Tan Yifei, Wei Shiyou, Zhang Wei, Yang Jian, Yang Jiayin, Yan Lunan
Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China,
Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Cancer Manag Res. 2019 Jan 14;11:705-713. doi: 10.2147/CMAR.S188238. eCollection 2019.
Type 2 diabetes mellitus has been proved to be a risk factor of hepatocellular carcinoma, but how diabetes affects incidence of hepatocellular carcinoma among patients with chronic hepatitis B virus infection remains controversial.
A comprehensive search of Medline and Embase was performed. Incidence of hepatocellular carcinoma in chronic hepatitis B patients was the primary outcome. Pooled HRs and 95% CIs were calculated to assess the correlation between diabetes and incidence of hepatocellular carcinoma.
Five cohort studies and two case-control studies were identified, with a total of 21,842 chronic hepatitis B patients. The diabetes mellitus cohort was found to have increased incidence of hepatocellular carcinoma (pooled HR 1.77, 95% CI 1.28-2.47; fixed effect) and worse overall mortality (pooled RR 1.93, 95% CI 1.64-2.27; fixed effect) in comparison with those without diabetes. In case-control studies, hepatocellular carcinoma cases were found to have an insignificantly elevated diabetes mellitus rate in comparison with the control group.
Type 2 diabetes mellitus is significantly associated with increased risk of hepatocellular carcinoma among patients with chronic hepatitis B virus infection, and aggressive management of diabetes mellitus is strongly suggested.
2型糖尿病已被证明是肝细胞癌的一个危险因素，但糖尿病如何影响慢性乙型肝炎病毒感染患者的肝细胞癌发病率仍存在争议。
对Medline和Embase进行全面检索。慢性乙型肝炎患者的肝细胞癌发病率是主要结局指标。计算合并风险比（HR）和95%可信区间（CI）以评估糖尿病与肝细胞癌发病率之间的相关性。
共纳入5项队列研究和2项病例对照研究，总计21,842例慢性乙型肝炎患者。与无糖尿病患者相比，糖尿病队列的肝细胞癌发病率增加（合并HR 1.77，95% CI 1.28 - 2.47；固定效应模型），总体死亡率更高（合并RR 1.93，95% CI 1.64 - 2.27；固定效应模型）。在病例对照研究中，与对照组相比，肝细胞癌病例的糖尿病发病率虽有升高但无统计学意义。
2型糖尿病与慢性乙型肝炎病毒感染患者肝细胞癌风险增加显著相关，强烈建议积极管理糖尿病。
