| 摘要: | 背景
肥胖會導致胰島素阻抗且過高的身體質量指標(body mass index, BMI)也顯著增加第二型糖尿病的風險。糖化血色素(glycated hemoglobin A1c, HbA1c)是糖尿病發生率和死亡率重要的危險因子。目前研究仍不清楚在台灣第二型糖尿病患者，身體質量指標和糖化血色素是否與肝癌的發生病率有關。本研究藉由回溯性世代研究，評估身體質量指標和糖化血色素與罹患肝癌風險間的相關。
方法
本研究之世代研究對象包括了48,684位第二型糖尿病患，在2001-2004之間進入全國糖尿病照護管理計畫，至2010年約平均追蹤7.9年。本研究使用Cox比例風險迴歸(Cox proportional hazards regression)估計不同身體質量指標與糖化血色素的分組和肝癌發生率的相對風險比。
結果
根據世界衛生組織準則，將身體質量指標分為<18.5，18.5-23.9，24-26.9及?27 kg/m2四組，肝癌的發病率分別為3.77，2.84，2.71和2.42人每1000人年。糖化血素色則根據臨床標準分為<7，7-7.9，8-8.9和?9 %四組，肝癌的發病率分別為2.76，2.50，2.58，和2.78人每1000人年。在校正了空腹血糖，急性酒精性肝炎，B型肝炎，C型肝炎及其他風險因素後，本研究發現相較於身體質量指標介於18.5-23.9 kg/m2，罹患肝癌的風險比在身體質量指指標?27 kg/m2為0.85 (0.72-0.99);相較於糖化血色素<7 %，糖化血色素介於8-8.9 %的罹患肝癌的風險比為1.20 (1.02-1.41)，且呈現顯著的線性趨勢(P for trend = 0.002)。
結論
全球的肝癌發生率正在迅速增加，我們需要公共衛生干預措施來制止這疾病的流行。我們的研究結果顯示在2型糖尿病患者中血糖控制和身體質量指標預測肝癌的發生。因此，生活方式的干預措施，如保持正常的體重和良好的血糖控制可能可以降低肝癌的發生。
Background
Obesity leads to insulin resistance, and excess body mass index (BMI) significantly increased the risk of type 2 diabetes. Glycated hemoglobin A1c (HbA1c) is one of classic risk factors that have been explored to explain the excess of mortality and morbidity in diabetes. However, what is still unclear is whether BMI and HbA1c are also important factors of liver cancer incidence in Chinese patients with type 2 diabetes in Taiwan. The aim of the study was to examine whether BMI and HbA1c were associated with liver cancer incidence in patients with type 2 diabetes.
Methods
A retrospective cohort study consisted of 48,684 patients with type 2 diabetes aged 30 years and over enrolled in National Diabetes Care Management Program before 2004 was used in Cox’s proportional hazard regression model.
Results
The mean follow-up years was 7.9 years. The incidence rates of liver cancer were 3.77, 2.84, 2.71, and 2.42 per 1,000 person-years in groups of BMI <18.5 kg/m2, 18.5-23.9 kg/m2, 24-26.9 kg/m2, and ≥27 kg/m2 according to WHO cut-off points of BMI, respectively. The incidence rates of liver cancer were 2.76, 2.50, 2.58, and 2.78 per 1,000 person-years in groups of HbA1c of <7%, 7%-7.9%, 8%-8.9%, and ≥9% according to clinical criteria as cutoff points. After adjusting for fasting plasma glucose, acute alcoholic hepatitis, hepatitis B, hepatitis C and other risk factors, BMI was independently associated with liver cancer incidence, and the corresponding hazard ratio for BMI ≥27 kg/m2 versus BMI of 18.5-23.9 kg/m2 was 0.85 (0.72, 0.99); HbA1C was independently associated with liver cancer incidence, and the corresponding hazard ratio for HbA1c of 8-8.9% compared with HbA1c<7% was 1.20 (1.02-1.41). In addition, there was a significant linear trend in liver cancer incidence with increasing HbA1c (p for trend=0.002).
Conclusions
Liver cancer incidence is rapidly increasing worldwide, and public health interventions are needed to halt this epidemic. Our findings suggest glucose control and BMI are predictors of liver cancer in patients with type 2 diabetes. Lifestyle interventions such as maintaining a normal body weight and good glycemic control may reduce the burden of liver cancer. |
