Bedogni Giorgio, Miglioli Lucia, Masutti Flora, Ferri Silvia, Castiglione Anna, Lenzi Marco, Crocè Lory Saveria, Granito Alessandro, Tiribelli Claudio, Bellentani Stefano
Liver Research Center, AREA Science Park, Basovizza, Trieste, Italy.
Am J Gastroenterol. 2008 Sep;103(9):2248-53. doi: 10.1111/j.1572-0241.2008.01948.x. Epub 2008 Jul 12.
Population-based studies of the natural course of chronic viral liver disease that consider comorbidity factors are lacking. Using data from the Dionysos Study, we quantified the burden of chronic viral liver disease and the role of alcohol intake to morbidity and mortality in a representative sample of subjects from the general population of two communities of Northern Italy.
We followed up 139 subjects with chronic hepatitis C virus (HCV) infection and 61 with chronic hepatitis B virus (HBV) infection for a median (IQR) time of 8.4 (1.0) and 8.3 (0.9) yr, respectively. Ethanol intake was evaluated using a food-frequency questionnaire, fatty liver (FL) was diagnosed by ultrasonography, and liver cirrhosis (LC) and hepatocarcinoma (HCC) were diagnosed by liver biopsy. Exact multivariable Poisson regression was performed to identify predictors of death. The incidence and remission rates of FL were 9.0 and 29.7 in the HCV cohort and 4.0 and 30.4 per 1,000 person-years (PY) in the HBV cohort. Progression to LC and HCC was more common in the HCV than in the HBV cohort (4.5 vs 2.0 and 2.7 vs 2.0 per 1,000 PY, respectively). Ethanol intake was an independent predictor of LC in the HCV cohort [rate ratio (RR) = 4.15 (95% CI 1.02-41.2) for every increase of 30 g/day of ethanol intake at baseline] and of death rate in both cohorts [RR = 8.53 (95% CI 1.40-24.61) and 3.56 (1.34 to 26.50) for every increase of 30 g/day of ethanol intake at baseline].
The morbidity and mortality rate of HBV and HCV infection in the general population is lower than that reported in secondary-care populations, blood donors, or clinical series. Ethanol intake is an independent predictor of LC in subjects with chronic HCV infection and an independent predictor of death in subjects with either HCV or HBV infection.
缺乏考虑合并症因素的基于人群的慢性病毒性肝病自然病程研究。利用狄俄尼索斯研究的数据，我们在意大利北部两个社区的普通人群代表性样本中，量化了慢性病毒性肝病的负担以及酒精摄入对发病和死亡的作用。
我们对139例慢性丙型肝炎病毒（HCV）感染患者和61例慢性乙型肝炎病毒（HBV）感染患者进行了随访，中位（四分位间距）随访时间分别为8.4（1.0）年和8.3（0.9）年。使用食物频率问卷评估乙醇摄入量，通过超声诊断脂肪肝（FL），通过肝活检诊断肝硬化（LC）和肝癌（HCC）。进行精确多变量泊松回归以确定死亡的预测因素。HCV队列中FL的发病率和缓解率分别为每1000人年9.0和29.7，HBV队列中分别为每1000人年4.0和30.4。HCV队列中进展为LC和HCC的情况比HBV队列更常见（分别为每1000人年4.5对2.0和2.7对2.0）。在HCV队列中，乙醇摄入是LC的独立预测因素[基线时乙醇摄入量每增加30克/天，率比（RR）=4.15（95%CI 1.02 - 41.2）]，在两个队列中都是死亡率的独立预测因素[基线时乙醇摄入量每增加30克/天，RR分别为8.53（95%CI 1.40 - 24.61）和3.56（1.34至26.50）]。
普通人群中HBV和HCV感染的发病率和死亡率低于二级护理人群、献血者或临床系列报道的水平。乙醇摄入是慢性HCV感染患者中LC的独立预测因素，也是HCV或HBV感染患者死亡的独立预测因素。
