Bell Beth P, Manos M Michele, Zaman Atif, Terrault Norah, Thomas Ann, Navarro Victor J, Dhotre Kathy B, Murphy Rosemary C, Van Ness Grace R, Stabach Nicole, Robert Marie E, Bower William A, Bialek Stephanie R, Sofair Andre N
Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Am J Gastroenterol. 2008 Nov;103(11):2727-36; quiz 2737. doi: 10.1111/j.1572-0241.2008.02071.x. Epub 2008 Jul 31.
Chronic liver disease (CLD) is an important cause of morbidity and mortality, but the epidemiology is not well described. We conducted prospective population-based surveillance to estimate newly diagnosed CLD incidence, characterize etiology distribution, and determine disease stage.
We identified cases of CLD newly diagnosed during 1999-2001 among adult county residents seen in any gastroenterology practice in New Haven County, Connecticut; Multnomah County, Oregon; and Northern California Kaiser Permanente Medical Care Program (KPMCP, Oakland, California [total population 1.48 million]). We defined CLD as abnormal liver tests of at least 6 months' duration or pathologic, clinical, or radiologic evidence of CLD. Consenting patients were interviewed, a blood specimen obtained, and the medical record reviewed.
We identified 2,353 patients with newly diagnosed CLD (63.9 cases/100,000 population), including 1,225 hepatitis C patients (33.2 cases/100,000). Men aged 45-54 yr had the highest hepatitis C incidence rate (111.3/100,000). Among 1,040 enrolled patients, the median age was 48 yr (range 19-86 yr). Hepatitis C, either alone (442 [42%]) or in combination with alcohol-related liver disease (ALD) (228 [22%]), accounted for two-thirds of the cases. Other etiologies included nonalcoholic fatty liver disease (NAFLD, 95 [9%]), ALD (82 [8%]), and hepatitis B (36 [3%]). Other identified etiologies each accounted for <3% of the cases. A total of 184 patients (18%) presented with cirrhosis, including 44% of patients with ALD.
Extrapolating from this population-based surveillance network to the adult U.S. population, approximately 150,000 patients with CLD were diagnosed in gastroenterology practices each year during 1999-2001. Most patients had hepatitis C; heavy alcohol consumption among these patients was common. Almost 20% of patients, an estimated 30,000 per year, had cirrhosis at presentation. These results provide population-level baseline data to evaluate trends in identification of patients with CLD in gastroenterology practices.
慢性肝病（CLD）是发病和死亡的重要原因，但其流行病学情况尚未得到充分描述。我们开展了基于人群的前瞻性监测，以估计新诊断的CLD发病率、确定病因分布并判定疾病阶段。
我们在康涅狄格州纽黑文县、俄勒冈州马尔特诺马县以及北加利福尼亚凯撒医疗集团（KPMCP，加利福尼亚州奥克兰市[总人口148万]）的任何胃肠病科诊所就诊的成年县居民中，识别出1999 - 2001年间新诊断的CLD病例。我们将CLD定义为持续至少6个月的肝功能检查异常，或CLD的病理、临床或影像学证据。对同意参与的患者进行访谈，采集血样并查阅病历。
我们识别出2353例新诊断的CLD患者（63.9例/10万人口），其中包括1225例丙型肝炎患者（33.2例/10万）。45 - 54岁男性的丙型肝炎发病率最高（111.3/10万）。在1040例登记患者中，中位年龄为48岁（范围19 - 86岁）。丙型肝炎单独发病（442例[42%]）或与酒精性肝病（ALD）合并发病（228例[22%]）的病例占三分之二。其他病因包括非酒精性脂肪性肝病（NAFLD，95例[9%]）、ALD（82例[8%]）和乙型肝炎（36例[3%]）。其他已识别的病因各占病例数的<3%。共有184例患者（18%）表现为肝硬化，其中ALD患者占44%。
根据这个基于人群的监测网络推断美国成年人群体，在1999 - 2001年期间，每年在胃肠病科诊所约有15万例CLD患者被诊断出来。大多数患者患有丙型肝炎；这些患者中大量饮酒很常见。几乎20%的患者（估计每年3万例）就诊时已患有肝硬化。这些结果提供了人群层面的基线数据，以评估胃肠病科诊所中CLD患者识别情况的趋势。
