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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Increased risk of cirrhosis and its decompensation in chronic hepatitis C patients with new-onset diabetes: A nationwide cohort study
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Increased risk of cirrhosis and its decompensation in chronic hepatitis C patients with new-onset diabetes: A nationwide cohort study

机译：一项全国性队列研究：慢性丙型肝炎合并新发糖尿病的患者发生肝硬化的风险增加和代偿失调

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The effect of diabetes on cirrhosis, its decompensation, and their time relationship in chronic hepatitis C (CHC) patients remains unclear. We conducted a nation-wide cohort study by using the Taiwanese National Health Insurance Research Database, which is comprised of data from >99% of the entire population. Among having randomly sampled 1 million enrollees, 6,251 adult CHC patients were identified from 1997 to 2009. Diabetes was defined as new onset in CHC patients who were given the diagnosis in the years 1999-2003, but not in 1997-1998. The cohorts of CHC with new-onset diabetes (n=424) and nondiabetes (n=1,708) were followed up from inception point in diabetes and from year 1999 in the nondiabetes cohort until development of cirrhosis or its decompensation, withdrawal from insurance, or December 2009. Kaplan-Meier's survival analysis showed a significantly higher cumulative incidence of cirrhosis (relative risk [RR]=1.53; 95% confidence interval [CI]=1.11-2.11; log-rank test; P<0.001) and decompensated cirrhosis (RR=2.01; 95% CI=1.07-3.79; log-rank test; P<0.001) among patients with new-onset diabetes, as compared to those without. After adjustment for age, gender, CHC treatment, diabetes treatment, hepatocellular carcinoma, comorbidity index, hypertension, hyperlipidemia, and obesity by Cox's proportional hazard model, diabetes was still an independent predictor for cirrhosis (hazard ratio [HR]=2.505; 95% CI=1.609-3.897; P<0.001) and its decompensation (HR=3.560; 95% CI=1.526-8.307; P=0.003). Conclusion: CHC patients who develop diabetes are at an increased risk of liver cirrhosis and its decompensation over time.
机译：在慢性丙型肝炎（CHC）患者中，糖尿病对肝硬化，失代偿及其时间关系的影响尚不清楚。我们使用台湾国民健康保险研究数据库在全国范围内进行了队列研究，该数据库包含了超过99％的总人口数据。在随机抽样的100万名参与者中，从1997年至2009年识别出6,251名成人CHC患者。糖尿病被定义为在1999-2003年进行诊断但在1997-1998年未被诊断的CHC患者中的新发病例。从糖尿病的始发点和非糖尿病队列的1999年开始，对伴有新发糖尿病（n = 424）和非糖尿病（n = 1,708）的CHC队列进行随访，直到发生肝硬化或其代偿失调，退出保险或2009年12月。Kaplan-Meier的生存分析显示，肝硬化的累积发生率显着更高（相对风险[RR] = 1.53; 95％置信区间[CI] = 1.11-2.11;对数秩检验; P <0.001）和失代偿性肝硬化（与没有糖尿病的新发糖尿病患者相比，RR = 2.01; 95％CI = 1.07-3.79;对数秩检验; P <0.001）。在通过Cox比例风险模型对年龄，性别，CHC治疗，糖尿病治疗，肝细胞癌，合并症指数，高血压，高脂血症和肥胖症进行调整后，糖尿病仍然是肝硬化的独立预测因子（风险比[HR] = 2.505; 95％ CI = 1.609-3.897; P <0.001）及其失代偿（HR = 3.560; 95％CI = 1.526-8.307; P = 0.003）。结论：患有糖尿病的CHC患者随着时间的推移，肝硬化及其失代偿的风险增加。

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