Clique aqui para imprimir esta página para sua referência e consulta.

"Diabete em Pacientes com Grau Avançado de Fibrose"

Pacientes diabéticos com fibrose em grau avançado tem mais chances de desenvolver câncer hepático.

Pacientes que sofrem de hepatite C crônica, com fibrose avançada, tem duas vezes mais chances de desenvolver câncer hepático se também tiverem diabetes.
Estes achados foram publicados na Revista Hepatology de junho.
Estudos recentes sugerem que o diabetes aumenta o risco de carcinoma hepatocelular (HCC) ou cancer de fígado, possivelmente porque o dibates ocorre com frequência como parte de uma síndrome metabólica que aumenta o risco de esteatose não alcóolica (NASH), que por sua vez, pode levar ao câncer.
A hepatite C crônica também aumenta os riscos decancer hepático, portanto pacientes com hepatite C tem dois motivos para desenvolver HCC.

Pesquisadores liderados por Bart Veldt e Harry Janssen da Erasmus MC University Medical Center na Noruega, estudaram o risco de cancer hepático em pacientes com diabetes melitus e hepatite C avançada. Eles utilizaram informações de cinco grandes centros de hepatologia na Europa e Canadá e incluíram 541 pacientes consecutivos entre 1990 e 2003, que sofriam com hepatite C e fibrose avançada ou cirrose, demonstrada por meio de biópsia hepática.
Para cada paciente eles agregaram informações demográficas. clínicas, bioquímicas e virológicas juntamente com graus de fibrose e detalhes sobre o tratamento utilizado.

85 dos 541 pacientes incluidos no estudo, tinham diabetes. Pacientes com fibrose mais severa eram portadores de diabetes em maior grau.
" A prevalência de diabetes melitus foi de 10.5% nos pacientes com grau de fibrose Ishak 4; 12,5% com Ishak 5 e 19.1% com Ishak 6, dizem os autores.

Durante o acompanhamento de 4 anos, 11 pacientes (13%) com dibates versus 27 pacientes (5.9%) sem diabetes, desenvolveram hepatocarcinoma.
A ocorrência em cinco anos foi de 11.4% e 5% respectivamente.
Sexo masculino e maior idade tiveram incidência significativamente maior de risco HCC. . "A demais, houve uma grande tendência ao HCC em pacientes com dibetes melitus" dizem os autores do estudo.
A anãlise de regressão Cox multivarietal nos pacientes com Ishak 6 - cirrose - demonstrram que o diabetes não estava associado com o desenvolvimento do HCC.

O interessante é que nos pacientes com diabetes, houve uma tendência de risco maior à medida que os níveis de glucose aumentavam. Os autores pensaram na hipótese que a hiperinsulinemia poderia explicar o risco aumentado de HCC em pacientes com diabetes.

Abaixo a matéria completa:

Diabetic Patients With Advanced Hepatitis C Have Double The Risk Of Liver Cancer
31 May 2008

Patients who have chronic hepatitis C with advanced fibrosis have twice the risk of developing liver cancer if they also have diabetes. These findings are published in the June issue of Hepatology, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases (AASLD). The article is also available online at Wiley Interscience (http://www.interscience.wiley.com/).

Recent studies have suggested that diabetes increases one's risk for hepatocellular carcinoma (HCC), also known as liver cancer, possibly because diabetes often occurs as part of the metabolic syndrome, which increases the risk of non-alcoholic steatohepatitis (NASH), which can lead to liver cancer. Chronic hepatitis C also increases the risk of liver cancer, so patients who have both diabetes and hepatitis C have two pathways through which HCC might develop.

Researchers led by Bart Veldt and Harry Janssen of the Erasmus MC University Medical Center in the Netherlands, aimed to quantify the liver cancer risk of patients who have both diabetes mellitus and advanced hepatitis C. They used data from five large hepatology units in Europe and Canada and included 541 consecutive patients between 1990 and 2003 who had chronic hepatitis C and advanced liver fibrosis or cirrhosis as shown by liver biopsy. For each patient, they gathered demographic, clinical, biochemical and virological data, along with fibrosis assessment and details of hepatitis C treatment.

Eighty-five of the 541 patients included in the study had diabetes. Patients with more severe fibrosis were more likely to be diabetic. "The prevalence of diabetes mellitus was 10.5 percent for patients with Ishak fibrosis score 4, 12.5 percent for Ishak-score 5 and 19.1 percent for Ishak-score 6," the authors report.

During the median follow-up time of four years, 11 patients (13 percent) with diabetes vs. 27 patients (5.9 percent) without diabetes developed hepatocellular carcinoma. The 5-year occurrence was 11.4 percent and 5.0 percent, respectively. Male gender and older age were significantly associated with elevated HCC risk. "In addition, there was a strong trend towards a higher incidence of HCC among patients with diabetes mellitus," the authors report. Multivariate Cox regression analysis of patients with Ishak 6 cirrhosis showed that diabetes was independently associated with the development of HCC.

Interestingly, among patients with diabetes, there was a trend towards higher risk of HCC as fasting glucose levels increased. The authors hypothesize that resulting hyperinsulinemia might help explain the increased risk of HCC among diabetic patients.

Whatever the mechanism, the risk is clear. "For patients with chronic hepatitis C and advanced cirrhosis, diabetes mellitus increases the risk of developing HCC," the authors conclude.

----------------------------
Article adapted by Medical News Today from original press release. http://www.medicalnewstoday.com/articles/109348.php
----------------------------

Source: Sean Wagner
Wiley-Blackwell