Nguyen Huy A, Miller April I, Dieperink Eric, Willenbring Mark L, Tetrick Lori L, Durfee Janet M, Ewing Stephen L, Ho Samuel B
Department of Medicine, Veterans Affairs Medical Center, University of Minnesota, Minneapolis 55417, USA.
Am J Gastroenterol. 2002 Jul;97(7):1813-20. doi: 10.1111/j.1572-0241.2002.05800.x.
Hepatitis C virus (HCV) infection is more prevalent in U.S. veterans attending Veterans Affairs Medical Centers than in the general population. The purpose of this study was to examine the risk factors, psychiatric and substance abuse conditions, and severity of liver disease in veterans with HCV.
The medical records and liver biopsies of 206 consecutive patients with HCV attending a multidisciplinary medical/psychiatric chronic hepatitis clinic and who met eligibility criteria for interferon alpha-2b therapy were reviewed.
The mean age was 46.5+/-6.8 yr and 77% were Vietnam-era veterans. Risk factors included i.v. drug use (64%), blood transfusion (15%), and cocaine use (9%), and were unknown in 12%. The average estimated duration of disease was 24+/-7.6 yr. A history of alcohol abuse or dependence was identified in 80% of patients. Psychiatric illnesses were present in 60%, the most common being depression and posttraumatic stress disorder. Overall, 89% of patients had documented psychiatric and/or substance abuse diagnoses. Severe fibrosis (stages 3-4) was present in 32% and severe inflammation (grades 2-3) was present in 71% of biopsies. Psychiatric and substance abuse diagnoses did not correlate with severity of liver disease. A total of 145 patients (71%) were prescribed interferon-based treatment. The overall virological sustained response rates were 16% after interferon monotherapy and 28% after interferon/ribavirin therapy. Reasons for not receiving interferon therapy included minimal fibrosis on liver biopsy (37 patients [18%]), worsening medical conditions (nine [4%]), and worsening psychiatric and substance abuse problems (14 [7%]).
Advanced fibrosis is common in this cohort of veteran patients with chronic hepatitis C, and the overwhelming majority of these patients have psychiatric and/or substance abuse diagnoses. Despite these comorbidities, the majority received interferon therapies in the context of a multidisciplinary clinic. These data emphasize the importance of hepatitis C care that includes linkage of medical care and psychiatric services.
丙型肝炎病毒（HCV）感染在美国退伍军人事务医疗中心就诊的退伍军人中比在普通人群中更为普遍。本研究的目的是调查HCV退伍军人的危险因素、精神疾病和药物滥用情况以及肝病的严重程度。
回顾了206例连续就诊于多学科医学/精神科慢性肝炎门诊且符合α-2b干扰素治疗资格标准的HCV患者的病历和肝活检结果。
平均年龄为46.5±6.8岁，77%为越战时期退伍军人。危险因素包括静脉吸毒（64%）、输血（15%）和可卡因使用（9%），12%的患者危险因素不明。疾病的平均估计病程为24±7.6年。80%的患者有酗酒或酒精依赖史。60%的患者存在精神疾病，最常见的是抑郁症和创伤后应激障碍。总体而言，89%的患者有精神疾病和/或药物滥用诊断记录。32%的活检显示有严重纤维化（3-4期）；71%有严重炎症（2-3级）。精神疾病和药物滥用诊断与肝病严重程度无关。共有145例患者（71%）接受了基于干扰素的治疗。干扰素单药治疗后的总体病毒学持续应答率为16%，干扰素/利巴韦林联合治疗后为28%。未接受干扰素治疗的原因包括肝活检显示纤维化程度较轻（37例[18%]）、病情恶化（9例[4%]）以及精神疾病和药物滥用问题恶化（14例[7%]）。
在这组慢性丙型肝炎退伍军人患者中，晚期纤维化很常见，而且这些患者绝大多数都有精神疾病和/或药物滥用诊断。尽管存在这些合并症，但大多数患者在多学科门诊接受了干扰素治疗。这些数据强调了丙型肝炎护理的重要性，其中包括医疗护理与精神科服务的联系。
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