不同病因慢性肝病合并2型糖尿病的流行病学特征

蔡明明; 李强

doi:10.12449/JCH260532

不同病因慢性肝病合并2型糖尿病的流行病学特征

DOI: 10.12449/JCH260532

蔡明明,
李强^, ,

山东大学附属公共卫生临床中心肝病诊疗中心，济南 250101

基金项目:

山东省重点研发计划 (2021SFGC0504)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：蔡明明负责查阅文献及论文撰写；李强负责确定选题及论文审阅。

详细信息

通信作者:
李强， doctorliqiang@aliyun.com （ORCID： 0000-0002-8667-4676）

计量
- 文章访问数: 6
- HTML全文浏览量: 2
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-05-02
- 录用日期: 2025-11-26
- 出版日期: 2026-05-20

Epidemiological features of chronic liver disease with different etiologies comorbid with type 2 diabetes mellitus

Mingming CAI,
Qiang LI^{,
,}

Division of Liver Disease Center，Public Health Clinical Center Affiliated to Shandong University，Jinan 250101，China

Research funding:

Key R&D Plan of Shandong Province (2021SFGC0504)

More Information

Corresponding author: LI Qiang， doctorliqiang@aliyun.com （ORCID： 0000-0002-8667-4676）

摘要

摘要: 慢性肝病和2型糖尿病（T2DM）均为全球重大公共卫生问题。在不同病因慢性肝病患者中，T2DM的患病率存在差异。慢性丙型肝炎病毒感染、脂肪代谢功能障碍和酒精滥用在引起慢性肝病的同时也导致T2DM的患病率增加；慢性乙型肝炎病毒感染是否可引起T2DM风险增加尚不明确，而慢性乙型肝炎患者随着疾病进展，其T2DM患病率显著升高；自身免疫性肝病与T2DM的关系仍缺乏大样本证据。此外，T2DM会增加肝硬化和肝细胞癌等终末期肝病的发生风险。T2DM的早期诊断和个体化管理对改善慢性肝病患者的预后具有重要意义。
- 肝疾病 /
- 糖尿病， 2型 /
- 患病率
Abstract: Both chronic liver disease （CLD） and type 2 diabetes mellitus （T2DM） are major public health issues worldwide， and there is a significant difference in the prevalence rate of T2DM across patients with CLD of different etiologies. Chronic hepatitis C virus infection， dysregulation of fat metabolism， and excessive drinking not only lead to CLD， but also increase the prevalence rate of T2DM. It remains unclear whether chronic hepatitis B virus infection can cause an increase in the risk of T2DM， although the prevalence rate of T2DM significantly increases with disease progression in patients with chronic hepatitis B， and there is still a lack of large-sample evidence for the association between autoimmune liver disease and T2DM. In addition， T2DM may increase the risk of end-stage liver diseases such as cirrhosis and hepatocellular carcinoma. Therefore， early diagnosis and individualized management of T2DM are of great importance for improving the prognosis of patients with CLD.
- Liver Diseases /
- Diabetes Mellitus， Type 2 /
- Prevalence

HTML全文

表 1 CLD的流行病学特征、合并T2DM的患病率及相互关系

Table 1. Epidemiological characteristics of CLD， prevalence of comorbid T2DM， and their interrelationship

肝病类型	肝病流行情况	T2DM患病率	相互关系
CHB	美洲：0.81%；东南亚：1.90%；欧洲：2.06%；西太平洋地区：5.26%；非洲：8.83%^［40］	3.97%～22.10%	HBV感染与T2DM的关系存在争议，但是随着CHB疾病进展，患者T2DM的患病率明显高于普通人群
CHC	北美：0.60%～1.00%；巴西：0.90%；澳大利亚及新西兰：1.00%；日本：1.10%；欧洲：0.12%～ 2.50%；西亚：0.20%～0.30%；墨西哥：0.40%；非洲：0.20%～6.30%；东南亚：0.50%～3.80%^［41］	1.4%～46.7%	HCV感染者T2DM的患病率明显高于普通人群，随着肝脏疾病进展，T2DM的发病风险进一步升高，伴T2DM患者的HCC发生率及病死率明显升高
MAFLD	日本：22.3%；南亚：24.74%～33.86%；中国： 32.50%；欧洲：32.60%；南美：35.70%；澳大利亚：35.70%～38.00%；北美：47.80%；东南亚： 38.50%～51.40%^［42］	9%～55%	T2DM和MAFLD患者具有相同的病因；血糖代谢状态与MAFLD的发生呈“倒L型” 关联
ALD	欧洲：3.0%；西太平洋地区：3.6%；美洲：7.0%^［43］	14.7%～30%	嗜酒可以引起T2DM和ALD，T2DM和酒精协同加速ALD的疾病进展
自身免疫性肝病	德国AIH：23.0/10万；德国PBC：36.9/10万^［44］	AIH：7%～37.9%	自身免疫性肝病患者中T2DM的流行情况尚缺少大样本研究，糖皮质激素治疗 AIH可显著增加糖尿病发病风险
		PBC：9%～30.7%
		PSC：2.9%～11.1%
注：CLD，慢性肝病；T2DM，2型糖尿病；CHB，慢性乙型肝炎；CHC，慢性丙型肝炎；MAFLD，代谢相关脂肪性肝病；ALD，酒精性肝病；AIH，自身免疫性肝炎；PBC，原发性胆汁性胆管炎；PSC，原发性硬化性胆管炎；HBV，乙型肝炎病毒；HCV，丙型肝炎病毒；HCC，肝细胞癌。

下载: 导出CSV

参考文献(44)

[1]	DEVARBHAVI H, ASRANI SK, ARAB JP, et al. Global burden of liver disease: 2023 update[J]. J Hepatol, 2023, 79( 2): 516- 537. DOI: 10.1016/j.jhep.2023.03.017.
[2]	HICKMAN IJ, MACDONALD GA. Impact of diabetes on the severity of liver disease[J]. Am J Med, 2007, 120( 10): 829- 834. DOI: 10.1016/j.amjmed.2007.03.025.
[3]	YU YF, TONG KK, HU G, et al. Love-hate relationship between hepatitis B virus and type 2 diabetes: A Mendelian randomization study[J]. Front Microbiol, 2024, 15: 1378311. DOI: 10.3389/fmicb.2024.1378311.
[4]	LIU DF, ZHOU LY, ZHANG XY, et al. Significantly decreased islet β cell function is closely associated with hyperglycemia in chronic hepatitis B patients[J]. Int J Endocrinol, 2021, 2021: 1264707. DOI: 10.1155/2021/1264707.
[5]	SHIN HJ, PARK YH, KIM SU, et al. Hepatitis B virus X protein regulates hepatic glucose homeostasis via activation of inducible nitric oxide synthase[J]. J Biol Chem, 2011, 286( 34): 29872- 29881. DOI: 10.1074/jbc.M111.259978.
[6]	JIANG C, ZHANG ZH, LI JX. Current status of drug therapy for chronic hepatitis B[J]. World J Gastroenterol, 2025, 31( 2): 99443. DOI: 10.3748/wjg.v31.i2.99443.
[7]	LEI SY, CHEN SH, ZHAO XY, et al. Hepatitis B virus infection and diabetes mellitus: The Kailuan prospective cohort study in China[J]. Hepatol Int, 2020, 14( 5): 743- 753. DOI: 10.1007/s12072-020-10086-2.
[8]	BAKER F ABU, ZEINA AR, NATOUR RT, et al. Prevalence and risk factors of type 2 diabetes mellitus among hepatitis B virus patients: A large retrospective cohort study[J]. Int J Med Sci, 2025, 22( 3): 716- 722. DOI: 10.7150/ijms.104839.
[9]	SPRADLING PR, SIMONS B, NARAYANAN M, et al. Incidence of diabetes mellitus in a population-based cohort of persons with chronic hepatitis B virus infection[J]. J Viral Hepat, 2013, 20( 7): 510- 513. DOI: 10.1111/jvh.12071.
[10]	WANG YY, LIN SY, SHEU WH, et al. Obesity and diabetic hyperglycemia were associated with serum alanine aminotransferase activity in patients with hepatitis B infection[J]. Metabolism, 2010, 59( 4): 486- 491. DOI: 10.1016/j.metabol.2009.07.038.
[11]	XIE JZ, WANG X, WANG XR, et al. Assessing the impact of comorbid type 2 diabetes mellitus on the disease burden of chronic hepatitis B virus infection and its complications in China from 2006 to 2030: A modeling study[J]. Glob Health Res Policy, 2024, 9( 1): 5. DOI: 10.1186/s41256-024-00345-2.
[12]	AYTUG S, REICH D, SAPIRO LE, et al. Impaired IRS-1/PI₃ ^-kinase signaling in patients with HCV: A mechanism for increased prevalence of type 2 diabetes[J]. Hepatology, 2003, 38( 6): 1384- 1392. DOI: 10.1016/j.hep.2003.09.012.
[13]	CUA IHY, HUI JM, BANDARA P, et al. Insulin resistance and liver injury in hepatitis C is not associated with virus-specific changes in adipocytokines[J]. Hepatology, 2007, 46( 1): 66- 73. DOI: 10.1002/hep.21703.
[14]	WHO. Hepatitis C[EB/OL].( 2024-04-09)[ 2025-03-12]. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
[15]	HUANG JF, DAI CY, HWANG SJ, et al. Hepatitis C viremia increases the association with type 2 diabetes mellitus in a hepatitis B and C endemic area: An epidemiological link with virological implication[J]. Am J Gastroenterol, 2007, 102( 6): 1237- 1243. DOI: 10.1111/j.1572-0241.2007.01181.x.
[16]	JEONG D, KARIM ME, WONG S, et al. Impact of HCV infection and ethnicity on incident type 2 diabetes: Findings from a large population-based cohort in British Columbia[J]. BMJ Open Diabetes Res Care, 2021, 9( 1): e002145. DOI: 10.1136/bmjdrc-2021-002145.
[17]	IMAZEKI F, YOKOSUKA O, FUKAI K, et al. Prevalence of diabetes mellitus and insulin resistance in patients with chronic hepatitis C: Comparison with hepatitis B virus-infected and hepatitis C virus-cleared patients[J]. Liver Int, 2008, 28( 3): 355- 362. DOI: 10.1111/j.1478-3231.2007.01630.x.
[18]	WHITE DL, RATZIU V, EL-SERAG HB. Hepatitis C infection and risk of diabetes: A systematic review and meta-analysis[J]. J Hepatol, 2008, 49( 5): 831- 844. DOI: 10.1016/j.jhep.2008.08.006.
[19]	LI X, XU HQ, GAO Y, et al. Diabetes mellitus increases the risk of hepatocellular carcinoma in treatment-naïve chronic hepatitis C patients in China[J]. Medicine, 2017, 96( 13): e6508. DOI: 10.1097/MD.0000000000006508.
[20]	JANUARIO E, BARAKAT A, RAJSUNDAR A, et al. A comprehensive review of pathophysiological link between non-alcoholic fatty liver disease, insulin resistance, and metabolic syndrome[J]. Cureus, 2024, 16( 12): e75677. DOI: 10.7759/cureus.75677.
[21]	KOZLITINA J, SOOKOIAN S. Global epidemiological impact of PNPLA3 I148M on liver disease[J]. Liver Int, 2025, 45( 3): e16123. DOI: 10.1111/liv.16123.
[22]	CAO LM, AN Y, LIU HY, et al. Global epidemiology of type 2 diabetes in patients with NAFLD or MAFLD: A systematic review and meta-analysis[J]. BMC Med, 2024, 22( 1): 101. DOI: 10.1186/s12916-024-03315-0.
[23]	AMPUERO J, ALLER R, GALLEGO-DURÁN R, et al. Significant fibrosis predicts new-onset diabetes mellitus and arterial hypertension in patients with NASH[J]. J Hepatol, 2020, 73( 1): 17- 25. DOI: 10.1016/j.jhep.2020.02.028.
[24]	FUKUDA T, HAMAGUCHI M, KOJIMA T, et al. Transient remission of nonalcoholic fatty liver disease decreases the risk of incident type 2 diabetes mellitus in Japanese men[J]. Eur J Gastroenterol Hepatol, 2016, 28( 12): 1443- 1449. DOI: 10.1097/MEG.0000000000000736.
[25]	ZHOU M, BO T, FAN XD, et al. Metabolic dysfunction-associated fatty liver disease: A central hub in systemic metabolic dysregulation[J]. J Clin Hepatol, 2025, 41( 9): 1725- 1728. DOI: 10.12449/JCH250902. 周蒙, 薄涛, 范修德, 等. 代谢相关脂肪性肝病: 全身代谢性紊乱的核心枢纽之一[J]. 临床肝胆病杂志, 2025, 41( 9): 1725- 1728. DOI: 10.12449/JCH250902.
[26]	DUAN HX, JIANG YY, WU TY, et al. The genetic association between nonalcoholic fatty liver disease and type 2 diabetes mellitus in different body mass index categories: A bidirectional Mendelian randomization study[J]. J Clin Hepatol, 2024, 40( 10): 1992- 1999. DOI: 10.12449/JCH241011. 段浩鑫, 江宇泳, 吴亭彧, 等. 基于双向孟德尔随机化的不同BMI分型非酒精性脂肪性肝病与2型糖尿病的遗传关联分析[J]. 临床肝胆病杂志, 2024, 40( 10): 1992- 1999. DOI: 10.12449/JCH241011.
[27]	HAN XY, ZHANG X, LIU ZQ, et al. Prevalence of nonalcoholic fatty liver disease and liver cirrhosis in Chinese adults with type 2 diabetes mellitus[J]. J Diabetes, 2024, 16( 5): e13564. DOI: 10.1111/1753-0407.13564.
[28]	EGUCHI Y, HYOGO H, ONO M, et al. Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: A multicenter large retrospective study[J]. J Gastroenterol, 2012, 47( 5): 586- 595. DOI: 10.1007/s00535-012-0533-z.
[29]	YABE D, SEINO Y, FUKUSHIMA M, et al. β cell dysfunction versus insulin resistance in the pathogenesis of type 2 diabetes in East Asians[J]. Curr Diab Rep, 2015, 15( 6): 36. DOI: 10.1007/s11892-015-0602-9.
[30]	LI YM, FAN JG. Guidelines of prevention and treatment for alcoholic liver disease(2018, China)[J]. J Dig Dis, 2019, 20( 4): 174- 180. DOI: 10.1111/1751-2980.12687.
[31]	JENSEN AH, WINTHER-SØRENSEN M, BURISCH J, et al. Autoimmune liver diseases and diabetes: A propensity score matched analysis and a proportional meta-analysis[J]. Liver Int, 2023, 43( 11): 2479- 2491. DOI: 10.1111/liv.15720.
[32]	N’KONTCHOU G, PARIES J, HTAR MTT, et al. Risk factors for hepatocellular carcinoma in patients with alcoholic or viral C cirrhosis[J]. Clin Gastroenterol Hepatol, 2006, 4( 8): 1062- 1068. DOI: 10.1016/j.cgh.2006.05.013.
[33]	RAYNARD B, BALIAN A, FALLIK D, et al. Risk factors of fibrosis in alcohol-induced liver disease[J]. Hepatology, 2002, 35( 3): 635- 638. DOI: 10.1053/jhep.2002.31782.
[34]	BALBI M, DONADON V, GHERSETTI M, et al. Alcohol and HCV chronic infection are risk cofactors of type 2 diabetes mellitus for hepatocellular carcinoma in Italy[J]. Int J Environ Res Public Health, 2010, 7( 4): 1366- 1378. DOI: 10.3390/ijerph7041366.
[35]	HAMEED I, MASOODI SR, MIR SA, et al. Type 2 diabetes mellitus: From a metabolic disorder to an inflammatory condition[J]. World J Diabetes, 2015, 6( 4): 598- 612. DOI: 10.4239/wjd.v6.i4.598.
[36]	LV D, WANG H, LENG Y, et al. Association between diabetes mellitus and primary biliary cholangitis: A two-sample Mendelian randomization study[J]. Front Endocrinol, 2024, 15: 1362584. DOI: 10.3389/fendo.2024.1362584.
[37]	MATSUMOTO N, OGAWA M, MATSUOKA S, et al. Prevalence and risk factors of diabetes mellitus in patients with autoimmune hepatitis[J]. Intern Med, 2016, 55( 8): 879- 885. DOI: 10.2169/internalmedicine.55.4957.
[38]	WANG Q, ZHANG CR, TANG YM. Research advances in glucose and lipid metabolism disorders in different types of chronic liver diseases[J]. J Clin Hepatol, 2022, 38( 8): 1937- 1940. DOI: 10.3969/j.issn.1001-5256.2022.08.043. 王倩, 张宸瑞, 唐映梅. 不同类型慢性肝病糖脂代谢紊乱研究进展[J]. 临床肝胆病杂志, 2022, 38( 8): 1937- 1940. DOI: 10.3969/j.issn.1001-5256.2022.08.043.
[39]	BOSCH DE, ZEN Y, BOUKHAR SA, et al. Hepatocellular carcinoma in primary sclerosing cholangitis and primary biliary cholangitis: A clinical and pathological study in an uncommon but emerging setting[J]. Virchows Arch, 2021, 479( 6): 1131- 1143. DOI: 10.1007/s00428-021-03183-6.
[40]	SCHWEITZER A, HORN J, MIKOLAJCZYK RT, et al. Estimations of worldwide prevalence of chronic hepatitis B virus infection: A systematic review of data published between 1965 and 2013[J]. Lancet, 2015, 386( 10003): 1546- 1555. DOI: 10.1016/S0140-6736(15)61412-X.
[41]	GUNTIPALLI P, PAKALA R, KUMARI GARA S, et al. Worldwide prevalence, genotype distribution and management of hepatitis C[J]. Acta Gastroenterol Belg, 2021, 84( 4): 637- 656. DOI: 10.51821/84.4.015.
[42]	TENG ML, NG CH, HUANG DQ, et al. Global incidence and prevalence of nonalcoholic fatty liver disease[J]. Clin Mol Hepatol, 2023, 29( Suppl): S32- S42. DOI: 10.3350/cmh.2022.0365.
[43]	AMONKER S, HOUSHMAND A, HINKSON A, et al. Prevalence of alcohol-associated liver disease: A systematic review and meta-analysis[J]. Hepatol Commun, 2023, 7( 5): e0133. DOI: 10.1097/HC9.0000000000000133.
[44]	SEBODE M, KLOPPENBURG A, AIGNER A, et al. Population-based study of autoimmune hepatitis and primary biliary cholangitis in Germany: Rising prevalences based on ICD codes, yet deficits in medical treatment[J]. Z Gastroenterol, 2020, 58( 5): 431- 438. DOI: 10.1055/a-1135-9306.