Imai Yasuharu, Kasahara Akinori, Tanaka Hideo, Okanoue Takeshi, Hiramatsu Naoki, Tsubouchi Hirohito, Yoshioka Kentaro, Kawata Sumio, Tanaka Eiji, Hino Keisuke, Hayashi Katsuhiro, Tamura Shinji, Itoh Yoshito, Sasaki Yutaka, Kiyosawa Kendo, Kakumu Shinichi, Okita Kiwamu, Hayashi Norio
Department of Internal Medicine, Ikeda Municipal Hospital, 3-1-18 Johnan, 563-8510, Ikeda, Japan.
J Gastroenterol. 2004 Nov;39(11):1069-77. doi: 10.1007/s00535-004-1448-0.
In Japan, generally, patients with chronic hepatitis C are aged. The aim of this study was to investigate the effect of interferon (IFN) therapy on the mortality of chronic hepatitis C patients over age 60.
Seven-hundred and seven patients with histologically proven chronic hepatitis C were enrolled in this study; 649 received IFN therapy (IFN group) and 58 did not (control group). The standardized mortality ratio (SMR) and Cox proportional hazard regression analysis were used to evaluate the effect of IFN on the survival of the patients.
Mean follow-up periods in the IFN and control groups were 5.7 and 6.7 years, respectively. During follow-up, 13 patients in the control group died (7 of liver-related diseases) and 42 in the IFN group died (29 of liver-related diseases). The SMRs of the control and IFN groups were 1.40 (95% confidence interval [CI], 0.76-2.45) and 0.73 (95% CI, 0.52-0.98) for overall death, and 10.70 (95% CI, 4.29-22.05) and 5.05 (95% CI, 3.38-7.26) for liver-related death, respectively. Sustained and transient biochemical responders in the IFN group (SMR, 0.53; 95% CI, 0.01-2.97 and SMR, 3.25; 95% CI, 0.87-8.32, respectively) showed lower liver-related mortality compared with the control group. In patients with sustained virological response, liver-related mortality was also very low (SMR, 0.65; 95% CI, 0.01-3.61). The risk for liver-related death of sustained and transient biochemical responders was also low compared with that of the control group (adjusted risk ratios 0.10 [95% CI, 0.01-0.95] and 0.50 [95% CI, 0.11-2.21], respectively).
These results suggest that IFN treatment could reduce liver-related mortality in chronic hepatitis C patients over age 60, notably in patients showing a biochemical response and in those showing a sustained virological response.
在日本，慢性丙型肝炎患者普遍年龄较大。本研究旨在调查干扰素（IFN）治疗对60岁以上慢性丙型肝炎患者死亡率的影响。
707例经组织学证实为慢性丙型肝炎的患者纳入本研究；649例接受IFN治疗（IFN组），58例未接受治疗（对照组）。采用标准化死亡率（SMR）和Cox比例风险回归分析评估IFN对患者生存的影响。
IFN组和对照组的平均随访时间分别为5.7年和6.7年。随访期间，对照组13例患者死亡（7例死于肝脏相关疾病），IFN组42例患者死亡（29例死于肝脏相关疾病）。总体死亡的对照组和IFN组的SMR分别为1.40（95%置信区间[CI]，0.76 - 2.45）和0.73（95% CI，0.52 - 0.98），肝脏相关死亡的SMR分别为10.70（95% CI，4.29 - 22.05）和5.05（95% CI，3.38 - 7.26）。IFN组的持续生化应答者和短暂生化应答者（SMR分别为0.53；95% CI，0.01 - 2.97和SMR为3.25；95% CI，0.87 - 8.32）与对照组相比，肝脏相关死亡率较低。在持续病毒学应答的患者中，肝脏相关死亡率也很低（SMR，0.65；95% CI，0.01 - 3.61）。持续生化应答者和短暂生化应答者的肝脏相关死亡风险与对照组相比也较低（调整风险比分别为0.10 [95% CI，0.01 - 0.95]和0.50 [95% CI，0.11 - 2.21]）。
这些结果表明，IFN治疗可降低60岁以上慢性丙型肝炎患者的肝脏相关死亡率，特别是在出现生化应答的患者和出现持续病毒学应答的患者中。
