Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, 4315 Diplomacy Drive, Anchorage, Alaska 99508, USA.
Gastroenterology. 2010 Mar;138(3):922-31.e1. doi: 10.1053/j.gastro.2009.10.056. Epub 2009 Nov 10.
BACKGROUND & AIMS: The factors associated with adverse outcome from hepatitis C virus (HCV) infection are incompletely understood. To determine the incidence and risk factors associated with the development of end-stage liver disease (ESLD) and liver-related death (LRD), we conducted a retrospective/prospective population-based study in a cohort of Alaska Native persons chronically infected with HCV from 1994 to 2005.
We followed 960 persons prospectively for an average of 7.2 years and retrospectively for 12.1 years with data from medical records and serum samples. We compared data from subjects that were chronically infected with those who recovered from HCV infection, stratified by alcohol use. Survival models were used to examine factors associated with ESLD and LRD in chronically infected patients.
During prospective follow-up, 80 (8.8%) and 47 (5.2%) patients developed ESLD and LRD, respectively. In examining incidence per 100 person-years, no difference was found among heavy alcohol users in the incidence of LRD (2.28 versus 3.50; P = .34) or ESLD (3.21 versus 5.69; P = .13) in persons with chronic HCV compared with those recovered from HCV infection. In subjects that consumed <50 g alcohol/d, the incidences of LRD were 0.77 and 0.09 (P = .01) and of ESLD were 1.58 versus 0.36 (P = .002), respectively, in subjects with chronic infection versus those that recovered. Multivariate analysis showed that older age, heavy alcohol use, and HCV genotype 3 were associated with ESLD.
A history of heavy alcohol use is associated with the highest incidence of LRD and ESLD, regardless of whether patients are chronically infected or recover from HCV infection.
丙型肝炎病毒（HCV）感染导致不良后果的相关因素尚未完全明确。为了确定与终末期肝病（ESLD）和肝脏相关死亡（LRD）发展相关的发生率和危险因素，我们对 1994 年至 2005 年间慢性 HCV 感染的阿拉斯加原住民队列进行了回顾性/前瞻性基于人群的研究。
我们对 960 名患者进行了平均 7.2 年的前瞻性随访和 12.1 年的回顾性随访，数据来自病历和血清样本。我们将慢性 HCV 感染患者的数据与 HCV 感染恢复患者的数据进行比较，并按酒精使用情况进行分层。生存模型用于检查慢性感染患者发生 ESLD 和 LRD 的相关因素。
前瞻性随访期间，分别有 80（8.8%）和 47（5.2%）例患者发生 ESLD 和 LRD。在检查每 100 人年的发病率时，与 HCV 感染恢复患者相比，慢性 HCV 感染患者中重度饮酒者的 LRD 发生率（2.28 比 3.50；P =.34）或 ESLD 发生率（3.21 比 5.69；P =.13）无差异。在每日酒精摄入量<50 g 的患者中，慢性感染患者的 LRD 发生率分别为 0.77 和 0.09（P =.01），ESLD 发生率分别为 1.58 和 0.36（P =.002）。多变量分析显示，年龄较大、重度饮酒和 HCV 基因型 3 与 ESLD 相关。
无论患者是慢性感染还是从 HCV 感染中恢复，重度饮酒史与 LRD 和 ESLD 的发生率最高相关。
