Lee Mei-Hsuan, Yang Hwai-I, Lu Sheng-Nan, Jen Chin-Lan, You San-Lin, Wang Li-Yu, Wang Chih-Hao, Chen Wei J, Chen Chien-Jen
Genomics Research Center, Academia Sinica, Taipei, Taiwan.
J Infect Dis. 2012 Aug 15;206(4):469-77. doi: 10.1093/infdis/jis385. Epub 2012 Jul 17.
The study aimed to evaluate the risk of hepatitis C virus (HCV) infection on hepatic and extrahepatic deaths.
A cohort of 23 820 adults aged 30-65 years old were enrolled during 1991-1992. The seromarkers hepatitis B surface antigen (HBsAg), anti-HCV, and serum HCV RNA levels at study entry were tested. The vital status was ascertained through computerized linkage with national death certification profiles from 1991 to 2008.
There were 19,636 HBsAg-seronegatives, including 18,541 anti-HCV seronegatives and 1095 anti-HCV seropositives. Among anti-HCV seropositives, 69.4% had detectable serum HCV RNA levels. There were 2394 deaths that occurred during an average follow-up period of 16.2 years. Compared with anti-HCV seronegatives, anti-HCV seropositives had higher mortality from both hepatic and extrahepatic diseases, showing multivariate-adjusted hazard ratio (95% confidence interval) of 1.89 (1.66-2.15) for all causes of death; 12.48 (9.34-16.66) for hepatic diseases; 1.35 (1.15-1.57) for extrahepatic diseases; 1.50 (1.10-2.03) for circulatory diseases; 2.77 (1.49-5.15) for nephritis, nephrotic syndrome, and nephrosis; 4.08 (1.38-12.08) for esophageal cancer; 4.19 (1.18-14.94) for prostate cancer; and 8.22 (1.36-49.66) for thyroid cancer. Anti-HCV seropositives with detectable HCV RNA levels had significantly higher mortality from hepatic and extrahepatic diseases than anti-HCV seropositives with undetectable HCV RNA.
Monitoring HCV RNA in anti-HCV seropositives is essential for the prediction of mortality associated with hepatitis C.
本研究旨在评估丙型肝炎病毒（HCV）感染导致肝脏和肝外死亡的风险。
1991 - 1992年期间纳入了一组23820名年龄在30 - 65岁的成年人。检测了研究开始时的血清标志物乙肝表面抗原（HBsAg）、抗HCV以及血清HCV RNA水平。通过与1991年至2008年国家死亡证明档案进行计算机链接来确定生命状态。
有19636名HBsAg血清学阴性者，其中包括18541名抗HCV血清学阴性者和1095名抗HCV血清学阳性者。在抗HCV血清学阳性者中，69.4%的人血清HCV RNA水平可检测到。在平均16.2年的随访期内发生了2394例死亡。与抗HCV血清学阴性者相比，抗HCV血清学阳性者因肝脏和肝外疾病导致的死亡率更高，所有死因的多变量调整风险比（95%置信区间）为1.89（1.66 - 2.15）；肝脏疾病为12.48（9.34 - 16.66）；肝外疾病为1.35（1.15 - 1.57）；循环系统疾病为1.50（1.10 - 2.03）；肾炎、肾病综合征和肾病为2.77（1.49 - 5.15）；食管癌为4.08（1.38 - 12.08）；前列腺癌为4.19（1.18 - 14.94）；甲状腺癌为8.22（1.36 - 49.66）。血清HCV RNA水平可检测到的抗HCV血清学阳性者因肝脏和肝外疾病导致的死亡率显著高于血清HCV RNA水平不可检测到的抗HCV血清学阳性者。
监测抗HCV血清学阳性者的HCV RNA对于预测丙型肝炎相关死亡率至关重要。
