Fattovich Giovanna, Pantalena Maurizio, Zagni Irene, Realdi Giuseppe, Schalm Solko W, Christensen Erik
Servizio Autonomo Clinicizzato di Gastroenterologia, University of Verona, Italy.
Am J Gastroenterol. 2002 Nov;97(11):2886-95. doi: 10.1111/j.1572-0241.2002.07057.x.
The aim of this study was to compare the prognosis of patients with hepatitis B surface antigen (HBsAg) positive and those with antibody to hepatitis C (anti-HCV) positive cirrhosis.
This was a retrospective cohort study of 297 untreated Western European patients with compensated viral cirrhosis (Child class A; 161 patients with hepatitis type B and 136 with type C) who were followed for a median period of 6.6 yr.
At diagnosis, median age was lower (48 vs 58 yr, respectively) in HBsAg-positive cirrhotic patients. The Kaplan-Meier 5-yr probability of hepatocellular carcinoma (HCC) was 9% and 10% in HBsAg and anti-HCV-positive cirrhotic patients, respectively; the corresponding figures for decompensation unrelated to HCC were 16% and 28% and for survival were 86% and 84%, respectively. After adjustment for clinical and serological differences at baseline, the relative risk (95% CI) for HCC, decompensation and mortality was 1.53 (CI = 0.81-2.89), 0.59 (CI = 0.37-0.94), and 1.44 (CI = 0.85-2.46) respectively, in HBsAg-positive patients compared with anti-HCV-positive cirrhotic patients. Among HBsAg-positive cirrhotic patients, the relative risk for HCC, decompensation, and mortality was 0.89 (CI = 0.30-2.63), 4.05 (CI = 1.09-15.1), and 5.9 (CI = 1.64-21.3), respectively, in HBV-DNA positive (HBeAg positive or negative) compared with HBV-DNA negative (HBeAg negative) patients at entry.
Patients with HBV infection may present with cirrhosis about 10 yr earlier than those with HCV infection. HCV infection tends to be associated with a higher risk of decompensation, but these data should take into consideration the heterogeneity of HBV-related cirrhosis in terms of viremia levels and risk of hepatic failure. Survival shows no significant differences according to HBV or HCV etiology in Western European cirrhotic patients.
本研究旨在比较乙肝表面抗原（HBsAg）阳性和丙肝抗体（抗-HCV）阳性肝硬化患者的预后。
这是一项对297例未经治疗的西欧代偿期病毒性肝硬化患者（Child A级；161例乙型肝炎患者和136例丙型肝炎患者）进行的回顾性队列研究，随访中位时间为6.6年。
诊断时，HBsAg阳性肝硬化患者的中位年龄较低（分别为48岁和58岁）。HBsAg阳性和抗-HCV阳性肝硬化患者肝细胞癌（HCC）的Kaplan-Meier 5年发生率分别为9%和10%；与HCC无关的失代偿发生率分别为16%和28%，生存率分别为86%和84%。在对基线时的临床和血清学差异进行调整后，与抗-HCV阳性肝硬化患者相比，HBsAg阳性患者发生HCC、失代偿和死亡的相对风险（95%CI）分别为1.53（CI = 0.81-2.89）、0.59（CI = 0.37-0.94）和1.44（CI = 0.85-2.46）。在HBsAg阳性肝硬化患者中，与入组时HBV-DNA阴性（HBeAg阴性）患者相比，HBV-DNA阳性（HBeAg阳性或阴性）患者发生HCC、失代偿和死亡的相对风险分别为0.89（CI = 0.30-2.63）、4.05（CI = 1.09-15.1）和5.9（CI = 1.64-21.3）。
HBV感染患者出现肝硬化的时间可能比HCV感染患者早约10年。HCV感染往往与更高的失代偿风险相关，但这些数据应考虑到HBV相关肝硬化在病毒血症水平和肝衰竭风险方面的异质性。在西欧肝硬化患者中，根据HBV或HCV病因，生存率无显著差异。
