Sagnelli Evangelista, Stroffolini Tommaso, Sagnelli Caterina, Smedile Antonina, Morisco Filomena, Furlan Caterina, Babudieri Sergio, Brancaccio Giuseppina, Coppola Nicola, Gaeta Giovanni Battista, Almasio Piero Luigi
Department of Mental Health and Public Medicine, Second University of Naples, Italy.
Department of Tropical and Infectious Diseases, Policlinico Umberto Primo, Rome, Italy.
Dig Liver Dis. 2016 Sep;48(9):1066-71. doi: 10.1016/j.dld.2016.05.014. Epub 2016 May 26.
The last Italian prevalence survey on chronic liver diseases (CLD) was performed in 2001. The present study evaluated the changes occurring over thirteen years.
We enrolled 2,557 CLD consecutive patients in 16 Italian liver units in 2014.
HBV etiology accounted for 513 (20.2%) cases, alone in 439 and associated with HCV and/or alcohol abuse in 74. Of these 513, 11.9% were anti-HDV-positive and 7.2% HBeAg-positive. HCV alone was responsible for 50.3% of CLD and with alcohol abuse for 5.9%. HCV RNA was detected in 64.0% of the anti-HCV-positive patients tested. HCV genotyping, performed for 899 patients, showed genotype-1a, 1b, 2, 3, 4 and 5 respectively in 16.5%, 45.5%, 15.4%, 8.2%, 15.1% and 0.2%. Alcohol abuse alone was responsible for 6.4% of cases and NAFLD/NASH for 6.3%. Liver cirrhosis (p<0.001) and HCC (p<0.001) were more frequent in alcoholic than viral etiologies. HCV and alcohol etiologies were more frequent in 2001 than 2014 (from 69.9% to 59.9% and from 23.0% to 12.3%, respectively). HBV showed a similar impact. In all etiologies, the 2001 CLD cases were 10 years younger and with a significantly lower rate of cirrhosis than the 2014 cases.
The changes in HCV, HBV and alcohol etiologies may help apply more appropriate healthcare strategies.
意大利上一次慢性肝病（CLD）患病率调查于2001年进行。本研究评估了13年来发生的变化。
2014年，我们在意大利16个肝病中心纳入了2557例连续性CLD患者。
HBV病因导致513例（20.2%），其中单纯HBV感染439例，合并HCV和/或酒精滥用74例。在这513例中，11.9%抗HDV阳性，7.2%HBeAg阳性。单纯HCV导致50.3%的CLD，合并酒精滥用导致5.9%。在接受检测的抗HCV阳性患者中，64.0%检测到HCV RNA。对899例患者进行HCV基因分型，结果显示基因1a型、1b型、2型、3型、4型和5型分别占16.5%、45.5%、15.4%、8.2%、15.1%和0.2%。单纯酒精滥用导致6.4%的病例，非酒精性脂肪性肝病/非酒精性脂肪性肝炎导致6.3%。酒精性病因导致的肝硬化（p<0.001）和肝癌（p<0.001）比病毒性病因更常见。2001年HCV和酒精性病因比2014年更常见（分别从69.9%降至59.9%和从23.0%降至12.3%）。HBV也有类似影响。在所有病因中，2001年的CLD病例比2014年的病例年轻10岁，肝硬化发生率显著更低。
HCV、HBV和酒精性病因的变化可能有助于应用更合适的医疗保健策略。
