期刊
JOURNAL OF GASTROENTEROLOGY
卷 54, 期 1, 页码 64-77出版社
SPRINGER JAPAN KK
DOI: 10.1007/s00535-018-1494-7
关键词
Type 2 diabetes mellitus; Hepatocellular carcinoma; Mortality risk; Platelet count
资金
- Ministry of Health, Labor, and Welfare, Japan [H20-Hepatitis-general-008]
- Research Program on Hepatitis from Japan Agency for Medical Research and Development, AMED
BackgroundWe reported a cross-sectional study on causes of liver injury in Japanese type 2 diabetes mellitus (T2D) patients (JG 2013). We assessed overall and cause-specific mortality risk during follow-up of patients enrolled in JG 2013.MethodsThis was a longitudinal, multicenter cohort study. Of the 5642 Japanese T2D patients who visited T2D clinics of nine hospitals in the original study, 3,999 patients were followed up for an average of 4.5years. Expected deaths in T2D patients were estimated using age-specific mortality rates in the general population (GP) of Japan. Standardized mortality ratios (SMRs) were calculated to compare mortality between T2D patients and GP.ResultsAll-cancer mortality was significantly higher in T2D patients than in the GP [SMR 1.58, 95% confidence interval (CI) 1.33-1.87]. Among malignancies, hepatocellular carcinoma (HCC) conferred the highest mortality risk in T2D patients (SMR 3.57, 95% CI 2.41-5.10). HCC-associated mortality risk in T2D patients remained significantly high (SMR 2.56, 95% CI 1.64-3.97) after adjusting for high positivity rates of hepatitis B surface antigen (1.7%) and anti-hepatitis C virus (5.3%). In T2D patients with platelet counts<200x10(3)/l, SMR of HCC increased from 3.57 to 6.58 (95% CI 4.34-9.58). T2D patients with platelet count>200x10(3)/l showed no increase in mortality risk (SMR 0.68) of HCC.ConclusionsHCC-associated mortality risk was the highest among all cancers in Japanese T2D patients. Regular follow-up may be important for T2D patients with platelet counts<200x10(3)/l for early detection of HCC.
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