당뇨병이 간세포암 발생에 미치는 영향에 대한 연구

Abstract

As of 2016, the prevalence of domestic diabetes mellitus is increasing with one out of seven adults for 30 years of age and three out of ten for over 65 years of age. Hepatocellular carcinoma is also an increasingly global health problem, and mortality and prognosis do not make good readings. The risk factors for hepatocellular carcinoma are known to be hepatitis B or C virus, cirrhosis, excessive alcohol consumption, autoimmune hepatitis, and nonalcoholic fatty liver disease. However, several studies have shown that diabetes increases the risk of developing hepatocellular carcinoma. Therefore, we conducted this research to investigate the risk of diabetes mellitus to hepatocellular carcinoma. Subject and Methods The study was conducted using the 2002-2013 National Health Insurance Corporation sample cohort database. A total of 637,088 subjects under age 40, and 342 subjects who had a history of cancer in 2002 based on 1,025,340 subjects eligible for the sample cohort DB qualification in 2002 were eliminated with a total of 387,910 people selected as subjects. Landmark time was set to 2 years (2002-2003) and 4 years (2002-2005) for landmark analysis based on 2002 when the sample cohort was started. The subjects who died within the period and those who have history requested for hepatocellular carcinoma were sequentially excluded and 382,226 and 372,606 people were selected for the landmark time 2 and 4 years, respectively and the group that divided according to the status of diabetes was analyzed. The hazard ratios were calculated using the Cox Proportional Hazard Model and differences between groups according to the occurrence of hepatocellular carcinoma were examined. We also analyzed the relationship between diabetes and hepatocellular carcinoma according to the presence or absence of chronic liver disease such as alcoholic liver disease, nonalcoholic fatty liver disease, chronic viral hepatitis, and liver cirrhosis. Results As a result of the analysis, the occurrence of hepatocellular carcinoma was higher in the diabetic group than in the non-diabetic group, and it was confirmed that the difference between the two groups was statistically significant(p<.0001). When controlling other variables (sex, age, alcoholic liver disease, nonalcoholic fatty liver, chronic viral hepatitis, liver cirrhosis), the risk of developing hepatocellular carcinoma in the diabetic group was 1.464 times (95% CI: 1.330-1.610) higher in the case of landmark time 2 years and 1.370 times (95% CI: 1.246-1.506) higher in the case of 4 years. This was also found to be statistically significant(p<.0001). Conclusion Chronic viral hepatitis, cirrhosis, alcoholic liver disease, and nonalcoholic fatty liver disease are widely known as risk factors for hepatocellular carcinoma, but this study implies that diabetes is also one of the risk factors for the development of hepatocellular carcinoma. In the case of people with diabetes, especially those with chronic liver disease, more specific measures should be taken to prevent and manage diabetes to strive further for health care.