Type 2 Diabetes Is Associated With Increased Risk For Cirrhosis In Chronic Hepatitis B Patients Without Antiviral Therapy

Objective: To analyze retrospectively a large sample of patients with chronic hepatitis B virus infection to investigate whether type 2 diabetes promote cirrhosis in patients with chronic hepatitis B without antiviral therapy.Led to early attention and intervention measures,improve survival and quality of life.Methods: A total of 521 hospitalized patients with chronic hepatitis B virus infection were enrolled from January 1,2016 to December 31,2017 in the Department of Infectious Diseases,Affiliated Hospital of Southwest Medical University.All patients did not receive antiviral treatment.The diagnostic criteria for chronic hepatitis B refer to the “Guide to the Prevention and Treatment of Chronic Hepatitis B”(2015 edition).HBsAg and(or)HBV-DNA were positive for more than 6 months;at least one of the patients with clinical diagnosis of hepatitis B cirrhosis was based on imaging studies;The diagnostic criteria for liver failure refer to "Guidelines for the Prevention and Treatment of Liver Failure"(2012 edition);the diagnostic criteria for type 2 diabetes refer to the "Guideline for the Prevention and Treatment of Type 2 Diabetes in China"(2013 edition);the diagnostic criteria for hypertension refer to the "Guide to the Prevention and Treatment of Hypertension in China"(2010 edition).Of the 521 patients enrolled,229 were HBeAg-positive and 292 were HBeAg-negative.The age,sex,PTA,PLT,ALT,AST,TBIL,GGT,HBV-DNA quantification,and gamma-glutamyl transpeptidase-to-platelet ratio(GPR)at admission were collected for all patients.Aspartate aminotransferase-to-platelet ratio index(APRI),FIB-4 index(Fibrosis index based on the four factors,FIB-4)and other indicators,whether the merger of type 2 diabetes,hypertension,liver failure.All patients were divided into 336 cases of chronic hepatitis B group and 185 cases of hepatitis B cirrhosis group according to whether they had developed cirrhosis,and the K-S test was used to analyze the frequency distribution of the samples.The t-test was used to compare the normal distribution variables and the t-test was used to compare the non-normal distribution variable groups using the rank sum test.The categorical variables were chi-square test.The use of binary logistic regression analysis to investigate whether type 2 diabetes is a risk factor for liver cirrhosis in patients with chronic hepatitis B.According to the status of E antigen,they were divided into two groups: HBeAg positive and HBeAg negative.The effects of type 2 diabetes on cirrhosis of hepatitis B were observed under different E antigen status.According to the duration of type 2 diabetes,the duration of diabetes is less than 1 year,the duration is 1-4 years,and the duration is greater than 4 years.Using Chi-Square Test and Logistic Regression to Study the Relationship between Hepatitis Cirrhosis and Diabetes Mellitus.Results: 1.A total of 521 patients with chronic hepatitis B virus were collected,including 185 patients with hepatitis B liver cirrhosis and 336 patients with chronic hepatitis B virus.Through comparison between groups,it was found that PTA,PLT,ALT,GGT,AST were higher in patients with chronic hepatitis B than those in patients with hepatitis B cirrhosis,and the difference was statistically significant(P<0.05).Age,GPR,FIB-4 index,hepatitis B cirrhosis group was higher than chronic hepatitis B group,the difference was statistically significant,P <0.05;The proportion of HBeAg-negative patients,type 2 diabetes mellitus,hypertension,and hepatic failure in patients with hepatitis B cirrhosis was higher,and the difference was statistically significant(P<0.05).Among them,gender composition ratio,TBIL,HBV-DNA quantification and APRI had no difference between chronic hepatitis B group and hepatitis B cirrhosis group,P>0.05.2.The univariate Logistic regression analysis found that the age-causing OR of hepatitis B cirrhosis in chronic hepatitis B was 1.084,95% CI was(1.066-1.103),the GPR's OR was 1.308,and 95% CI was(1.182-1.447),the OR of the FIB-4 index was 1.110,95% CI was(1.081-1.141),the OR of the type 2 diabetes was 6.406,the 95% CI was(2.826-14.520),and the OR of the hypertension was 2.699,95% CI(1.380-5.281),P <0.05;However,there was no correlation between PTA,PLT,ALT,AST,GGT,APRI,E antigen status,liver failure and the occurrence of hepatitis B cirrhosis,P>0.05.The multivariate logistic regression analysis revealed that age,GPR,FIB-4 index and type 2 diabetes mellitus were independent risk factors for hepatitis B cirrhosis in chronic hepatitis B patients.The OR of age was 1.067,95% CI was(1.047-1.088),the GPR's OR was 1.125,95% CI was(1.004-1.260),the FIB-4 index's OR was 1.054,and 95% CI was(1.023-1.086),OR of type 2 diabetes was 4.15,95% CI was(1.646-9.794),P<0.05.From the above results,it was found that type 2 diabetes has the greatest relationship with hepatitis B cirrhosis,while age,GPR,and FIB-4 index can promote the occurrence of hepatitis B cirrhosis,but the correlation is small.By investigating the effect of type 2 diabetes on hepatitis B cirrhosis in different states of E antigen,it was found that in HBeAg-positive patients,type 2 diabetes had no effect on the occurrence of hepatitis B liver cirrhosis by two-class Logistic regression analysis;n HBeAg-negative patients,logistic regression analysis revealed that age,FIB-4 index,and type 2 diabetes were risk factors for hepatitis B cirrhosis.mong them,the OR value of age was 1.044,95% CI was(1.019-1.069),the FIB-4 index was OR 1.072,95% CI was(1.029-1.116),and the OR of type 2 diabetes was 3.887.95% CI was(1.515-9.973),the difference was statistically significant,P <0.05,with type 2 diabetes and hepatitis B cirrhosis the greatest correlation.According to the different course of type 2 diabetes,For patients whose disease duration was less than 1 year,there was no significant difference between the groups,P>0.05;Patients with a disease course of 1-4 years had an OR of 7.175 for hepatitis B cirrhosis and 95% CI for(1.474-34.933).Patients with a disease course of more than 4 years had an OR of 11.275 for hepatitis B cirrhosis and 95% CI(2.470-51.473),P<0.05.Conclusion: 1.Type 2 diabetes results in an increased risk of cirrhosis in chronic hepatitis B patients who have not received antiviral therapy;2.The longer the duration of diabetes,the higher the risk of liver cirrhosis;3.Age,GPR,FIB-4 index can also promote the occurrence of hepatitis B cirrhosis,but the correlation is small.