Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, United Kingdom.
Hepatology. 2011 Nov;54(5):1547-58. doi: 10.1002/hep.24561.
Our objective was to address two shortfalls in the hepatitis C virus (HCV) literature: (1) Few data exist comparing post-treatment liver-related mortality/morbidity in HCV-sustained virologic response (SVR) patients to non-SVR patients and (2) no data exist examining liver-related morbidity among treatment response subgroups,particularly among noncirrhotic SVR patients, a group who in the main are discharged from care without further follow-up. A retrospective cohort of 1,215 previously naïve HCV interferon patients (treated 1996-2007)was derived using HCV clinical databases from nine Scottish clinics. Patients were followed up post-treatment for a mean of 5.3 years. (1) By Cox-regression, liver-related hospital episodes (adjusted hazard ratio [AHR]:0.22; 95% confidence interval [CI]: 0.15-0.34) and liver-related mortality [corrected] (AHR: 0.22; 95% CI: 0.09-0.58)were significantly lower in SVR patients, compared to non-SVR patients. (2) Rates of liver-related hospitalization were elevated among all treatment subgroups compared to the general population: Among noncirrhotic SVR patients, adjusted standardized morbidity ratio (SMBR) up to 5.9 (95% CI: 4.5-8.0); among all SVR patients,SMBR up to 10.5 (95% CI: 8.7-12.9); and among non-SVR patients, SMBR up to 53.2 (95% CI: 49.4-57.2).Considerable elevation was also noted among patients who have spontaneously resolved their HCV infection(a control group used to gauge the extent to which lifestyle factors, and not chronic HCV, can contribute toliver-related morbidity), SMBR up to 26.8 (95% CI: 25.3-28.3).
(1) Patients achieving an SVR were more than four times less likely to be hospitalized, or die for a liver-related reason, than non-SVR patients and (2) although discharged, noncirrhotic SVR patients harbor a disproportionate burden of liver-related morbidity; up to six times that of the general population. Further, alarming levels of liver-related morbidity in spontaneous resolvers is an important finding warranting further study..
我们的目的是解决丙型肝炎病毒（HCV）文献中的两个不足：（1）很少有数据比较持续病毒学应答（SVR）和非 SVR 患者治疗后的肝脏相关死亡率/发病率；（2）没有数据检查治疗反应亚组中的肝脏相关发病率，特别是非肝硬化 SVR 患者，这群患者主要是从护理中出院，不再进行进一步随访。使用来自苏格兰九个诊所的 HCV 临床数据库，从以前未接受过干扰素治疗的 1215 例 HCV 患者中获得了一项回顾性队列研究。患者在治疗后平均随访 5.3 年。（1）通过 Cox 回归，与非 SVR 患者相比，SVR 患者的肝脏相关住院治疗（校正危险比 [AHR]：0.22；95%置信区间 [CI]：0.15-0.34）和肝脏相关死亡率 [校正]（AHR：0.22；95%CI：0.09-0.58）显著降低。（2）与一般人群相比，所有治疗亚组的肝脏相关住院率均升高：非肝硬化 SVR 患者的校正标准化发病率比（SMBR）高达 5.9（95%CI：4.5-8.0）；所有 SVR 患者的 SMBR 高达 10.5（95%CI：8.7-12.9）；非 SVR 患者的 SMBR 高达 53.2（95%CI：49.4-57.2）。在自发清除 HCV 感染的患者中也观察到相当大的升高（使用对照组来衡量生活方式因素而非慢性 HCV 可以在多大程度上导致肝脏相关发病率），SMBR 高达 26.8（95%CI：25.3-28.3）。结论：（1）与非 SVR 患者相比，达到 SVR 的患者因肝脏相关原因住院或死亡的可能性低四倍以上；（2）尽管出院，非肝硬化 SVR 患者仍存在不成比例的肝脏相关发病率负担；高达普通人群的六倍。此外，自发缓解者中令人震惊的肝脏相关发病率是一个重要的发现，值得进一步研究。
