肝癌及乙肝患者近5年空腹高血糖发病状况对照研究

摘要

Objective :To study the incidence of fasting hyperglycemia between hepatocellular carcinoma (HCC)and hepatitis B patients in recent five years .Methods :468 male patients with HCC were selected for our study (group 1 ,rate of DM precedes HCC patients was 25 .9% ) .We divided 1 046 HBV patients into the chronic hepatitis B/cirrhosis (group 2) ,the fatty liver (group 3) and the B ultrasound image hepatic“normal”(group 4) as control .HBV markers , anti-HCV ,FBG ,BMI and blood pressure were detected .Results:In group 1:rate of impaired fasting glucose (IFG) and diabetes mellitus (DM ) were 17 .2% and 17% respectively (P>0 .05) in HBsAg-positive patients ;those were 15 .4%and 17 .9% (P>0 .05) in HBsAg-negative;there were no correlation between DM and HBV infection (r= -0 .007) . In the four groups :The incidence of IFG were similar in each group (P>0 .05);the rate of DM in four groups were 17.3% ,16 .7% ,26 .2% and 9 .1% respectively .There were no difference between Group 1 and 2 (P>0 .05) ,yet sta-tistical differences between 1 and 3/4(P=0 .008 ,P=0 .001) .BMI in group 1 ,2 ,4 was lower than group 3 .The blood pressure in group 1 and group 2 were significantly lower than that in group 3 and the group 4 (P<0 .005) .There were no significant difference of IFG between the four group(P>0 .05) .The risk age of DM is 60~69 years old in group 1 (26.4% ) ,group 3 (35 .1% ) ,group 4 (12 .2% ) ,but 50~59 years old in group 2 (22 .5% ) .Conclusion:There are no correlation in DM and HBV in HCC patients ,but in CHB and LC .Hepatitis B associated with fatty liver is higher risk of DM ,overweight or obese is the main factors .In patients with HCC ,CHB and LC ,severity of Liver disease may accel-erate the process from IFG to DM .%目的：以乙肝患者为对照，对近5年来肝细胞肝癌（HCC ）空腹高血糖发病状况作对照研究。方法：HCC的男性患者468例（①HCC组，其DM先于 HCC确诊者25．9％），对照人群1046例分为慢乙肝/肝硬化（②CHB/LC）组、③脂肪肝组和B超提示肝“正常”图像组（④肝“正常”组）。以常规方法进行 HBV标志物、抗-HCV、空腹血糖、身体质量指数（BM I）、血压检测等。结果：HCC组中：HBV阳性者空腹血糖受损阶段（IFG ）和糖尿病（DM ）发病率17．2％和17．0％；HBV阴性者抗-HCV均为阴性，其IFG和DM分别为15．4％和17．9％，两者间IFG和DM 发病率无显著性差异（P＞0．05）；HCC的DM发病率与 HBV相关性 r＝-0．007。各组中：IFG发生率在各组间均相似，（P＞0．05）；DM发病率在①～④组分别为17．3％、16．7％、26．2％和9．1％，①组与②组、③组和④组相比 P＞0．05、P＝0．008和P＝0．001。BM I均值：①组、②组和④组在23．0～23．7kg/m2之间，显著低于③组（30．3kg/m2）；血压均值：①和②组相似，显著低于③组和④组（P＜0．005）。在各组内未显示有明显的IFG高发年龄段（P＞0．05）；DM在各组高发年龄段：①组、③组和④组均为60～69岁（26．4％、35．1％和12．2％）；②组为50～59岁（22．5％）。结论：HCC患者发生DM与 HBV感染无关，与慢乙肝、肝硬化密切相关。乙肝伴脂肪肝者发生DM的风险较高，超重或肥胖为主要因素；HCC和CHB/LC患者的病情严重性可能加速了IFG阶段发展为DM 的过程。