Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland.
J Viral Hepat. 2011 Nov;18(11):745-59. doi: 10.1111/j.1365-2893.2011.01481.x. Epub 2011 Jul 1.
The progression of liver fibrosis in chronic hepatitis C has long been considered to be independent from viral genotypes. However, recent studies suggest an association between Hepatitis C virus (HCV) genotype 3 and accelerated liver disease progression. We completed a systematic review and meta-analysis of studies evaluating the association between HCV genotypes and fibrosis progression. PubMed, Embase and ISI Web of Knowledge databases were searched for cohort, cross-sectional and case-control studies on treatment-naïve HCV-infected adults in which liver fibrosis progression rate (FPR) was assessed by the ratio of fibrosis stage in one single biopsy to the duration of infection (single-biopsy studies) or from the change in fibrosis stage between two biopsies (paired biopsies studies). A random effect model was used to derive FPR among different HCV genotypes. Eight single-biopsy studies (3182 patients, mean/median duration of infection ranging from 9 to 21 years) and eight paired biopsies studies (mean interval between biopsies 2-12 years) met the selection criteria. The odds ratio for the association of genotype 3 with accelerated fibrosis progression was 1.52 (95% CI 1.12-2.07, P = 0.007) in single-biopsy studies and 1.37 (95% CI 0.87-2.17, P = 0.17) in paired biopsy studies. In conclusion, viral genotype 3 was associated with faster fibrosis progression in single-biopsy studies. This observation may have important consequences on the clinical management of genotype 3-infected patients. The association was not significant in paired biopsies studies, although the latter may be limited by important indication bias, short observation time and small sample size.
慢性丙型肝炎肝纤维化的进展长期以来一直被认为与病毒基因型无关。然而，最近的研究表明丙型肝炎病毒（HCV）基因型 3 与加速肝病进展之间存在关联。我们对评估 HCV 基因型与纤维化进展之间关系的研究进行了系统评价和荟萃分析。在未接受治疗的 HCV 感染成年患者中，通过单一活检中纤维化分期与感染持续时间的比值（单活检研究）或两次活检之间纤维化分期的变化（配对活检研究）评估纤维化进展率（FPR）的队列研究、横断面研究和病例对照研究，检索了 PubMed、Embase 和 ISI Web of Knowledge 数据库。使用随机效应模型得出不同 HCV 基因型之间的 FPR。符合选择标准的有 8 项单活检研究（3182 例患者，感染持续时间的平均值/中位数范围为 9 至 21 年）和 8 项配对活检研究（两次活检之间的平均间隔时间为 2 至 12 年）。在单活检研究中，基因型 3 与加速纤维化进展相关的比值比为 1.52（95%CI 1.12-2.07，P=0.007），在配对活检研究中为 1.37（95%CI 0.87-2.17，P=0.17）。总之，在单活检研究中，病毒基因型 3 与纤维化更快进展相关。这一观察结果可能对基因型 3 感染患者的临床管理产生重要影响。在配对活检研究中，这种关联并不显著，尽管后者可能受到重要的指示偏倚、观察时间短和样本量小的限制。
