Terrault Norah A, Im Kelly, Boylan Ross, Bacchetti Peter, Kleiner David E, Fontana Robert J, Hoofnagle Jay H, Belle Steven H
Department of Medicine, University of California San Francisco, San Francisco, California 94143-0538, USA.
Clin Gastroenterol Hepatol. 2008 Dec;6(12):1403-11. doi: 10.1016/j.cgh.2008.08.006. Epub 2008 Aug 19.
BACKGROUND & AIMS: Prior studies suggest the rate of liver fibrosis progression is slower in African Americans (AAs) than Caucasian Americans (CAs) with chronic HCV infection.
With a multi-state Markov model, fibrosis progression was evaluated in a well-characterized cohort of 143 AA and 157 CA adults with untreated chronic HCV genotype 1 infection. In subjects with a history of injection drug use, duration of infection was imputed from a fitted risk model rather than assumed to be the reported first year of use.
The distribution of Ishak fibrosis stages was 0 (8.7%), 1/2 (55.7%), 3/4 (29.3%), and 5/6 (6.3%) and was similar in AAs and CAs (P = .22). After adjusting for biopsy adequacy, AAs had a 10% lower rate of fibrosis progression than did CAs, but the difference was not statistically significant (hazard ratio, 0.90; 95% confidence interval, 0.72-1.12). The overall 20-year estimates of probabilities of progression from stage 0 to stages 1/2, 3/4, and 5/6 were 59.3%, 28.8%, and 4.7%, respectively. The estimated median time from no fibrosis to cirrhosis was 79 years for the entire cohort and 74 and 83 years for CAs and AAs, respectively. In 3-variable models including race and biopsy adequacy, the factors significantly associated with fibrosis progression were age when infected, steatosis, ALT level, and necroinflammatory score.
The rates of fibrosis progression were slow and did not appear to differ substantially between AAs and CAs.
先前的研究表明，慢性丙型肝炎病毒（HCV）感染的非裔美国人（AAs）肝纤维化进展速度比美国白人（CAs）慢。
采用多状态马尔可夫模型，在一个特征明确的队列中评估了143名未治疗的慢性HCV 1型感染的成年非裔美国人和157名成年白人的纤维化进展情况。在有注射吸毒史的受试者中，感染持续时间是根据拟合的风险模型推算出来的，而不是假定为报告的首次使用年份。
Ishak纤维化分期的分布为0期（8.7%）、1/2期（55.7%）、3/4期（29.3%）和5/6期（6.3%），非裔美国人和白人相似（P = 0.22）。在调整活检充分性后，非裔美国人的纤维化进展率比白人低10%，但差异无统计学意义（风险比，0.90；95%置信区间，0.72 - 1.12）。从0期进展到1/2期、3/4期和5/6期的总体20年估计概率分别为59.3%、28.8%和4.7%。整个队列从无纤维化到肝硬化的估计中位时间为79年，白人为74年，非裔美国人为83年。在包括种族和活检充分性的三变量模型中，与纤维化进展显著相关的因素是感染时的年龄、脂肪变性、ALT水平和坏死性炎症评分。
纤维化进展速度缓慢，非裔美国人和白人之间似乎没有实质性差异。
