B型肝炎帶原者非酒精性脂肪肝病與第二型糖尿病危險性之縱貫性研究

Abstract

背景及研究目的 一般族群中，脂肪肝與第二型糖尿病相關，但此關係在HBV患者是否成立仍不清楚。本研究使用縱貫性研究來探討HBV男性病患中，脂肪肝與新診斷第二型糖尿病的相關性，並進一步討論瘦型人與胖型人對此關係的影響。 材料與方法 本研究使用台灣公務人員保險聯合門診研究資料，從2005年追蹤至2018年，研究對象為1208位HBsAg陽性且在第一次來檢時無第二型糖尿病的男性(包含66位HBV/HCV共同感染的患者)，並於追蹤期間重複回診做全面檢查(包含肝臟超音波、血液檢查及人體學檢查)。脂肪肝使用腹部超音波診斷，而糖尿病定義為空腹血糖值≥126 mg/dL或有第二型糖尿病史。共有332位研究對象在十年中有四次或四次以上的健檢回診資料。使用多變項羅吉斯迴歸來研究脂肪肝情形和發生糖尿病的相對危險比(OR)，以及縱貫性研究使用重複事件Cox比例風險模型。 結果 第一次來檢時，脂肪肝的盛行率為39.2%。平均追蹤8.7±3.1年後，121位研究對象(10.0%)新診斷出第二型糖尿病。多變項迴歸分析顯示脂肪肝相較於無脂肪肝者，其危險性為1.97倍(95%CI=1.25-3.11)，此關係獨立於空腹血糖異常(IFG)、BMI及血脂。對於332位在十年中有四次或四次以上的健檢回診資料的研究對象，脂肪肝造成新診斷第二型糖尿病的風險比為2.80(95%CI=1.23-6.40)。相對於胖型人，此關係在瘦型人中更加明顯。在瘦型人當中，脂肪肝相對於無脂肪肝造成新診斷第二型糖尿病的危險性達9倍之多。不考慮BMI的話，IFG是脂肪肝造成新診斷第二型糖尿病的最重要的危險因子。 iv 結論 在男性HBV帶原者中，脂肪肝會增加罹患第二型糖尿病的危險性且獨立於代謝危險因子，而且相對於胖型人，瘦型人的脂肪肝效應更加顯著。

Background and Aim Fatty liver has been associated with type 2 diabetes (T2DM) in general population, but its role among people infected with hepatitis B virus (HBV) is unclear. We used a longitudinal study to investigate the association between fatty liver and the development of T2DM in men with HBV, and to understand the impact of lean or obese body mass on this relationship. Material and Methods Clinical and laboratory data from Taiwan’s Government Employees’ Central Clinic were assessed in 1,208 (including 66 with HBV/HCV dual infection) HBsAg positive men who were free of T2DM at initial examination and were examined repeatedly with a comprehensive investigation (including liver ultrasonography, blood testing, and anthropometric measurements) between 2005 and 2018. Fatty liver was diagnosed by abdominal ultrasound, and diabetes was defined as fasting blood glucose≥126 mg/dL or having a history of T2DM. A total of 332 participants had four or more check-up records in ten years. We used multivariate logistic regression to investigate fatty liver status and OR of development T2DM, and repeated events Cox’s proportional hazards model in longitudinal study. vi Results At initial examination, the prevalence of fatty liver was 39.2%. After an average of 8.7±3.1 years of follow-up, 121 study subjects (10.0%) developed T2DM. Multivariate analysis showed that the risk of T2DM was 1.97 (95% CI=1.25-3.11) times higher among subjects with fatty liver than those without. This association was independent of impaired fasting glucose, body mass index (BMI), and blood lipids. For the 332 subjects who had ≥ 4 clinical visits in 10 years, the hazard ratio of T2DM associated with fatty liver was 2.80 (95% CI=1.23-6.40). This association was more striking among subjects with lean body mass than those with obese body mass. Among those with lean body mass, fatty liver was associated with a 9-fold higher risk of developing T2DM. Impaired fasting glucose was the most important risk factor for T2DM among patients with fatty liver, irrespective of body mass. Conclusions In male HBV carriers, fatty liver increased risk of T2DM independent of other metabolic risk factors, and the effect of fatty liver was more striking among subjects with lean body mass than those with obese body mass.