Sanna Alice, Le Strat Yann, Roudot-Thoraval Françoise, Deuffic Burban Sylvie, Carrieri Patrizia, Delarocque-Astagneau Elisabeth, Larsen Christine
Santé publique France, French National Public Health Agency, Saint-Maurice, France.
Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Paris, France.
Euro Surveill. 2017 Jul 27;22(30). doi: 10.2807/1560-7917.ES.2017.22.30.30582.
Given recent profound improvements in the effectiveness of antiviral treatment for chronic Hepatitis C virus (HCV) infection, we aimed to describe the characteristics of patients referred to hepatology expert centres in France from 2000 to 2007 and from 2010 to 2014, and to identify factors associated with severe liver disease at their first visit for evaluation. We analysed data from two sources covering all of France: the former hepatitis C surveillance network, which included patients between 2000 and 2007, and the ANRS CO22 HEPATHER multi-centre cohort, which included patients between 2012 and 2014. Severe liver disease (SLD) was defined as the presence of either cirrhosis (histological, biochemical or clinical) or hepatocellular carcinoma. Multivariable Poisson regression models were used to identify the factors associated with SLD in complete-case analysis and after multiple imputation. Overall, 16,851 patients were included in the analysis and SLD was diagnosed in 11.6%. SLD at first visit was significantly associated with known risk factors (male sex, history of excessive alcohol intake, HCV genotype 3), late referral to hepatologists after diagnosis and HCV diagnosis at an older age. Providing earlier specialised care and treatment may be an important target for public health action.
鉴于近期慢性丙型肝炎病毒（HCV）感染抗病毒治疗效果有了显著改善，我们旨在描述2000年至2007年以及2010年至2014年转诊至法国肝病专家中心的患者特征，并确定其首次就诊评估时与严重肝病相关的因素。我们分析了来自法国全境的两个数据源的数据：前丙型肝炎监测网络，涵盖2000年至2007年的患者；以及ANRS CO22 HEPATHER多中心队列，涵盖2012年至2014年的患者。严重肝病（SLD）定义为存在肝硬化（组织学、生化或临床诊断）或肝细胞癌。多变量泊松回归模型用于在完全病例分析和多次插补后确定与严重肝病相关的因素。总体而言，16,851名患者纳入分析，其中11.6%被诊断为严重肝病。首次就诊时的严重肝病与已知危险因素（男性、过量饮酒史、HCV基因3型）、诊断后转诊至肝病专家较晚以及年龄较大时诊断出HCV显著相关。提供更早的专科护理和治疗可能是公共卫生行动的一个重要目标。
