Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei, Taiwan.
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
Gut Liver. 2023 Jan 15;17(1):24-33. doi: 10.5009/gnl220357. Epub 2022 Dec 19.
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world. NAFLD is a hepatic manifestation of insulin resistance, the core pathophysiology of diabetes. Multiple clinical studies show that diabetes increases the risk of liver disease progression and cirrhosis development in patients with NAFLD. Diabetes has causal associations with many different cancers, including hepatocellular carcinoma (HCC). More recent studies demonstrate that diabetes increases the risk of HCC in patients with underlying NAFLD cirrhosis, confirming the direct hepatocarcinogenic effect of diabetes among cirrhosis patients. Diabetes promotes hepatocarcinogenesis via the activation of inflammatory cascades producing reactive oxygen species and proinflammatory cytokines, leading to genomic instability, cellular proliferation, and inhibition of apoptosis. Given the global increase in the burden of NAFLD and HCC, high-risk patients such as older diabetic individuals should be carefully monitored for HCC development. Future larger studies should explore whether the effect of diabetes on HCC risk in NAFLD cirrhosis is modifiable by the type of antidiabetic medication and the effectiveness of diabetes control.
非酒精性脂肪性肝病（NAFLD）是世界范围内最常见的慢性肝病病因。NAFLD 是胰岛素抵抗的肝脏表现，也是糖尿病的核心病理生理学基础。多项临床研究表明，糖尿病会增加非酒精性脂肪性肝病患者肝纤维化进展和肝硬化发生的风险。糖尿病与多种不同的癌症具有因果关联，包括肝细胞癌（HCC）。最近的研究表明，糖尿病会增加患有潜在非酒精性脂肪性肝病肝硬化患者发生 HCC 的风险，这证实了糖尿病在肝硬化患者中具有直接的致癌作用。糖尿病通过激活产生活性氧和促炎细胞因子的炎症级联反应促进肝癌发生，导致基因组不稳定、细胞增殖和细胞凋亡抑制。鉴于非酒精性脂肪性肝病和 HCC 的全球负担增加，应仔细监测年龄较大的糖尿病等高危患者的 HCC 发展情况。未来的大型研究应探讨通过抗糖尿病药物的类型和糖尿病控制的有效性是否可以改变糖尿病对非酒精性脂肪性肝病肝硬化患者 HCC 风险的影响。
