Liu Zi-Jin, Yan Yi-Jie, Weng Hong-Lei, Ding Hui-Guo
Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated to Capital Medical University, Beijing 100069, China.
Department of Medicine II, Section Molecular Hepatology, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany.
World J Clin Cases. 2021 Jul 16;9(20):5514-5525. doi: 10.12998/wjcc.v9.i20.5514.
The impact of type 2 diabetes mellitus (T2DM) on the prognosis and complications of liver cirrhosis is not fully clarified.
To clarify the mortality and related risk factors as well as complications in cirrhotic patients with T2DM.
We searched PubMed, EMBASE, and the Cochrane Library from their inception to December 1, 2020 for cohort studies comparing liver transplant-free mortality, hepatocellular carcinoma (HCC), ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy (HE) in cirrhotic patients with without T2DM. Odds ratios (ORs) were combined by using fixed-effects or random-effects models with RevMan software.
The database search generated a total of 17 cohort studies that met the inclusion criteria. Among these studies, eight reported the risk of mortality, and eight reported the risk of HCC. Three studies provided SBP rates, and two documented ascites rates. Four articles focused on HE rates, and three focused on variceal bleeding rates. Meta-analysis indicated that T2DM was significantly associated with an increased risk of liver transplant-free mortality [OR: 1.28, 95% confidence intervals (CI): 1.16-1.41, < 0.0001] and HCC incidence (OR: 1.82, 95%CI: 1.32-2.51, = 0.003). The risk of SBP was not significantly increased (OR: 1.16 95%CI: 0.86-1.57, = 0.34). Additionally, T2DM did not significantly increase HE (OR: 1.31 95%CI: 0.97-1.77, = 0.08), ascites (OR: 1.11 95%CI: 0.84-1.46, = 0.46), and variceal bleeding (OR: 1.34, 95%CI: 0.99-1.82, = 0.06).
The findings suggest that cirrhotic patients with T2DM have a poor prognosis and high risk of HCC. T2DM may not be associated with an increased risk of SBP, variceal bleeding, ascites, or HE in cirrhotic patients with T2DM.
2型糖尿病（T2DM）对肝硬化预后和并发症的影响尚未完全阐明。
阐明T2DM肝硬化患者的死亡率、相关危险因素及并发症。
我们检索了PubMed、EMBASE和Cochrane图书馆自建库至2020年12月1日的队列研究，比较有或无T2DM的肝硬化患者无肝移植情况下的死亡率、肝细胞癌（HCC）、腹水、自发性细菌性腹膜炎（SBP）、静脉曲张出血和肝性脑病（HE）。使用RevMan软件通过固定效应或随机效应模型合并比值比（OR）。
数据库检索共产生17项符合纳入标准的队列研究。在这些研究中，8项报告了死亡率风险，8项报告了HCC风险。3项研究提供了SBP发生率，2项记录了腹水发生率。4篇文章关注HE发生率，3篇关注静脉曲张出血发生率。荟萃分析表明，T2DM与无肝移植情况下的死亡风险增加显著相关[OR：1.28，95%置信区间（CI）：1.16 - 1.41，P < 0.0001]和HCC发病率增加显著相关（OR：1.82，95%CI：1.32 - 2.51，P = 0.003）。SBP风险未显著增加（OR：1.16，95%CI：0.86 - 1.57，P = 0.34）。此外，T2DM未显著增加HE（OR：1.31，95%CI：0.97 - 1.77，P = 0.08）、腹水（OR：1.11，95%CI：0.84 - 1.46，P = 0.46）和静脉曲张出血（OR：1.34，95%CI：0.99 - 1.82，P = 0.06）。
研究结果表明，T2DM肝硬化患者预后较差且HCC风险较高。T2DM可能与T2DM肝硬化患者的SBP、静脉曲张出血、腹水或HE风险增加无关。
