[波兰慢性丙型肝炎患者的肝纤维化进展率]

Kryczka Wiesław, Chrapek Magdalena, Paluch Katarzyna, Zarebska-Michaluk Dorota, Urbaniak Antoinette

Oddział Obserwacyjno-Zakaźny Wojewódzkiego Szpitala Zespolonego w Kielcach.

Pol Arch Med Wewn. 2003 Aug;110(2):869-75.

AIM

To assess the rate of liver fibrosis (RLF) among previously untreated patients with chronic hepatitis C (CHC) and to identify predictors of rapid progression to cirrhosis in this group.

PATIENTS AND METHODS

Medical records of 337 consecutive patients with biopsy proven CHC (anti-HCV and HCVRNA positive; F/M: 153/184; mean age at biopsy: 43 +/- 14 years) and with known probable age at infection have been analysed. There were no intravenous drug users among the patients. HBsAg--and HIV-positive subjects as well as those with other concomitant liver disease were excluded from the analysis. The RLF was defined as the ratio between fibrosis stage (scored 0-6 units [U] according to Ishak's criteria, with 6 representing established cirrhosis) and the duration of HCV infection (in years). The RLF was analysed in relation to the age at infection, sex, route of transmission, alcohol abuse, past HBV infection, acute hepatitis history, HCV genotype and hepatic steatosis. Based on published data, a patient with RLF > or = 0.3 U/yr (cirrhosis up to 20 years after HCV infection) was arbitrarily defined as a rapid progressor. Both uni- and multivariate statistical analyses were performed.

RESULTS

The mean RLF was 0.14 +/- 0.17 U/yr (range 0-0.83) and the expected mean duration from infection to cirrhosis was 43 years. In multivariate analysis the only independent factors associated with an increase in RLF were the older age at infection and alcohol abuse (both with p < 0.0001). 58 [17.2%] patients were rapid progressors and the same factors as mentioned above have been independent predictors of cirrhosis up to 20 years after infection. There were as much as 55.5% of rapid progressors among alcohol abusers infected in the age over 30 and only 1.9% among non-alcoholic patients infected in the age up to 30 years.

CONCLUSIONS

Our study showed that natural course of CHC in Poland is similar to other regions of the world. HCV-related liver disease progression is accelerated among alcohol abusers and infected in older age. In contrast, risk of cirrhosis seems to be minimal among non-alcoholic patients infected before the age of 30.

目的

评估既往未经治疗的慢性丙型肝炎（CHC）患者的肝纤维化率（RLF），并确定该组患者快速进展至肝硬化的预测因素。

患者与方法

分析了337例经活检证实为CHC（抗-HCV和HCVRNA阳性；男/女：153/184；活检时平均年龄：43±14岁）且已知可能的感染年龄的连续患者的病历。患者中无静脉吸毒者。分析排除了HBsAg和HIV阳性受试者以及患有其他合并肝病的患者。RLF定义为纤维化分期（根据Ishak标准评分为0 - 6分[U]，6分代表已确诊的肝硬化）与HCV感染持续时间（以年为单位）的比值。分析RLF与感染年龄、性别、传播途径、酒精滥用、既往HBV感染、急性肝炎病史、HCV基因型和肝脂肪变性的关系。根据已发表的数据，RLF>或=0.3 U/年（HCV感染后20年内发展为肝硬化）的患者被任意定义为快速进展者。进行了单因素和多因素统计分析。

结果

平均RLF为0.14±0.17 U/年（范围0 - 0.83），从感染到肝硬化的预期平均持续时间为43年。在多因素分析中与RLF增加相关的唯一独立因素是感染时年龄较大和酒精滥用（两者p均<0.0001）。58例[17.2%]患者为快速进展者，上述相同因素是感染后20年内肝硬化的独立预测因素。30岁以上感染的酒精滥用者中快速进展者多达55.5%，而30岁及以下感染的非酒精性患者中仅为1.9%。