Seeff L B, Buskell-Bales Z, Wright E C, Durako S J, Alter H J, Iber F L, Hollinger F B, Gitnick G, Knodell R G, Perrillo R P
Veterans Affairs Medical Center, Washington, DC 20422.
N Engl J Med. 1992 Dec 31;327(27):1906-11. doi: 10.1056/NEJM199212313272703.
Acute non-A, non-B hepatitis after blood transfusion often progresses to chronic hepatitis and sometimes culminates in cirrhosis or even hepatocellular carcinoma. However, the frequency of these sequelae and their effects on mortality are not known.
We traced patients with transfusion-related non-A, non-B hepatitis who had been identified in five major prospective studies conducted in the United States between 1967 and 1980. We matched each patient with two control subjects (identified as the first and second controls) who received transfusions but who did not have hepatitis. The mortality rates in the three groups were determined with use of data from the National Death Index and Social Security Death Tapes. Cause-specific mortality was determined by reviewing death certificates.
Vital status was established for over 94 percent of the 568 patients who had had non-A, non-B hepatitis and the two control groups (526 first controls and 458 second controls). After an average follow-up of 18 years, the estimate by life-table analysis of mortality from all causes was 51 percent for those with transfusion-associated non-A, non-B hepatitis, as compared with 52 percent for the first controls and 50 percent for the second controls. The survival curves for the three groups were virtually the same. Mortality related to liver disease was 3.3, 1.1, and 2.0 percent, respectively, among the three groups (P = 0.033 for the comparison of the group with non-A, non-B hepatitis with the combined control group). Seventy-one percent of the deaths related to liver disease occurred among patients with chronic alcoholism.
In this long-term follow-up study, there was no increase in mortality from all causes after transfusion-associated non-A, non-B hepatitis, although there was a small but statistically significant increase in the number of deaths related to liver disease.
输血后急性非甲非乙型肝炎常进展为慢性肝炎，有时最终发展为肝硬化甚至肝细胞癌。然而，这些后遗症的发生率及其对死亡率的影响尚不清楚。
我们追踪了1967年至1980年在美国进行的五项主要前瞻性研究中确定的输血相关性非甲非乙型肝炎患者。我们将每位患者与两名接受输血但未患肝炎的对照者（分别确定为第一对照和第二对照）进行匹配。利用国家死亡指数和社会保障死亡记录的数据确定三组的死亡率。通过审查死亡证明确定死因特异性死亡率。
在568例非甲非乙型肝炎患者及两个对照组（526例第一对照和458例第二对照）中，超过94%的患者确定了生命状态。平均随访18年后，通过寿命表分析估计，输血相关性非甲非乙型肝炎患者的全因死亡率为51%，第一对照为52%，第二对照为50%。三组的生存曲线基本相同。三组中与肝病相关的死亡率分别为3.3%、1.1%和2.0%（非甲非乙型肝炎组与合并对照组比较，P = 0.033）。71%的肝病相关死亡发生在慢性酒精中毒患者中。
在这项长期随访研究中，输血相关性非甲非乙型肝炎后全因死亡率没有增加，尽管肝病相关死亡人数有小幅但具有统计学意义的增加。
