McMahon Brian J, Bruden Dana, Townshend-Bulson Lisa, Simons Brenna, Spradling Phillip, Livingston Stephen, Gove James, Hewitt Annette, Plotnik Julia, Homan Chriss, Espera Hannah, Negus Susan, Snowball Mary, Barbour Youssef, Bruce Michael, Gounder Prabhu
Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, Alaska; Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control, Anchorage, Alaska.
Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control, Anchorage, Alaska.
Clin Gastroenterol Hepatol. 2017 Mar;15(3):431-437.e2. doi: 10.1016/j.cgh.2016.10.012. Epub 2016 Oct 17.
BACKGROUND & AIMS: Few studies have examined factors associated with disease progression in hepatitis C virus (HCV) infection. We examined the association of 11 risk factors with adverse outcomes in a population-based prospective cohort observational study of Alaska Native/American Indian persons with chronic HCV infection.
We collected data from a population-based cohort study of liver-related adverse outcomes of infection in American Indian/Alaska Native persons with chronic HCV living in Alaska, recruited from 1995 through 2012. We calculated adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for end-stage liver disease (ESLD; presence of ascites, esophageal varices, hepatic encephalopathy, or coagulopathy), hepatocellular carcinoma (HCC), and liver-related death using a Cox proportional hazards model.
We enrolled 1080 participants followed up for 11,171 person-years (mean, 10.3 person-years); 66%, 19%, and 14% were infected with HCV genotypes 1, 2, and 3, respectively. On multivariate analysis, persons infected with HCV genotype 3 had a significantly increased risk of developing all 3 adverse outcomes. Their aHR for ESLD was 2.1 (95% CI, 1.5-3.0), their aHR for HCC was 3.1 (95% CI, 1.4-6.6), and their aHR for liver-related death was 2.4 (95% CI, 1.5-4.0) compared with genotype 1. Heavy alcohol use was an age-adjusted risk factor for ESLD (aHR, 2.2; 95% CI, 1.6-3.2), and liver-related death (aHR, 2.9; 95% CI, 1.8-4.6). Obesity was a risk factor for ESLD (aHR, 1.4; 95% CI, 1.0-1.9), and diabetes was a risk factor for ESLD (aHR, 1.5; 95% CI, 1.1-2.2). Male sex was a risk factor for HCC (aHR, 3.6; 95% CI, 1.6-8.2).
In a population-based cohort study of American Indian/Alaska Native persons with chronic HCV infection, we found those infected with HCV genotype 3 to be at high risk for ESLD, HCC, and liver-related death.
很少有研究探讨丙型肝炎病毒（HCV）感染疾病进展的相关因素。在一项基于人群的前瞻性队列观察研究中，我们研究了阿拉斯加原住民/美国印第安慢性HCV感染者中11种风险因素与不良结局的关联。
我们收集了1995年至2012年招募的阿拉斯加慢性HCV感染美国印第安/阿拉斯加原住民肝脏相关感染不良结局的人群队列研究数据。我们使用Cox比例风险模型计算终末期肝病（ESLD；存在腹水、食管静脉曲张、肝性脑病或凝血障碍）、肝细胞癌（HCC）和肝脏相关死亡的校正风险比（aHR）及95%置信区间（CI）。
我们纳入了1080名参与者，随访11171人年（平均10.3人年）；分别有66%、19%和14%的人感染HCV 1型、2型和3型。多因素分析显示，感染HCV 3型的人发生所有3种不良结局的风险显著增加。与1型相比，他们发生ESLD的aHR为2.1（95%CI，1.5 - 3.0），发生HCC的aHR为3.1（95%CI，1.4 - 6.6），发生肝脏相关死亡的aHR为2.4（95%CI，1.5 - 4.0）。大量饮酒是ESLD（aHR，2.2；95%CI，1.6 - 3.2）和肝脏相关死亡（aHR，2.9；95%CI，1.8 - 4.6）的年龄校正风险因素。肥胖是ESLD的风险因素（aHR，1.4；95%CI，1.0 - 1.9），糖尿病是ESLD的风险因素（aHR，1.5；95%CI，1.1 - 2.2）。男性是HCC的风险因素（aHR，3.6；95%CI，1.6 - 8.2）。
在一项基于人群的慢性HCV感染美国印第安/阿拉斯加原住民队列研究中，我们发现感染HCV 3型的人发生ESLD、HCC和肝脏相关死亡的风险很高。
