| Due to the high disease incidence and death rate of hepatocellular carcinoma,it's a constant hot issue to approach the etiological factors and pathogenesy in the international circumscription.It's to be considered the Hepatitis B and C virus infection and heavy alcohol consumption were the main etiological factors,but drinking water dirty, aflatoxins B1 and hereditary factor were also to be presumed in related with carcinogenesis of hepatocellular carcinoma.In additon,recently researchers pay close attation to the high probability of diabetic occurence hepatocellular carcinoma, and it's possible that diabetes mellitus invaribly impact the carcinogenesis and develepoment of hepatocellular carcinoma.The relationship between diabetes mellitus and hepatocellular carcinoma was investigated in a case-control study conducted on 681 cases with hepatocellular carcinoma and 1968 controls with no history of cancer,from the same catchment areas as the cases,admitted to the same hospitals for non-nelplastic conditions.Thus,their distribution according to sex ,age and cigarette smoking was singularly matched with case.To compare the information of patients on the risk of history of diabetes mellitus, synergism of diabetes,viral hepatitis and heavey alcohol consumption in the development of hepatocellular carcinoma. We used uncondtional logistical regression methods to analyze the entire study data comprising 681 patients with hepatocellular carcinoma and 1968 control subjects.The strengh of the exposure-hepatocellular carcinoma association was measured by odds ratios(ORs) ,their 95% confidence intervals (95%CI) and P values.The measured factors-age,gender,and cigarette smoking were included covariates in all models.We examined the potential interaction effects between two independent factors on hepatocellular carcinoma risk.When assessed the combined effect of two factors on hepatocellular carcinoma was greater than the sum of the individual effects.A history of diabetes was more prevalent in patients with hepatocellular carcinoma than control subjects.127 cases of hepatocellular carcinoma vs 68 controls reported a history of diabetes,corresponding to an odds ratios (ORs)of 6.4 after allowance for age,sex,and cigarette smoking,and of 2.7 after further allowance for heavey alcohol intake,history of hepatitis and liver cancer in first-degree relatives.The OR was 3.9 for subjects whose diabetes was diagnosed <10 years before diagnosis of liver cancer,and 9.6 for those diagnosed since 10 years or more.The OR were 9.6 and 13.3 when assessing the concurrence diabetes mellitus with hepatocellular carcinoma except HBV/HCVinfection and heavy alcohol consumption.Results were similar and remained statistically significant when subjects both negetive for HBV and HCV serology and heavy alcohol consumption were included in the analysis.Results presents the pairwise interactions of diabetes,heavy alcohol intake, and HBV/HCV infection on risk of hepatocellular carcinoma.Heavy drinkers with a history of diabetes were at very high risk for hepatocellular carcinoma (OR=9.6) relative to nondiabetics who consumed ethanol<80 gram per day.The risk for hepatocellular carcinoma on HBV/HCV infection with a history of diabetes were high(OR=13.3).The combined effect was more than the sum of the two individual effects.and the risk for hepatocellular carcinoma on HBV/HCV infection ,heavey alcohol consumption with a history diabetes was more high (OR=32.5).Thus,there was a synergistic interacting on hepatocellular carcinoma risk was observed between heavy alcohol consumption and diabetes, between diabetes and viral hepatitis,also between diabetes and viral hepatitis,heavy alcohol consumption. Similar epidemiological data show an increased risk of hepatocellular carcinoma among patients with diabetes is frequently in lots of studies .The current study confirmed history of diabetes was an independent risk factor for hepatocellular carcinoma,There were synergistic effects on hepatocellularcarcinoma between HBV/HCV infection and diabetes, also heavy alcohol consumption and diabetes.The biologic mechanism of diabetes causing hepatocellular carcinoma is unknown.Diabetes can lead to insulin resistance and steatosis, which is associated with the release of inflammatory mediators such as tumor necrosis factor-αin Kuppfer cells ,which in turn enhances the production of cytokines leading to steatohepatitis.Recent study showed that diabetes can cause hepatic inflammation,leading to oxidative stress and lipid peroxidation of the phospholipid constituents of hepatocyte and intracellular membranes, resulting in hepatocyte injury and necrosis.The injury to hepatocytes leads to the activation of hepatic stellate cells, exessive secretion of extracellular matix components, the formation of hepatic fibrosis,and ultimately the development of cirrhosis and carciongenesis . The current study, like any other case-control study, potentially could be limited by information bias.One of the potential limitations is in the diagnosis of dibetes among hepatocellular carcinoma cases.Patients with viral hepatitis might be closely examined by their physicians and thus more likely to have their diabetes detected than those without viral hepatitis.This would result in a spurious association between diabetes and hepatocellular carcinoma risk.However, we noted a positive,and...
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