Potential role of diabetes mellitus in the progression of cirrhosis to hepatocellular carcinoma：a cross-sectional case-control study from Chinese patients with HBV infection

摘要

BACKGROUND: Diabetes mellitus (DM) is regarded as a new risk factor for hepatocellular carcinoma (HCC), but few studies have  focused  on  the  potential  role  of  DM  in  the  progression of  cirrhosis  to  HCC  as  well  as  in  patients  with  simple  HBV infection. METHODS: A cohort of 1028 patients, treated at our hospital and  with  a  hospital  discharge  diagnosis  of  HCC  and/or cirrhosis,  was  screened.  Among  them,  558  were  diagnosed with chronic HBV infection and 370 were analyzed statistically according  to  the  diagnostic,  inclusion  and  exclusion  criteria. The demographic, clinical, metabolic, virological, biochemical, radiological  and  pathological  features  were  analyzed  and  the multivariate  logistic  regression  model  was  used  to  determine the potential role of DM. RESULTS: In 248 cirrhotic patients, 76 were diabetic and their mean duration of DM was 4.6 years. In 122 HCC patients with cirrhosis,  25  were  diabetic  and  their  mean  duration  of  DM was 4.4 years. Univariate analysis showed that compared with cirrhotic patients, the HCC patients had a higher percentage in males (P=0.001), a lower percentage in DM patients (P=0.039), a  higher  percentage  in  cigarette  smokers  (P=0.005),  a  higher percentage in patients with AFP>400 ng/mL (P<0.001), higher values of white blood cells (P<0.001), hemoglobin (P<0.001) and platelet (P<0.001), increased levels of ALT (P<0.001) and GGT (P<0.001), higher total bilirubin (P=0.018) and albumin levels (P<0.001), and a lower international normalized ratio (P<0.001). Multivariate logistic regression analysis showed that DM was an independent associated factor for HCC [odds ratio (OR)=0.376; 95%  CI,  0.175-0.807;  P=0.012].  Even  after  the  HCC  patients were  restricted  to  those  with  decompensated  cirrhosis  and compared  with  decompensated  cirrhotic  patients,  the  similar result was observed (OR=0.192; 95% CI, 0.054-0.679; P=0.010). CONCLUSIONS: DM is an independent factor in the progression of cirrhosis to HCC, but the role may be contrary to our current viewpoint. To clarify the causal relationship of DM and HCC, prospective and experimental studies are required.