Posthouwer Dirk, Makris Michael, Yee Thynn T, Fischer Kathelijn, van Veen Joost J, Griffioen Anja, van Erpecum Karel J, Mauser-Bunschoten Eveline P
Van Creveldkliniek, University Medical Center Utrecht, The Netherlands.
Blood. 2007 May 1;109(9):3667-71. doi: 10.1182/blood-2006-08-038349. Epub 2007 Jan 9.
Prior to 1990, many patients with inherited bleeding disorders were infected with hepatitis C virus (HCV). This study assessed the risk of end-stage liver disease (ESLD) in patients with hemophilia with chronic hepatitis C. Patients were infected between 1961 and 1990 and were followed up to August 2005. Of 847 anti-HCV(+) patients, 160 (19%) spontaneously cleared HCV and 687 (81%) developed chronic hepatitis C. Coinfection with HIV was present in 210 patients. After 35 years of infection the cumulative incidence of ESLD was 11.5% (95% CI, 8.2%-14.8%) in HIV(-) patients and 35.1% (95% CI, 29.2%-41.0%; P < .001) in patients coinfected with HIV. Independent risk factors of ESLD were HIV coinfection (hazard ratio 13.8; 95% CI, 7.5-25.3), older age at infection (hazard ratio 2.3 per 10 years; 95% CI, 2.0-2.8), alcohol abuse (hazard ratio 4.9; 95% CI, 2.5-9.6), and presence of HCV genotype 1 (hazard ratio 2.2; 95% CI, 1.1-4.2). With longer duration of HCV infection, the risk of developing ESLD is emerging in patients with inherited bleeding disorders. Risk factors for rapid progression to ESLD are alcohol abuse, coinfection with HIV, older age at infection, and presence of HCV genotype 1.
1990年以前，许多遗传性出血性疾病患者感染了丙型肝炎病毒（HCV）。本研究评估了慢性丙型肝炎血友病患者发生终末期肝病（ESLD）的风险。患者于1961年至1990年间感染，并随访至2005年8月。在847例抗HCV（+）患者中，160例（19%）自发清除HCV，687例（81%）发展为慢性丙型肝炎。210例患者合并感染HIV。感染35年后，HIV（-）患者ESLD的累积发病率为11.5%（95%CI，8.2%-14.8%），合并感染HIV的患者为35.1%（95%CI，29.2%-41.0%；P<0.001）。ESLD的独立危险因素为合并感染HIV（风险比13.8；95%CI，7.5-25.3）、感染时年龄较大（每10年风险比2.3；95%CI，2.0-2.8）、酗酒（风险比4.9；95%CI，2.5-9.6）以及存在HCV基因型1（风险比2.2；95%CI，1.1-4.2）。随着HCV感染时间延长，遗传性出血性疾病患者发生ESLD的风险正在显现。快速进展至ESLD的危险因素为酗酒、合并感染HIV、感染时年龄较大以及存在HCV基因型1。
