Minola Eliseo, Prati Daniele, Suter Fredy, Maggiolo Franco, Caprioli Flavio, Sonzogni Aurelio, Fraquelli Mirella, Paggi Silvia, Conte Dario
Infectious Diseases Unit, Ospedali Riuniti, Bergamo, Italy.
Blood. 2002 Jun 15;99(12):4588-91. doi: 10.1182/blood-2001-12-0192.
Before the introduction of hepatitis C virus (HCV) screening for blood donors, the risk of acquiring HCV infection as a result of a transfusion was about 10%. The aim of this study was to assess the frequency and rate of progression to cirrhosis in patients with transfusion-associated chronic HCV infection and identify possibly negative prognostic factors. Of 2477 consecutive patients with clinical or laboratory evidence of liver disease, 392 (16%) were anti-HCV- and HCV-RNA-positive, had anamnestic evidence of a single and precisely dated transfusion event, and showed no other causes of chronic liver disease; 268 (68%) underwent ultrasound-guided liver biopsy and were enrolled in the study. After a mean interval of 18.4 years, 54 patients (20.1%) had cirrhosis, which multivariate analysis showed to be independently associated with the duration of follow-up, age at infection and at the time of liver biopsy, and serum alanine aminotransferase levels at biopsy. The time necessary to have a 50% probability of developing cirrhosis in patients aged 21-30, 31-40, and more than 40 years was 33, 23, and 16 years, respectively. In comparison with those aged 20 years or less at infection, the risk ratio of developing cirrhosis over a period of 30 years for patients aged 21-30 and at least 31 years at infection was, respectively, 4.51 (95% confidence interval, 1.03-19.76) and 12.29 (95% confidence interval, 3.06-49.40). In patients with transfusion-associated chronic hepatitis C, the risk of cirrhosis is related to age at infection and disease activity. Our findings suggest that an aggressive therapeutic approach should be adopted in patients infected by HCV at an older age to prevent the progression to end-stage liver disease.
在对献血者进行丙型肝炎病毒（HCV）筛查之前，因输血感染HCV的风险约为10%。本研究的目的是评估输血相关慢性HCV感染患者发生肝硬化的频率和进展速度，并确定可能的不良预后因素。在2477例有临床或实验室肝病证据的连续患者中，392例（16%）抗-HCV和HCV-RNA呈阳性，有单次且确切日期输血事件的既往史证据，且无其他慢性肝病病因；268例（68%）接受了超声引导下肝活检并纳入研究。平均随访18.4年后，54例患者（20.1%）发生肝硬化，多因素分析显示肝硬化与随访时间、感染时及肝活检时的年龄以及活检时血清丙氨酸转氨酶水平独立相关。21 - 30岁、31 - 40岁和40岁以上患者发生肝硬化的概率达到50%所需时间分别为33年、23年和16年。与感染时年龄在20岁及以下的患者相比，感染时年龄为21 - 30岁和至少31岁的患者在30年期间发生肝硬化的风险比分别为4.51（95%置信区间，1.03 - 19.76）和12.29（95%置信区间，3.06 - 49.40）。在输血相关慢性丙型肝炎患者中，肝硬化风险与感染时年龄和疾病活动度有关。我们的研究结果表明，对于年龄较大的HCV感染者应采取积极的治疗方法以防止进展至终末期肝病。
