| BackgroundNowadays, rapid increasing prevalence of type II diabetes mellitus (hereinafter referred to as diabetes) followed by growing numbers of the affected has lead to a prominent issue:diabetes has emerged as the main public health concern threatening the life and survival of human. Liver, the primary site of glucose metabolism, plays a crucial role in the storage, decomposition and regulation of blood glucose. Thus imbalance of glucose metabolism, worse still, impaired glucose tolerance (IGT) and diabetes might occur with liver damage. And evidence suggested that the prevalence of IGT and diabetes is 80% and 30% among patients with chronic liver disease separately, as opposed to a diabetes prevalence of only 0.6% in populations.Hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV) all can cause different degree of chronic liver damage among all types of hepatitis virus, with HBV being the most common type. In China, the prevalence of people infected by HBV is as high as 59.17%, and seroprevalence of HBsAg is 10%. The number dying of liver cirrhosis or liver cancer related to hepatitis B equals to 250 thousand per year. About 5%-10% of the HBV-infected among adolescents and adults will progress to chronic hepatitis, which is characterized by chronic active hepatitis B. Among subjects progressing to chronic hepatitis B,2.1% will develop into liver cirrhosis in a year.How hepatitis virus infection might be related to diabetes remains an area of active investigation. Several etiologic connections were already suspected, which involves insulin resistance, metabolic disorder of insulin, "escape" theory of portosystemic shunts, defect in enzymes of liver, detrimental effect of hepatitis virus, et al. Virus theory claims that liver and pancreas tissues are similar and have the common embryonic origin. Therefore, besides liver, pancreas is also subjected to the adverse effect of hepatitis virus including deposition of immune complex and functional disturbance of beta cells, in which scenario blood glucose level is raised.Ample evidence, at home and abroad, has documented the positive association between hepatitis C virus (HCV) infection and diabetes risk. Whether this association holds true for chronic hepatitis B virus (HBV) infection is less well established and thus deserves further studies. In this study, a nested case-control design was conducted to understand the impact of HBV infection on diabetes development and we detected (HBsAg) as the serologic marker of HBV infection. And it counts much more in terms of providing evidence for formulating prevention and control strategy, identifying high-risk populations, conducting tertiary prevention, reducing the threat of diabetes and hepatitis B, promoting human health and reducing economic loss.Objectives1. Investigate the association between HBV infection and development of diabetes, using HBsAg as the serologic marker of HBV infection.2. Evaluate the interaction between HBsAg and HbcAb in the development of diabetes.Methods A nested case-control study was conducted. We enrolled 5107 subject undergoing regular health examination from staff of 51 companies at the People's hospital in Zhangqiu, and followed them for 4 years (2006-2009). A total of 221 subjects with diabetes were identified. Each case patient was individually matched to two control subjects on date of examination, same working place, gender and age (≤5 years). If a suitable control was not found in the same company, the case was matched on the similar date of examination and company. Univariate and multivariate logistic regression models were used to assess the relationship of HBsAg to diabetes risk. Additive model was adopted to evaluate the interaction between HBsAg and HBcAb on diabetes risk.Results1. The association between HBV infection and diabetes risk:The "healthy" subjects undergoing physical examination were targeted with HBsAg being the important serologic marker of HBV infection. Results of univariate logistic regression model suggested that the risk for developing diabetes among subjects with a positive presence of HBsAg is 3.526 times higher (95%CI=1.320-9.608) than that of subjects with a negative presence. And the relationship was still significant after multi-variable adjustment (OR=5.153,95%CI=1.796-14.782).2. Interaction between HBsAg and HBcAb on the development of diabetes:Both before or after adjustment of potential confounders, the effect of HBsAg and HBcAb is greater than that of either of HBsAg or HBcAb, which suggested that a positive additive effect might be existed. Before the multiple variables adjustment, synergy index (S)=1.636 (95%CI:0.362-7.389), relative excess risk due to interaction (RERI)=3.461 (95%CI:-8.880-15.801), and attributable proportion due to interaction (AP)=34.958 (95%CI:-51.822-121.739). After the multiple variables adjustment, S=1.701 (95%CI:0.317-9.135), RERI=4.848 (95%CI:-12.387-22.083), and AP=37.973(95%CI:-56.226-132.173).Conclusions1. HBV infection might be an important risk factor for developing diabetes.2. Positive additive interaction exists considering the combined effect of HBsAg and HBcAb on diabetes risk. |
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