Planas Ramon, Ballesté Belén, Alvarez Marco Antonio, Rivera Monica, Montoliu Silvia, Galeras Josep Anton, Santos Justiniano, Coll Susanna, Morillas Rosa Maria, Solà Ricard
Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Universitat Autónoma de Barcelona, Badalona, Spain.
J Hepatol. 2004 May;40(5):823-30. doi: 10.1016/j.jhep.2004.01.005.
BACKGROUND/AIMS: Since few data are available concerning the clinical course of decompensated hepatitis C virus (HCV)-related cirrhosis, the aim of the present study was to define the natural long-term course after the first hepatic decompensation.
Cohort of 200 consecutive patients with HCV-related cirrhosis, and without known hepatocellular carcinoma (HCC), hospitalized for the first hepatic decompensation.
Ascites was the most frequent first decompensation (48%), followed by portal hypertensive gastrointestinal bleeding (PHGB) (32.5%), severe bacterial infection (BI) (14.5%) and hepatic encephalopathy (HE) (5%). During follow-up (34+/-2 months) there were 519 readmissions, HCC developed in 33 (16.5%) patients, and death occurred in 85 patients (42.5%). The probability of survival after diagnosis of decompensated cirrhosis was 81.8 and 50.8% at 1 and 5 years, respectively. HE and/or ascites as the first hepatic decompensation, baseline Child-Pugh score, age, and presence of more than one decompensation during follow-up were independently correlated with survival.
Once decompensated HCV-related cirrhosis was established, patients showed not only a very high frequency of readmissions, but also developed decompensations different from the initial one. These results contribute to defining the natural course and prognosis of decompensated HCV-related cirrhosis.
背景/目的：由于关于失代偿期丙型肝炎病毒（HCV）相关肝硬化临床病程的数据较少，本研究的目的是明确首次肝失代偿后的自然长期病程。
对200例连续的HCV相关肝硬化患者进行队列研究，这些患者均无已知肝细胞癌（HCC），因首次肝失代偿而住院。
腹水是最常见的首次失代偿（48%），其次是门静脉高压性胃肠道出血（PHGB）（32.5%）、严重细菌感染（BI）（14.5%）和肝性脑病（HE）（5%）。在随访期间（34±2个月），有519次再次入院，33例（16.5%）患者发生HCC，85例患者死亡（42.5%）。失代偿期肝硬化诊断后的1年和5年生存率分别为81.8%和50.8%。以HE和/或腹水作为首次肝失代偿、基线Child-Pugh评分、年龄以及随访期间出现不止一次失代偿与生存独立相关。
一旦确立失代偿期HCV相关肝硬化，患者不仅再次入院频率非常高，而且会出现与初始失代偿不同的失代偿情况。这些结果有助于明确失代偿期HCV相关肝硬化的自然病程和预后。
