese (≥25.0 kg/m) patients (P < 0.001).
In this cohort of men with chronic hepatitis B infection, elevated fasting serum glucose level and T2DM were significantly associated with an increased risk of HCC, regardless of obesity. Glycaemic control in men with chronic hepatitis B patients should be considered in clinical practice to prevent HCC.
在慢性乙型肝炎患者中，空腹血清葡萄糖水平升高和 2 型糖尿病（T2DM）与肝细胞癌（HCC）风险增加相关，而不论肥胖情况如何，目前其机制尚不清楚。
我们的研究人群包括 2002 年 1 月至 2006 年 12 月期间国家健康保险服务（NHIS）数据库中的 214167 名韩国慢性乙型肝炎男性患者。通过 NHIS 的记录获得 HCC 新发病例的相关数据。在随访期间，我们使用 Cox 比例风险模型，调整了社会人口统计学、生活方式、健康状况和临床状况，以评估不同空腹血糖水平和 T2DM 类别与 HCC 相关的风险比（HR）和 95%置信区间（95%CI），以空腹血糖<90mg/dL 为参考。
在 8 年的随访期间，214167 名慢性乙型肝炎男性患者中共有 11241 例发生 HCC。与参考组相比，空腹血糖水平超过 140mg/dL（HR=1.46；95%CI：1.36-1.57；p<0.001）和存在 T2DM（HR=1.23；95%CI：1.15-1.34；p<0.001）与潜在混杂因素校正后 HCC 风险增加相关。空腹血糖与 HCC 之间存在显著关联，无论患者是否肥胖（<25kg/m 或≥25.0kg/m）（P<0.001）。
在本队列的慢性乙型肝炎感染男性中，空腹血清葡萄糖水平升高和 T2DM 与 HCC 风险增加显著相关，而与肥胖无关。在临床实践中，应考虑控制慢性乙型肝炎患者的血糖水平，以预防 HCC。
