非裔美国人更不可能清除丙型肝炎病毒感染：来自美国近期人口数据的发现。

African americans are less likely to have clearance of hepatitis C virus infection: the findings from recent U.S. population data.

机构信息

Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA 22042, USA.

出版信息

J Clin Gastroenterol. 2012 Sep;46(8):e62-5. doi: 10.1097/MCG.0b013e318238352b.

DOI:10.1097/MCG.0b013e318238352b

PMID:22178959

Abstract

BACKGROUND

Hepatitis C virus (HCV) is the most common cause of chronic liver disease in the United States. African Americans are known to have a higher prevalence of HCV and lower response to anti-HCV therapy.

GOAL

The aim of this study is to assess the differences in the prevalence of chronic HCV infection in according to patients' ethnic background.

STUDY

We used the recent National Health and Nutrition Examination Survey with extensive clinical and laboratory data. Active HCV infection was defined as having HCV-positive antibody with detectable HCV RNA by polymerase chain reaction. HCV clearance was defined as HCV-positive antibody with negative HCV RNA. Clinico-demographic data were compared between anti-HCV positive individuals with or without HCV clearance. The stratum-specific χ test for independence was used. Logistic regression was used to identify independent predictors of HCV clearance. P-values ≤0.05 were considered statistically significant. All analyses were run using SAS 9.1 and SUDAAN 10.0.

RESULTS

The cohort included 14,750 adults (age 47.6 ± 0.75 y, 64% white, 21% African American, 10% Hispanics, and 63% male). Of these, 1.32 ± 0.11% were anti-HCV positive with 75.94 ± 4.72% having active HCV viremia. The only parameter significantly different between those who did or did not clear HCV was the proportion of African Americans: 8.0 ± 3.7% versus 24.9 ± 5.0%, P=0.0163. Indeed, the rate of HCV clearance was lowest among African Americans (9.3 ± 3.5%) as compared with both whites (27.2 ± 6.5%) and Hispanics 31.2 ± 9.1% (P<0.05). In multivariate analysis, the only independent predictor of active HCV infection was African American race: odds ratio (95% confidence interval)=3.80 (1.31-11.06), P=0.0151.

CONCLUSIONS

African Americans not only have lower response to anti-HCV therapy but also are less likely to naturally clear HCV, potentially contributing to higher prevalence of HCV.

摘要

背景

丙型肝炎病毒（HCV）是美国最常见的慢性肝病病因。已知非裔美国人 HCV 感染率较高，对 HCV 治疗的反应较差。

目的

本研究旨在评估根据患者的种族背景，慢性 HCV 感染的流行率差异。

研究

我们使用了最近的全国健康和营养调查（National Health and Nutrition Examination Survey），该调查具有广泛的临床和实验室数据。活性 HCV 感染定义为 HCV 阳性抗体伴可检测到的 HCV RNA 聚合酶链反应。HCV 清除定义为 HCV 阳性抗体伴 HCV RNA 阴性。比较抗 HCV 阳性个体中 HCV 清除者和未清除者的临床和人口统计学数据。采用分层 χ 检验进行独立性分析。采用 logistic 回归分析确定 HCV 清除的独立预测因素。P 值≤0.05 被认为具有统计学意义。所有分析均使用 SAS 9.1 和 SUDAAN 10.0 运行。

结果

该队列纳入了 14750 名成年人（年龄 47.6±0.75 岁，64%为白人，21%为非裔美国人，10%为西班牙裔，63%为男性）。其中，1.32%±0.11%为抗 HCV 阳性，75.94%±4.72%为活动性 HCV 病毒血症。在 HCV 清除者和未清除者之间，唯一显著不同的参数是非洲裔美国人的比例：8.0%±3.7%比 24.9%±5.0%，P=0.0163。事实上，非洲裔美国人 HCV 清除率最低（9.3%±3.5%），与白人（27.2%±6.5%）和西班牙裔（31.2%±9.1%）相比，差异均有统计学意义（P<0.05）。在多变量分析中，唯一独立预测 HCV 活动性感染的因素是非裔美国人种族：优势比（95%置信区间）=3.80（1.31-11.06），P=0.0151。