阿拉斯加原住民和美国印第安慢性丙型肝炎患者肝活检中与肝纤维化进展相关的因素。
Factors associated with the progression of fibrosis on liver biopsy in Alaska Native and American Indian persons with chronic hepatitis C.
作者信息
Livingston Stephen E, Deubner Heike, Bruden Dana L, McMahon Brian J, Homan Chriss E, Townshend-Bulson Lisa J, Bruce Michael G, Hennessy Thomas W, Williams James L, Gretch David R
机构信息
Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium Liver Disease & Hepatitis Program, Anchorage, Alaska 99508, USA.
出版信息
Can J Gastroenterol. 2010 Jul;24(7):445-51. doi: 10.1155/2010/692036.
BACKGROUND
Various factors influence the development and rate of fibrosis progression in chronic hepatitis C virus (HCV) infection.
OBJECTIVES
To examine factors associated with fibrosis in a longterm outcomes study of Alaska Native/American Indian persons who underwent liver biopsy, and to examine the rate of fibrosis progression in persons with subsequent biopsies.
METHODS
A cross-sectional analysis of the demographic, inflammatory and viral characteristics of persons undergoing liver biopsy compared individuals with early (Ishak fibrosis score of lower than 3) with those with advanced (Ishak score of 3 or greater) fibrosis. Persons who underwent two or more biopsies were analyzed for factors associated with fibrosis progression.
RESULTS
Of 253 HCV RNA-positive persons who underwent at least one liver biopsy, 76 (30%) had advanced fibrosis. On multivariate analysis, a Knodell histological activity index score of 10 to 14 and an alpha-fetoprotein level of 8 ng/mL or higher were found to be independent predictors of advanced liver fibrosis (P<0.0001 for each). When surrogate markers of liver inflammation (alanine aminotransferase, aspartate aminotransferase/alanine aminotransferase ratio and alpha-fetoprotein) were removed from the model, type 2 diabetes mellitus (P=0.001), steatosis (P=0.03) and duration of HCV infection by 10-year intervals (P=0.02) were associated with advanced fibrosis. Among 52 persons who underwent two or more biopsies a mean of 6.2 years apart, the mean Ishak fibrosis score increased between biopsies (P=0.002), with progression associated with older age at initial biopsy and HCV risk factors.
CONCLUSIONS
The presence of type 2 diabetes mellitus, steatosis and duration of HCV infection were independent predictors of advanced fibrosis in the present cohort, with significant fibrosis progression demonstrated in persons who underwent serial biopsies.
背景
多种因素影响慢性丙型肝炎病毒（HCV）感染中纤维化的发展及进展速度。
目的
在一项对接受肝活检的阿拉斯加原住民/美国印第安人的长期结局研究中，检查与纤维化相关的因素，并检查后续接受活检者的纤维化进展速度。
方法
对接受肝活检者的人口统计学、炎症和病毒特征进行横断面分析，比较早期纤维化（Ishak纤维化评分低于3）和晚期纤维化（Ishak评分3或更高）的个体。对接受两次或更多次活检的人分析与纤维化进展相关的因素。
结果
在253例至少接受过一次肝活检的HCV RNA阳性者中，76例（30%）有晚期纤维化。多因素分析显示，Knodell组织学活动指数评分为10至14以及甲胎蛋白水平为8 ng/mL或更高是晚期肝纤维化的独立预测因素（每项P<0.0001）。当从模型中去除肝脏炎症的替代标志物（丙氨酸氨基转移酶、天冬氨酸氨基转移酶/丙氨酸氨基转移酶比值和甲胎蛋白）后，2型糖尿病（P=0.001）、脂肪变性（P=0.03）和按10年间隔计算的HCV感染持续时间（P=0.02）与晚期纤维化相关。在52例平均间隔6.2年接受两次或更多次活检的人中，两次活检之间Ishak纤维化评分平均增加（P=0.002），进展与初次活检时年龄较大及HCV危险因素相关。
结论
在本队列中，2型糖尿病、脂肪变性的存在及HCV感染持续时间是晚期纤维化的独立预测因素，接受系列活检者显示有显著的纤维化进展。
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