肝硬度值可预测代偿期肝硬化的人类免疫缺陷病毒/丙型肝炎病毒合并感染患者的临床结局。

Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis.

机构信息

Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla, Spain.

出版信息

Hepatology. 2012 Jul;56(1):228-38. doi: 10.1002/hep.25616. Epub 2012 Jun 6.

DOI:10.1002/hep.25616

PMID:22278746

Abstract

UNLABELLED

Our aim was to assess the predictive value of liver stiffness (LS), measured by transient elastography (TE), for clinical outcome in human immunodeficiency virus / hepatitis C virus (HIV/HCV)-coinfected patients with compensated liver cirrhosis. This was a prospective cohort study of 239 consecutive HIV/HCV-coinfected patients with a new diagnosis of cirrhosis, done by TE, and no previous decompensation of liver disease. The time from diagnosis to the first liver decompensation and death from liver disease, as well as the predictors of these outcomes, were evaluated. After a median (Q1-Q3) follow-up of 20 (9-34) months, 31 (13%, 95% confidence interval [CI]: 9%-17%) patients developed a decompensation. The incidence of decompensation was 6.7 cases per 100 person-years (95% CI, 4.7-9-6). Fourteen (8%) out of 181 patients with a baseline LS < 40 kPa developed a decompensation versus 17 (29%) out of 58 with LS ≥ 40 kPa (P = 0.001). Factors independently associated with decompensation were Child-Turcotte-Pugh (CTP) class B versus A (hazard ratio [HR] 7.7; 95% CI 3.3-18.5; P < 0.0001), log-plasma HCV RNA load (HR 2.1; 95% CI 1.2-3.6; P = 0.01), hepatitis B virus coinfection (HR, 10.3; 95% CI, 2.1-50.4; P = 0.004) and baseline LS (HR 1.03; 95% CI 1.01-1.05; P = 0.02). Fifteen (6%, 95% CI: 3.5%-9.9%) patients died, 10 of them due to liver disease, and one underwent liver transplantation. CTP class B (HR 16.5; 95% CI 3.4-68.2; P < 0.0001) and previous exposure to HCV therapy (HR 7.4; 95% CI 1.7-32.4, P = 0.007) were independently associated with liver-related death; baseline LS (HR 1.03; 95% CI 0.98-1.07; P = 0.08) was of borderline significance.

CONCLUSION

LS predicts the development of hepatic decompensations and liver-related mortality in HIV/HCV-coinfection with compensated cirrhosis and provides additional prognostic information to that provided by the CTP score.

摘要

目的

评估瞬时弹性成像（TE）测量的肝硬度（LS）对人类免疫缺陷病毒/丙型肝炎病毒（HIV/HCV）合并感染代偿性肝硬化患者临床结局的预测价值。

方法

这是一项前瞻性队列研究，纳入了 239 例新诊断为肝硬化且无既往肝病失代偿的 HIV/HCV 合并感染患者，对其进行 TE 检查。评估从诊断到首次发生肝脏失代偿和因肝病死亡的时间，以及这些结局的预测因素。

结果

中位（95%可信区间）随访 20（9-34）个月后，31 例（13%，95%CI：9%-17%）患者发生失代偿。失代偿的发生率为每 100 人年 6.7 例（95%CI，4.7-9-6）。181 例基线 LS<40kPa 的患者中，有 14 例（8%）发生失代偿，而 LS≥40kPa 的 58 例患者中，有 17 例（29%）发生失代偿（P=0.001）。与失代偿相关的独立因素包括 Child-Turcotte-Pugh（CTP）评分 B 级与 A 级（风险比[HR]7.7；95%CI 3.3-18.5；P<0.0001）、log 血浆丙型肝炎病毒 RNA 载量（HR 2.1；95%CI 1.2-3.6；P=0.01）、乙型肝炎病毒合并感染（HR 10.3；95%CI 2.1-50.4；P=0.004）和基线 LS（HR 1.03；95%CI 1.01-1.05；P=0.02）。