Chen Hua-Fen, Chang Yung-Yueh, Chen Peter, Shen Xiao-Han, Chang Chin-Huan, Hsu Wan-Lun
Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan.
School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan.
World J Diabetes. 2025 May 15;16(5):104576. doi: 10.4239/wjd.v16.i5.104576.
Hepatitis B and C and alcoholic liver disease are the principal causes of hepatic-related morbidity and mortality. However, evidence of the associations between diabetes without the above risk factors and hepatic-related study endpoints is not well understood. In addition, the effects of associated metabolic dysfunction and exercise on hepatic outcomes are still not clear.
To investigate the incidence and relative hazards of cirrhosis of the liver, hepatocellular carcinoma (HCC), hepatic-related complications and mortality in patients with type 2 diabetes (T2D) who were nonalcoholic and serologically negative for hepatitis B and C in Taiwan.
A total of 33184 T2D patients and 648746 nondiabetic subjects selected from Taiwan's adult preventive health care service were linked to various National Health Insurance databases, cancer registry, and death registry to identify cirrhosis of the liver, HCC, hepatic-related complications, and mortality. The Poisson assumption and Cox proportional hazard regression model were used to estimate the incidences and relative hazards of all hepatic-related study endpoints, respectively. We also compared the risk of hepatic outcomes stratified by age, sex, associated metabolic dysfunctions, and regular exercise between T2D patients and nondiabetic subjects.
Compared with nondiabetic subjects, T2D patients had a significantly greater incidence (6.32 17.20 per 10000 person-years) and greater risk of cirrhosis of the liver [adjusted hazard ratio (aHR) 1.45; 95%CI: 1.30-1.62]. The aHRs for HCC, hepatic complications, and mortality were 1.81, 1.87, and 2.08, respectively. An older age, male sex, obesity, hypertension, and dyslipidemia further increased the risks of all hepatic-related study endpoints, and regular exercise decreased the risk, irrespective of diabetes status.
Patients with T2D are at increased risk of cirrhosis of the liver, HCC, hepatic-related complications, and mortality, and associated metabolic dysfunctions provide additional hazard. Coordinated interprofessional care for high-risk T2D patients and diabetes education, with an emphasis on the importance of physical activity, are crucial for minimizing hepatic outcomes.
乙型和丙型肝炎以及酒精性肝病是肝脏相关发病和死亡的主要原因。然而，无上述危险因素的糖尿病与肝脏相关研究终点之间关联的证据尚不清楚。此外，相关代谢功能障碍和运动对肝脏结局的影响仍不明确。
调查台湾非酒精性且乙肝和丙肝血清学阴性的2型糖尿病（T2D）患者肝硬化、肝细胞癌（HCC）、肝脏相关并发症及死亡率的发生率和相对风险。
从台湾成人预防保健服务中选取的33184例T2D患者和648746例非糖尿病受试者与各种国民健康保险数据库、癌症登记处和死亡登记处相链接，以确定肝硬化、HCC、肝脏相关并发症及死亡率。分别采用泊松假设和Cox比例风险回归模型估计所有肝脏相关研究终点的发生率和相对风险。我们还比较了T2D患者和非糖尿病受试者按年龄、性别、相关代谢功能障碍和规律运动分层的肝脏结局风险。
与非糖尿病受试者相比，T2D患者肝硬化的发生率显著更高（每10000人年6.32至17.20例），且肝硬化风险更高[调整后风险比（aHR）1.45；95%置信区间：1.30 - 1.62]。HCC、肝脏并发症及死亡率的aHR分别为1.81、1.87和2.08。年龄较大、男性、肥胖、高血压和血脂异常进一步增加了所有肝脏相关研究终点的风险，而规律运动可降低风险，与糖尿病状态无关。
T2D患者发生肝硬化、HCC、肝脏相关并发症及死亡的风险增加，相关代谢功能障碍会带来额外风险。对高危T2D患者进行跨专业协作护理以及糖尿病教育，强调体育活动的重要性，对于将肝脏结局降至最低至关重要。
