病毒清除可降低慢性丙型肝炎病毒感染患者的全因死亡率：一项倾向评分分析。

Viral eradication reduces all-cause mortality in patients with chronic hepatitis C virus infection: a propensity score analysis.

作者信息

Tada Toshifumi, Kumada Takashi, Toyoda Hidenori, Kiriyama Seiki, Tanikawa Makoto, Hisanaga Yasuhiro, Kanamori Akira, Kitabatake Shusuke, Yama Tsuyoki, Tanaka Junko

机构信息

Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.

Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan.

出版信息

Liver Int. 2016 Jun;36(6):817-26. doi: 10.1111/liv.13071. Epub 2016 Feb 12.

DOI:10.1111/liv.13071

PMID:26787002

Abstract

BACKGROUND & AIMS: Eradication of hepatitis C virus (HCV) by interferon (IFN)-based therapy has been reported to reduce all-cause mortality rates in patients with chronic HCV infection. However, the impact of HCV eradication on non-liver-related mortality including the causes of death has not been sufficiently investigated in patients with chronic HCV infection.

METHODS

We enrolled 2743 patients with chronic HCV infection. Causes of death, incidence of hepatocellular carcinoma (HCC), and all-cause mortality including non-liver-related diseases, were analysed.

RESULTS

Of these 2743 patients, 587 achieved sustained virological response (SVR) (eradication of HCV) by IFN-based therapy (IFN-SVR), 475 did not (without HCV eradication) (IFN-non-SVR), or 1681 did not receive IFN-based therapy (non-IFN patients) (Cohort 1); of these, 309 were selected from IFN-SVR and non-IFN groups using propensity score matching (Cohort 2).The median follow-up duration was 11.4 years. In Cohort 1 patients, mortality rates from non-liver-related diseases were 71.0% (22/31) in IFN-SVR patients, 34.9% (37/106) in IFN-non-SVR patients and 50.0% (248/496) in non-IFN patients respectively. In Cohort 2 patients, mortality rates from non-liver-related diseases were 72.2% (13/18) in IFN-SVR patients and 46.8% (29/62) in non-IFN patients respectively. The eradication of HCV reduced all-cause mortality (hazard ratio (HR), 0.265; 95% confidence interval (CI), 0.058-0.380) including non-liver-related mortality (HR, 0.439; 95% CI, 0.231-0.834) and the incidence of HCC (HR, 0.275; 95% CI, 0.156-0.448).

CONCLUSIONS

Eradication of HCV reduced not only liver-related mortality but also non-liver-related mortality in patients with chronic HCV.

摘要

背景与目的

据报道，基于干扰素（IFN）的疗法根除丙型肝炎病毒（HCV）可降低慢性HCV感染患者的全因死亡率。然而，在慢性HCV感染患者中，HCV根除对包括死亡原因在内的非肝脏相关死亡率的影响尚未得到充分研究。

方法

我们纳入了2743例慢性HCV感染患者。分析了死亡原因、肝细胞癌（HCC）的发病率以及包括非肝脏相关疾病在内的全因死亡率。

结果

在这2743例患者中，587例通过基于IFN的疗法实现了持续病毒学应答（SVR）（HCV根除）（IFN-SVR），475例未实现（未根除HCV）（IFN-非SVR），或1681例未接受基于IFN的疗法（非IFN患者）（队列1）；其中，使用倾向评分匹配从IFN-SVR组和非IFN组中选取了309例患者（队列2）。中位随访时间为11.4年。在队列1患者中，IFN-SVR患者的非肝脏相关疾病死亡率为71.0%（22/31），IFN-非SVR患者为34.9%（37/106），非IFN患者为50.0%（248/496）。在队列2患者中，IFN-SVR患者的非肝脏相关疾病死亡率为72.2%（13/18），非IFN患者为46.8%（29/62）。HCV根除降低了全因死亡率（风险比（HR），0.265；95%置信区间（CI），0.058 - 0.380），包括非肝脏相关死亡率（HR，0.439；95%CI，0.231 - 0.834）以及HCC的发病率（HR，0.275；95%CI，0.156 - 0.448）。