Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Merck & Co, Inc, Whitehouse Station, New Jersey.
Clin Gastroenterol Hepatol. 2017 Dec;15(12):1957-1964.e7. doi: 10.1016/j.cgh.2017.04.046. Epub 2017 Jun 1.
BACKGROUND & AIMS: Obesity, kidney disease, and diabetes are common conditions that can affect outcomes of patients with chronic hepatitis C. The authors aimed to quantify the burden of these comorbid conditions among adults with chronic hepatitis C in the United States and to estimate the risk of death among people with chronic hepatitis C and comorbidities.
The authors conducted cross-sectional and prospective analyses of 13,726 participants in the third National Health and Nutrition Examination Survey (NHANES III) and 23,691 participants of NHANES 1999-2012. Serum samples were analyzed for the presence of antibodies to hepatitis C virus (anti-HCV); in samples found to be positive for anti-HCV, the authors quantified HCV RNA (viral load). Individuals with anti-HCV and detectable HCV RNA were considered to have chronic hepatitis C. Comorbidities were defined using self-reported, physical examination, and laboratory data, as available. The authors used logistic models and predictive margins to estimate the adjusted prevalence of comorbidities in patients with chronic hepatitis C. The authors used Poisson regression models to estimate adjusted mortality rates based on chronic hepatitis C status, with or without comorbidities. Cox proportional hazards regression models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause, cardiovascular, and cancer mortality according to chronic hepatitis C status, with and without comorbidities.
Among persons with chronic hepatitis C, the demographic-adjusted prevalence estimate of diabetes was 17.9% (95% CI, 11.2%-27.5%) and of obesity was 20.9% (95% CI, 12.4%-29.5%). Overall, 69.6% of persons with chronic hepatitis C had at least 1 major cardiometabolic comorbidity (95% CI, 62.1%-76.2%). Only 38% of adults with chronic hepatitis C reported a diagnosis of liver disease. Chronic hepatitis C was associated with a substantially increased risk of death (HR, 2.45), especially in the presence of diabetes (HR, 3.24) or chronic kidney disease (HR, 4.39).
In an analysis of NHANES data, the authors found that individuals with chronic hepatitis C have a high burden of major cardiometabolic comorbidities. Diabetes and chronic kidney disease, in particular, are associated with substantial excess mortality in persons with chronic hepatitis C.
肥胖、肾脏疾病和糖尿病是常见的病症，可能会影响慢性丙型肝炎患者的预后。作者旨在量化美国慢性丙型肝炎患者合并这些共病的负担，并估计患有慢性丙型肝炎和合并症的患者的死亡风险。
作者对第三次全国健康和营养调查（NHANES III）中的 13726 名参与者和 NHANES 1999-2012 年的 23691 名参与者进行了横断面和前瞻性分析。对血清样本进行了抗丙型肝炎病毒（抗-HCV）抗体检测；在发现抗-HCV 阳性的样本中，作者对 HCV RNA（病毒载量）进行了定量。抗-HCV 阳性且可检测到 HCV RNA 的个体被认为患有慢性丙型肝炎。共病通过自我报告、体格检查和实验室数据来定义（如有）。作者使用逻辑模型和预测边缘来估计慢性丙型肝炎患者合并症的调整后患病率。作者使用泊松回归模型根据慢性丙型肝炎的状态，估计有或没有合并症的调整后死亡率。使用 Cox 比例风险回归模型，根据慢性丙型肝炎的状态和有无合并症，估计全因、心血管和癌症死亡率的调整危险比（HR）和 95%置信区间（CI）。
在患有慢性丙型肝炎的人群中，糖尿病的人群调整后患病率估计值为 17.9%（95%CI，11.2%-27.5%），肥胖的患病率估计值为 20.9%（95%CI，12.4%-29.5%）。总体而言，69.6%的慢性丙型肝炎患者至少有一种主要的代谢合并症（95%CI，62.1%-76.2%）。只有 38%的慢性丙型肝炎成年人报告了肝脏疾病的诊断。慢性丙型肝炎与死亡风险显著增加相关（HR，2.45），尤其是在合并糖尿病（HR，3.24）或慢性肾脏病（HR，4.39）的情况下。
在对 NHANES 数据的分析中，作者发现慢性丙型肝炎患者存在大量的主要代谢合并症。特别是糖尿病和慢性肾脏病与慢性丙型肝炎患者的大量超额死亡有关。
