Hsiang J C, Bai W W, Raos Z, Stableforth W, Upton A, Selvaratnam S, Gane E J, Gerred S J
Counties Manukau District Health Board, Middlemore Hospital, Auckland, New Zealand.
Intern Med J. 2015 Feb;45(2):160-9. doi: 10.1111/imj.12624.
Liver cirrhosis is an important cause of morbidity and mortality; however, little is known about its impact in New Zealand.
We aim to determine the disease burden, epidemiology and outcomes of cirrhotic patients.
This is a retrospective study of cirrhosis patients under secondary public hospital care in a geographically defined region, between the years 2000 and 2011. Cirrhosis complications and mortality was recorded. Poisson log-linear regression analysis was performed for incidence rate ratio (IRR) and Cox regression analysis was used to analyse time-related events.
Seven hundred and forty-six cirrhotic patients were analysed; most were European/Other (39.9%), Pacific islanders (21.6%), Southeast Asian/Chinese (17.8%) and Maori (12.3%). 68.4% were male. The common primary aetiologies for cirrhosis were chronic hepatitis B (CHB) cirrhosis (37.3%), alcoholic liver disease (ALD) cirrhosis (24.1%), chronic hepatitis C (CHC) cirrhosis (22.3%) and non-alcoholic fatty liver disease (NAFLD) cirrhosis (16.4%). The hepatocellular carcinoma (HCC) mortality rates were highest in NAFLD and CHB cirrhosis groups (3.0 and 3.1 per 100 patient-year respectively), compared with ALD and CHC groups (2.2 and 1.4 per 100 patient-year, all P < 0.05 respectively). Patients with ALD and NAFLD cirrhosis had the highest all-cause and non-HCC mortality rate compared with viral hepatitis cirrhosis groups. The IRR for HCC incidence, liver-related mortality and HCC mortality were 1.087, 1.098 and 1.114, respectively (all P < 0.001), suggesting increasing incidence and disease burden over the study period.
The number of cirrhotic patients in secondary care is increasing steadily. Cirrhosis complications and mortality rates are also rising, particularly the incidence and mortality of HCC.
肝硬化是发病和死亡的重要原因；然而，其在新西兰的影响鲜为人知。
我们旨在确定肝硬化患者的疾病负担、流行病学情况及预后。
这是一项对2000年至2011年期间在一个地理区域内二级公立医院接受治疗的肝硬化患者进行的回顾性研究。记录肝硬化并发症和死亡率。采用泊松对数线性回归分析计算发病率比（IRR），并使用Cox回归分析来分析与时间相关的事件。
共分析了746例肝硬化患者；大多数为欧洲裔/其他族裔（39.9%）、太平洋岛民（21.6%）、东南亚裔/华裔（17.8%）和毛利人（12.3%）。68.4%为男性。肝硬化的常见原发性病因是慢性乙型肝炎（CHB）肝硬化（37.3%）、酒精性肝病（ALD）肝硬化（24.1%）、慢性丙型肝炎（CHC）肝硬化（22.3%）和非酒精性脂肪性肝病（NAFLD）肝硬化（16.4%）。肝细胞癌（HCC）死亡率在NAFLD和CHB肝硬化组中最高（分别为每100患者年3.0和3.1），相比之下，ALD和CHC组分别为每100患者年2.2和1.4（所有P均<0.05）。与病毒性肝炎肝硬化组相比，ALD和NAFLD肝硬化患者的全因死亡率和非HCC死亡率最高。HCC发病率、肝脏相关死亡率和HCC死亡率的IRR分别为1.087、1.098和1.114（所有P<0.001），表明在研究期间发病率和疾病负担不断增加。
二级医疗机构中肝硬化患者数量在稳步增加。肝硬化并发症和死亡率也在上升，尤其是HCC的发病率和死亡率。
