Department of Hepatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan; Department of Health Management Center, Toranomon Hospital, Tokyo, Japan; Department of Third Internal Medicine, University of Yamanashi, Yamanashi, Japan.
J Med Virol. 2014 Jan;86(1):169-75. doi: 10.1002/jmv.23777. Epub 2013 Oct 24.
The aim of this retrospective cohort study was to assess the cumulative incidence and predictive factors for intracerebral hemorrhagic stroke after the termination of interferon (IFN) therapy in Japanese patients with hepatitis C virus (HCV). A total of 4,649 HCV-positive patients treated with IFN were enrolled. The primary goal is the first onset of intracerebral hemorrhagic stroke. The mean observation period was 8.0 years. Evaluation was performed using the Kaplan-Meier method and the Cox proportional hazard model. A P-value of less than 0.05 was considered statistically significant. A total of 28 developed intracerebral hemorrhagic stroke. The cumulative incidence of intracerebral hemorrhagic stroke was 0.3% at 5 years, 0.8% at 10 years, and 1.7% at 15 years. Intracerebral hemorrhagic stroke occurred when patients had age increments of 10 years (hazard ratio: 2.77; 95% confidence interval (CI) 1.48-5.18; P = 0.001), hypertension (hazard ratio: 2.30; 95% CI 1.09-4.83; P = 0.021), liver cirrhosis (hazard ratio: 4.50; 95% CI 2.07-9.78; P < 0.001), and HCV non-clearance (hazard ratio: 3.22; 95% CI 1.22-8.53; P = 0.018). On the intracerebral hemorrhagic stroke based on the difference of liver fibrosis and efficacy of IFN therapy, HCV clearance reduced to 24.3% (1/4.11) compared to HCV non-clearance in cirrhotic patients (P = 0.040). In conclusion, HCV clearance reduced the development of intracerebral hemorrhagic stroke. In particular, HCV clearance reduced intracerebral hemorrhagic stroke to about one-fourth in cirrhotic patients.
本回顾性队列研究旨在评估日本丙型肝炎病毒 (HCV) 患者干扰素 (IFN) 治疗终止后颅内出血性卒中的累积发生率和预测因素。共纳入 4649 例接受 IFN 治疗的 HCV 阳性患者。主要目标是首次发生颅内出血性卒中。平均观察期为 8.0 年。采用 Kaplan-Meier 法和 Cox 比例风险模型进行评估。P 值小于 0.05 被认为具有统计学意义。共有 28 例发生颅内出血性卒中。颅内出血性卒中的累积发生率为：5 年时为 0.3%，10 年时为 0.8%，15 年时为 1.7%。当患者年龄增加 10 岁时（风险比：2.77；95%置信区间 (CI) 1.48-5.18；P=0.001）、患有高血压（风险比：2.30；95%CI 1.09-4.83；P=0.021）、肝硬化（风险比：4.50；95%CI 2.07-9.78；P<0.001）和 HCV 未清除（风险比：3.22；95%CI 1.22-8.53；P=0.018）时，会发生颅内出血性卒中。基于肝纤维化和 IFN 治疗效果的差异，颅内出血性卒中的发生率从 HCV 清除组的 24.3%（1/4.11）降低到肝硬化患者的 HCV 未清除组（P=0.040）。综上所述，HCV 清除可降低颅内出血性卒中的发生风险。特别是，HCV 清除可将肝硬化患者的颅内出血性卒中风险降低到四分之一左右。
